Vitality Direct Primary Care
Care plans and products from your provider.
Care planADHD (Attention Deficit/Hyperactivity Disorder)ADHD is the most common behavioral condition in children, affecting more than 10% of kids in the U.S. It shows up in three different forms — trouble paying attention, hyperactivity and impulsivity, or a combination of both — and often continues into adulthood. It can make school harder, emotions more intense, and everyday planning and organization feel like an uphill battle. **Attention Deficit Disorder (ADD)** and **Attention Deficit Hyperactivity Disorder (ADHD)** are neurodevelopmental disorders characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning. ADHD is the official medical term and includes three primary subtypes, while ADD, an older term, typically refers to the predominantly inattentive presentation of ADHD, without significant hyperactivity. ## Understanding ADD / ADHD ### Treatment Options **Medication:** - **Stimulants** (e.g., methylphenidate, amphetamines): These boost two key brain chemicals — dopamine and norepinephrine — to sharpen attention and dial down impulsivity and hyperactivity. - **Non-Stimulants** (e.g., atomoxetine, guanfacine): These are good alternatives if stimulants aren't the right fit or cause unwanted side effects. **Behavioral Therapy:** - Teaches practical tools like coping strategies, organizational skills, and how to better manage emotions. - Parenting guidance and structured behavioral programs can make a real difference at home and in the classroom. **Lifestyle Modifications:** - Regular movement, consistent sleep, and predictable daily routines can go a long way in easing symptoms. **Diet and Supplements:** - Targeted nutrients like omega-3 fatty acids, magnesium, and vitamin D may help support brain function, calm the nervous system, and improve focus and the brain's ability to form new connections. - Removing certain foods from the diet — such as artificial additives — and lowering overall toxic exposures has helped some people feel and function better. ---
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Care planAdrenal Insufficiency> *"A person with adrenal insufficiency may be dehydrated, confused, or losing weight. He or she may feel weak, tired, or dizzy, and have low blood pressure. Other symptoms include stomach pain, nausea, vomiting, and diarrhea."* According to one source, *"adrenal insufficiency is diagnosed through blood tests, and can be treated with medications that replace the hormones the adrenals would normally make..."* What's worth noting here is that conventional medicine typically focuses on replacing those hormones rather than asking *why* the adrenal glands are struggling in the first place — or exploring how to nutritionally rebuild and restore their function from the ground up. ---
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Care planAlcoholismHeavy drinking is linked to a higher risk of injury, domestic violence, unsafe sexual behavior, and serious medical problems like liver disease, high blood pressure, and cancers of the digestive tract. For the brain in particular, chronic heavy alcohol use can be especially destructive — raising the risk of dementia, stroke, and difficulties functioning in everyday life and relationships. But mild to moderate drinking has been connected to a range of health benefits, including some that are good for your brain. > 📝 **NOTE:** The US Food and Drug Administration defines "moderate alcohol consumption" as up to 1 drink per day for women and up to 2 drinks per day for men. One drink is equivalent to 12 fluid ounces of regular beer, 5 fluid ounces of 12% alcohol wine, or 1.5 fluid ounces of distilled spirits. **Potential benefits of mild to moderate alcohol consumption:** - Protects against artery-clogging plaque (anti-atherogenic) - Reduces harmful inflammation (anti-inflammatory) - Improves cholesterol levels - Improves the body's response to insulin - Lowers stroke risk **Risks of heavy alcohol consumption:** - High blood pressure - Liver disease - Higher risk of bleeding stroke - Higher risk of digestive tract cancers --- ## Understanding Alcohol's Effects on the Brain ### What Alcohol Actually Does to Your Brain The relationship between alcohol and brain health is genuinely complicated. Many studies suggest that mild to moderate drinking protects against heart disease — likely due to both alcohol itself and the powerful antioxidant compounds called polyphenols found in certain drinks.³⁻⁶ Red wine appears to offer the greatest benefit, while dark beers like stouts and porters may also have some cardiovascular upside, though to a lesser degree. Specifically, alcohol has been reported to reduce artery-clogging inflammation, improve cholesterol, support healthy blood clotting, and improve insulin sensitivity — all of which may have meaningful benefits for the brain as well.³⁻⁶ Light to moderate drinking has also been tied to a lower risk of both types of stroke — the kind caused by a clot (ischemic) and the kind caused by bleeding (hemorrhagic).⁷ Heavy drinking, however, raises the risk of bleeding strokes⁸ and can make clot-related strokes more severe.⁹ It's worth noting that many of these studies were observational, meaning they can identify associations but cannot prove that alcohol directly causes these effects. ### How Common Is Alcohol Use? The Numbers May Surprise You According to a large national survey² by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), among adults over 18 years of age, 72% of men and nearly 60% of women have had at least 1 drink in the past year. Nearly 12% of men and 23% of women say they have never had a drink, while 43% of men and 29% of women report at least 1 binge-drinking episode in the past year — meaning they consumed more than 5 (for men) or 4 (for women) drinks within 2 hours. Over 42% of men say they typically drink 3 or more drinks on days when they drink, compared with just 22% of women surveyed. ### A Wake-Up Call: The Real Cost of Drinking Too Much According to the Centers for Disease Control and Prevention (CDC), excess alcohol consumption is responsible for nearly 90,000 deaths every year in the United States — making it the third leading cause of lifestyle-related death in the country. **The hidden toll of excess alcohol consumption:** - ~90,000 deaths per year - 2.5 million years of potential life lost per year - >1.2 million emergency department visits per year - >$223 billion in economic costs per year Excess drinking resulted in over 1.2 million emergency department visits and over 2.7 million physician office visits in 2006; that same year, excessive drinking was responsible for an estimated $223.5 billion in economic and healthcare costs.¹ ### Alcohol, Memory, and Dementia: What the Research Shows Light alcohol use has also been linked to a lower risk of developing dementia.¹⁰˒¹¹ Heavy drinking, however, tells a very different story. A study published in *Neurology* in January 2014 found that middle-aged men who drink more than 2.5 drinks daily are more likely to undergo faster decline in all cognitive areas — particularly memory — over a period of 10 years.¹² Interestingly, animal studies suggest that fish oil might help protect the brain from alcohol-related dementia by reducing the nerve cell damage caused by heavy drinking.¹³ **How alcohol harms the developing brain:** - Raises the risk of early-onset dementia - May shape future patterns of alcohol and drug use - Drinking before age 14 years increases dependence risk - Prenatal alcohol exposure reduces the brain's ability to grow and adapt ### Why Young Brains Are Especially Vulnerable One of the most pressing public health concerns is the impact of alcohol on the brains of children and teenagers. A Swedish study published in *JAMA Internal Medicine* in August 2013 found that among 9 factors identified as risk factors for young-onset dementia, alcohol intoxication was the most significant.¹³ These findings are especially troubling in light of research published in the *Archives of General Psychiatry* in 2012¹⁴ showing that most cases of alcohol and drug abuse begin during adolescence; the authors wrote, "The patterns of alcohol and drug use that emerge during adolescence are increasingly recognized as important determinants of later substance use behavior and associated disorders." Additionally, brain imaging research from 2012 found that children whose mothers drank heavily during pregnancy had significantly decreased brain plasticity compared with those whose mothers did not drink.¹⁵ ### Alcohol's Impact on Mental Health and Well-Being People living with mental illness are already more likely to struggle with alcohol and drug use — but the relationship goes both ways. Excessive drinking can itself trigger or worsen psychiatric problems, and nearly one third of people who abuse alcohol also suffer from a mental illness.¹⁶ Heavy alcohol use is well known to have wide-ranging effects on a person's life and mental health, including increased risk of legal troubles, difficulty functioning at work or in relationships, domestic violence, and a significantly higher risk of suicidal thoughts and actions. Drinking too much can also produce symptoms that closely resemble many psychiatric conditions — including mood disorders, anxiety, psychosis, sleep problems, sexual dysfunction, confusion, and memory loss.¹⁷ Some of alcohol's mental health effects may be rooted in how it disrupts brain chemistry — particularly the function of serotonin, a key mood-regulating chemical. Notably, a study published in *Alcoholism* in 2012 found that women are far more vulnerable to the serotonergic imbalance caused by heavy drinking than are men.¹⁸ ### Inside the Brain: How Alcohol Affects Your Reward System Like most addictive substances, alcohol triggers a surge of dopamine — the brain's "feel-good" chemical — along a pathway known as the mesocorticolimbic reward circuit. In people who drink socially, alcohol activates a key part of this circuit called the nucleus accumbens, creating feelings of pleasure and reducing sensitivity to fear.¹⁹ In heavy drinkers, however, this same brain region responds much less strongly to alcohol — suggesting that the pleasurable effect has diminished over time, which can drive people to drink more to achieve the same feeling.²⁰ In social drinkers, alcohol also makes risky choices feel more rewarding while dulling the brain's response to both positive and negative consequences in regions like the striatum, thalamus, and insula. In other words, under the influence of alcohol, taking risks can feel exciting — while the potential downsides feel less important.²¹ ### The Bottom Line Alcohol has complex interactions, both acutely and chronically, with many brain systems that vary considerably with the age and genetic makeup of the drinker. In moderation, alcohol may actually offer some brain benefits. But when drinking becomes excessive, the mental, neurological, and physical costs can quickly outweigh any potential upside. This is why it's so important for both patients and their healthcare providers to understand how common heavy drinking is — and how profoundly it can affect the brain and body. Recognizing the problem is the first step toward getting help. As the ancient Greeks touted, "Nothing in excess." **References:** 1. Centers for Disease Control and Prevention. Fact sheets — alcohol use and health. <http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm> Accessed February 5, 2014. 2. National Institute of Alcohol Abuse and Alcoholism. Drinking statistics. <http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics> Accessed March 31, 2014. 3. de Gaetano G, Di Castelnuovo A, Rotondo S, Iacoviello L, Donati MB. A meta-analysis of studies on wine and beer and cardiovascular disease. *Pathophysiol Haemost Thromb*. 2002;32:353–355. 4. Matos RS, Baroncini LA, Précoma LB, et al. Resveratrol causes antiatherogenic effects in an animal model of atherosclerosis. *Arq Bras Cardiol*. 2012;98:136–142. 5. Bertelli AA, Das DK. Grapes, wines, resveratrol, and heart health. *J Cardiovasc Pharmacol*. 2009;54:468–476. 6. Arranz S, Chiva-Blanch G, Valderas-Martínez P, et al. Wine, beer, alcohol and polyphenols on cardiovascular disease and cancer. *Nutrients*. 2012;4:759–781. 7. Jimenez M, Chiuve SE, Glynn RJ, et al. Alcohol consumption and risk of stroke in women. *Stroke*. 2012;43:939–945. 8. Casolla B, Dequatre-Ponchelle N, Rossi C, Hénon H, Leys D, Cordonnier C. Heavy alcohol intake and intracerebral hemorrhage: characteristics and effect on outcome. *Neurology*. 2012;79:1109–1115. 9. Ducroquet A, Leys D, Al Saabi A, et al. Influence of chronic ethanol consumption on the neurological severity in patients with acute cerebral ischemia. *Stroke*. 2013;44:2324–2326. 10. Peters R, Peters J, Warner J, Beckett N, Bulpitt C. Alcohol, dementia and cognitive decline in the elderly: a systematic review. *Age Ageing*. 2008;37:505–512. 11. Wayerer S, Schäufele M, Wiese B, et al; German AgeCoDe Study group. Current alcohol consumption and its relationship to incident dementia: results from a 3-year follow-up study among primary care attenders aged 75 years and older. *Age Ageing*. 2011;40:456–463. 12. Sabia S, Elbaz A, Britton A, et al. Alcohol consumption and cognitive decline in early old age. *Neurology*. 2014;82:332–339. 13. Collins M. Neuroinflammatory PARP pathways in ethanol-dependent neurodegeneration: suppression by omega-3 fatty acid. Proceedings and abstracts of the 14th Congress of the European Society for Biomedical Research on Alcoholism; September 8–11, 2013; Warsaw, Poland. Abstract 01.2. 14. Nordström P, Nordström A, Eriksson M, Wahlund LO, Gustafson Y. Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study. *JAMA Intern Med*. 2013;173:1612–1618. 15. Swendsen J, Burstein M, Case B, et al. Use and abuse of alcohol and illicit drugs in US adolescents: results of the National Comorbidity Survey-Adolescent Supplement. *Arch Gen Psychiatry*. 2012;69:390–398. 16. National Alliance on Mental Illness. Alcohol and mental illness. <http://www.nami.org/Template.cfm?Section=Smoking_Cessation&Template=/ContentManagement/ContentDisplay.cfm&ContentID=152818> Accessed February 7, 2014. 17. Shivani R, Goldsmith RJ, Anthenelli RM. Alcoholism and psychiatric disorders. National Institute on Alcohol Abuse and Alcoholism. November 2002. <http://pubs.niaaa.nih.gov/publications/arh26-2/90-98.htm> Accessed February 7, 2014. 18. Lebel C, Mattson SN, Riley EP, et al. A longitudinal study of the long-term consequences of drinking during pregnancy: heavy in utero alcohol exposure disrupts the normal processes of brain development. *J Neurosci*. 2012;32:15243–15251. 19. Gilman JM, Ramchandani VA, Davis MB, Bjork JM, Hommer DW. Why we like to drink: a functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol. *J Neurosci*. 2008;28:4583–4591. 20. Gilman JM, Ramchandani VA, Crouss T, Hommer DW. Subjective and neural responses to intravenous alcohol in young adults with light and heavy drinking patterns. *Neuropsychopharmacology*. 2012;37:467–477. 21. Gilman JM, Smith AR, Ramchandani VA, Momenan R, Hommer DW. The effect of intravenous alcohol on the neural correlates of risky decision making in healthy social drinkers. *Addict Biol*. 2012;17:465–478. 22. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: summary of national findings. Section 3.1: alcohol use. <http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#ch3.1> Accessed March 28, 2014. 23. Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. *Arch Pediatr Adolesc Med*. 2006;160:739–746. ---
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Care planAltitude SicknessSometimes called "mountain sickness," altitude sickness is a cluster of symptoms that can develop when you walk or climb to a higher elevation too quickly — your body simply hasn't had enough time to keep up. ## Understanding Altitude Sickness ### What's Actually Going On The air pressing down around you has a measurable force called barometric pressure. As you climb higher, that pressure drops — and with it, the amount of available oxygen decreases. If you've lived at a moderately high elevation for a while, your body has quietly adapted to that pressure. But travel to somewhere significantly higher, and your body will need time to catch up. Any time you venture above 8,000 feet, you're entering territory where altitude sickness becomes a real possibility. ### The Three Types Altitude sickness comes in three distinct forms: - **Acute Mountain Sickness (AMS)** is the mildest and most common form. The symptoms will feel familiar — dizziness, headache, muscle aches, nausea — much like a bad hangover. - **High Altitude Pulmonary Edema (HAPE)** is a dangerous, potentially life-threatening accumulation of fluid in the lungs. - **High Altitude Cerebral Edema (HACE)** is the most severe form of altitude sickness, involving dangerous fluid buildup in the brain. This is a medical emergency — seek care immediately. ### What to Watch For You might experience: - Headache - Dizziness - Nausea - Vomiting - Fatigue and loss of energy - Shortness of breath - Problems with sleep - Loss of appetite Symptoms typically appear within 12 to 24 hours of reaching a higher elevation, then ease within a day or two as your body finds its footing at the new altitude. In moderate cases, symptoms feel more intense and won't respond to over-the-counter medications. Rather than improving with time, you'll notice things getting worse — escalating shortness of breath and fatigue, along with: - Loss of coordination and difficulty walking - A severe headache that doesn't respond to medication - A tightening sensation in your chest In the most severe cases — HAPE or HACE — symptoms can escalate to: - Confusion - Shortness of breath even while at rest - Inability to walk - A cough that produces a white or pink frothy substance - Coma ### Who Is at Risk? Anyone can develop altitude sickness — regardless of age, fitness, or overall health. Even Olympic-caliber athletes aren't immune. In fact, being physically active at high elevation actually increases your risk. Your personal risk is shaped by several factors: how quickly you ascend, how high you go, the altitude at which you sleep, and other individual variables. Where you currently live (and at what altitude), your age (younger people tend to be more susceptible), and a prior history of altitude sickness all factor in as well. Conditions like diabetes or lung disease don't automatically raise your risk — but your genetics may quietly influence how well your body handles the climb. ### How It's Treated If you develop a headache plus at least one other symptom within a day or two of ascending, altitude sickness may be the culprit. More severe symptoms warrant prompt medical attention. A physician may listen to your lungs with a stethoscope or order a chest X-ray, brain MRI, or CT scan to check for fluid buildup. Recognizing the signs early gives you the best chance of managing the condition while it's still mild. The single most important treatment — at any level of severity — is descending to a lower elevation as safely and quickly as possible. In severe cases, descent must bring you below 4,000 feet, and a doctor's evaluation is essential — hospitalization may be necessary. HACE may require a steroid called dexamethasone. HAPE requires supplemental oxygen, possible medications, and immediate descent to a lower altitude. ### How to Prevent It The single most powerful prevention strategy is acclimatization — giving your body the time it needs to gradually adapt to rising air pressure as you ascend. Climbing slowly is key. A gradual pace encourages deeper, more efficient breathing and gives your red blood cells time to ramp up their oxygen-carrying capacity throughout your body. Here are the core acclimatization guidelines to follow: - **Begin your journey below 10,000 feet.** If flying or driving to a higher starting point, spend at least a full day at an intermediate, lower-elevation stop before continuing upward. - **Above 10,000 feet, limit yourself to gaining 1,000 feet per day.** For every 3,000 feet of elevation gained, plan at least one full rest day at that height. - **"Climb high and sleep low":** If you must gain more than 1,000 feet in a single day, descend to a lower altitude to sleep that night. - **Drink 3–4 quarts of water every day** and aim to get about 70% of your calories from carbohydrates. - **Avoid tobacco, alcohol, and sedating medications like sleeping pills.** - **Learn to recognize the earliest warning signs of altitude sickness.** If they appear, descend immediately. **Sources:** - <https://www.webmd.com/a-to-z-guides/altitude-sickness#1> - Cleveland Clinic: "Altitude Sickness." - Harvard Health Publications: "Altitude Sickness." - Altitude.org: "Altitude Sickness." - AAFP: "Altitude Illness: Risk Factors, Prevention, Presentation, and Treatment." - BMJ: "Altitude illness." ---
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Care planAmenorrheaAmenorrhea is the medical term for the absence of menstrual periods. It can be *primary* — meaning a young woman has never had a period — or *secondary* — meaning periods that once occurred have since stopped. Some forms of amenorrhea are completely normal (called physiologic), such as the absence of periods before puberty, during pregnancy and early breastfeeding, and after menopause. Any other cause of absent periods is considered abnormal and warrants further evaluation. --- ## Understanding Amenorrhea ### Causes of Primary Amenorrhea **Normal but Late Development** Some girls simply start their periods later than their peers, even though everything is developing normally. In a girl who is showing signs of puberty but has not yet had a period, no testing is typically needed until age 18. However, if no signs of puberty have appeared by age 14 and periods have not started, evaluation should begin sooner. It can be helpful to ask when the girl's mother first got her period, as this often runs in families. **Primary Ovarian Failure** In these cases, the ovaries are not functioning as expected from the start. Patients generally fall into two groups: those with normal but underdeveloped genitalia (such as in Turner's syndrome), and those with ambiguous genitalia. Chromosome testing (karyotyping) is an important part of the evaluation. Possible causes include: - Failure of the hypothalamus or pituitary gland (the brain's hormonal control centers) - Structural abnormalities present from birth (such as an absent or partially formed vagina, uterus, or cervix) - An imperforate hymen, in which a membrane blocks the opening of the vagina and prevents menstrual blood from flowing out — girls with this condition often experience monthly cramping as blood accumulates internally; treatment involves a minor procedure to open the hymen, typically after a needle test confirms the presence of a vagina behind it ### Causes of Secondary Amenorrhea **Scarring of the Uterine Lining (Endometrial Sclerosis)** This typically develops after a dilation and curettage (D&C) procedure, when the healing process leaves scar tissue behind instead of healthy tissue. **Narrowing of the Cervical Opening (Cervical Stenosis)** This can occur after a procedure called cervical conization, in which scarring causes the cervical opening to narrow or become difficult to locate. Growths inside the uterus must also be ruled out. **Failure to Ovulate (Anovulation)** This may happen occasionally or on an ongoing basis. The following are known causes of anovulation: - **Hypothalamic causes\*:** Problems with the hypothalamus (a key hormonal control center in the brain) may stem from physical damage such as tumors or scarring, or from functional issues such as polycystic ovarian disease or elevated prolactin levels. - **Pituitary causes\*:** The pituitary gland may underperform due to damage (as in Sheehan's syndrome, which can occur after severe blood loss during childbirth) or due to growths such as tumors or adenomas. - **Ovarian causes\*:** Scarring, tumors, or cysts on the ovaries can interfere with ovulation. - **Excessive Exercise and Low Body Fat\*** (less than 10% body fat): While this pattern resembles the hormonal disruption seen in anorexia nervosa, it is distinct in one important way — when the person regains a healthy weight or reduces their exercise load, periods typically return on their own. - **Adrenal Gland Problems:** Conditions such as adrenal hyperplasia, adenomas, or tumors can disrupt hormone balance and suppress ovulation. - **Whole-Body (Systemic) Causes of Anovulation:** A range of medical conditions can interfere with ovulation, including Cushing's disease; a prolonged absence of periods after stopping birth control pills; elevated prolactin levels; both overactive and underactive thyroid disease; and other illnesses such as ulcerative colitis, diabetes, long-term steroid use for autoimmune conditions, and celiac disease. In most cases, successfully treating the underlying condition allows periods to return to normal. \* Indicates primary or secondary causes, usually secondary. ### Contributing Factors - Poor diet - High stress - Impaired fatty acid conversion ### The Role of Vitamin D Deficiency Vitamin D deficiency appears to be surprisingly common in women with hormonal imbalances, including conditions like polycystic ovarian syndrome (PCOS), painful periods, endometriosis, and possibly infertility. Low vitamin D may contribute to some of the hormonal and metabolic problems seen in these conditions. In a study published in *Steroids* (1999; 64(6):430–435), of 13 women with PCOS, 5 were found to have frank vitamin D deficiency (serum 25-hydroxyvitamin D concentration <9 ng/mL) and 3 others had borderline-low vitamin D status. All 13 women were treated with vitamin D2 at a dose of 50,000 IU once or twice a week to maintain a serum 25-hydroxyvitamin D concentration of 30 to 40 ng/mL. Each woman also received 1,500 mg of supplemental calcium per day. Of the 9 women with amenorrhea or oligomenorrhea prior to vitamin D treatment, 7 experienced normalization of their menstrual cycles within 2 months and the other 2 became pregnant. Dysfunctional uterine bleeding also resolved within 2 months in both women whom it had been present. Vitamin D3 — the form your body naturally makes after sun exposure — is considerably more potent than the vitamin D2 used in the study above. Vitamin D3 is at least 3.4 times as potent as vitamin D2 and may be as much as 9.4 times as potent, according to a study published in *J Clin Endocrinol Metab.* (2004;89(11):5387–5391). Therefore, when supplementing with vitamin D3, lower doses than those administered in the aforementioned study should be used. According to the Food and Nutrition Board of the Institute of Medicine, long-term vitamin D3 intake up to 5,000 IU per day is unlikely to have any adverse effects in the general adult population. ---
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Care planAmyloidosisAmyloidosis (am-uh-loi-DO-sis) is a rare but serious disease that develops when an abnormal protein called amyloid accumulates in your organs and disrupts how they work. Amyloid doesn't normally exist in the body, but it can form from several different types of protein. The organs most commonly affected include the heart, kidneys, liver, spleen, nervous system, and digestive tract. Certain forms of amyloidosis are linked to other underlying diseases — and in those cases, successfully treating the underlying disease may also improve the amyloidosis. Some forms, however, can progress to life-threatening organ failure. Treatment options vary but may include chemotherapy similar to what is used in cancer care. Your doctor may also recommend medications to slow amyloid production and ease your symptoms. For some people, an organ or stem cell transplant may offer the best path forward. --- ## Understanding Amyloidosis ### What Causes Amyloidosis? Amyloidosis is not one single disease — it's a family of related conditions, each with its own cause. Some forms are inherited, while others are triggered by external factors such as chronic inflammatory diseases or long-term dialysis. Many types affect multiple organs simultaneously, while others remain confined to a single area of the body. The main subtypes of amyloidosis include: - **AL amyloidosis (immunoglobulin light chain amyloidosis).** The most common type of amyloidosis in developed countries, AL amyloidosis is also called primary amyloidosis. It usually affects the heart, kidneys, liver and nerves. - **AA amyloidosis.** Also known as secondary amyloidosis, this variety is usually triggered by an inflammatory disease, such as rheumatoid arthritis. Improved treatments for severe inflammatory conditions have resulted in a sharp decline in the number of cases of AA amyloidosis in developed countries. It most commonly affects the kidneys, liver and spleen. - **Hereditary amyloidosis (familial amyloidosis).** This inherited disorder often affects the nerves, heart and kidneys. It most commonly happens when a protein made by your liver is abnormal. This protein is called transthyretin (TTR). - **Wild-type amyloidosis.** This variety occurs when the TTR protein made by the liver is normal but produces amyloid for unknown reasons. Formerly known as senile systemic amyloidosis, wild-type amyloidosis tends to affect men over age 70 and typically targets the heart. It can also cause carpal tunnel syndrome. - **Localized amyloidosis.** This type often has a better prognosis than the varieties that affect multiple organ systems. Typical sites include the bladder, skin, throat or lungs. Correct diagnosis is important so that treatments that affect the entire body can be avoided. ### Who Is Most at Risk? Several factors can increase your likelihood of developing amyloidosis: - **Age.** Most people diagnosed with amyloidosis are between ages 60 and 70, although earlier onset occurs. - **Sex.** Amyloidosis occurs more commonly in men. - **Other diseases.** Having a chronic infectious or inflammatory disease increases your risk of AA amyloidosis. - **Family history.** Some types of amyloidosis are hereditary. - **Kidney dialysis.** Dialysis can't always remove large proteins from the blood. If you're on dialysis, abnormal proteins can build up in your blood and eventually be deposited in tissue. This condition is less common with more modern dialysis techniques. - **Race.** People of African descent appear to be at higher risk of carrying a genetic mutation associated with a type of amyloidosis that can harm the heart. ### What to Watch For: Symptoms Amyloidosis can be a quiet disease — you may not notice any signs or symptoms until it has become quite advanced. When symptoms do appear, they largely depend on which organs have been affected. Possible signs and symptoms of amyloidosis include: - Swelling of your ankles and legs - Severe fatigue and weakness - Shortness of breath with minimal exertion - Unable to lie flat in bed due to shortness of breath - Numbness, tingling or pain in your hands or feet, especially pain in your wrist (carpal tunnel syndrome) - Diarrhea, possibly with blood, or constipation - Unintentional weight loss of more than 10 pounds (4.5 kilograms) - An enlarged tongue, which sometimes looks rippled around its edge - Skin changes, such as thickening or easy bruising, and purplish patches around the eyes - An irregular heartbeat - Difficulty swallowing ### Potential Complications The complications of amyloidosis depend on which organs are affected by amyloid deposits. When amyloid accumulates, it can seriously damage your: **Heart.** Amyloid reduces your heart's ability to fill with blood between heartbeats. Less blood is pumped with each beat, and you may experience shortness of breath. If amyloidosis affects your heart's electrical system, your heart rhythm may be disturbed. Amyloid-related heart problems can become life-threatening. **Kidneys.** Amyloid can harm the kidneys' filtering system, causing protein to leak from your blood into your urine. The kidneys' ability to remove waste products from your body is lowered, which may eventually lead to kidney failure and the need for dialysis. **Nervous system.** You may experience pain, numbness or tingling of your fingers or numbness, lack of feeling or a burning sensation in your toes or the soles of your feet. If amyloid affects the nerves that control your bowel function, you may experience periods of alternating constipation and diarrhea. If it affects the nerves that control blood pressure, you may feel faint after standing up too quickly. ---
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Care planAmyotrophic Lateral Sclerosis (Lou Gehrig's Disease)Amyotrophic lateral sclerosis (ALS) — sometimes called Lou Gehrig's disease — is a rapidly progressive and ultimately fatal disease of the nervous system. It specifically attacks the nerve cells (neurons) that control your voluntary muscles: the ones you consciously use to move, speak, and breathe. In ALS, both the upper and lower motor neurons — the two-part relay system that carries movement signals from your brain to your muscles — progressively break down and die. Without these signals, muscles gradually weaken, waste away, and may twitch uncontrollably. Over time, the brain loses its ability to initiate and direct voluntary movement. Symptoms often first appear in the hands and arms, legs, or the muscles used for swallowing. The weakness and muscle loss eventually affect both sides of the body. As the disease advances, people with ALS lose the ability to move their limbs, hold themselves upright, and ultimately, to breathe without the help of a ventilator. Importantly, ALS does not rob you of your senses — your ability to see, smell, taste, hear, and feel touch remains intact. And while the disease typically spares a person's intellect and personality, more recent research suggests that some people with ALS may experience subtle cognitive changes, particularly in areas like word fluency, decision-making, and memory. What causes ALS — and why it strikes certain individuals and not others — remains one of medicine's enduring mysteries. ### Are There Any Treatments? There is currently no cure for ALS. However, the drug riluzole — the only prescription medication approved by the Food and Drug Administration specifically for ALS — has been shown to extend survival by 2 to 3 months, though it does not ease symptoms. Other treatments focus on managing symptoms and maintaining quality of life. Medications exist to help with spasticity, pain, panic attacks, and depression. Physical therapy, occupational therapy, and rehabilitation programs can help preserve joint mobility and slow the progression of muscle weakness and wasting. As the disease advances, many individuals with ALS also explore mechanical ventilation (respirators) to assist with breathing. ### What Can Someone with ALS Expect? Regardless of where symptoms first appear, muscle weakness and wasting gradually spread throughout the body as ALS progresses. Moving, swallowing, and speaking become increasingly difficult. Eventually, people with ALS are unable to stand or walk, get in or out of bed independently, or use their hands and arms. In the later stages, breathing becomes labored as the muscles of the respiratory system weaken. While ventilator support can ease breathing difficulties and extend survival, it does not slow the underlying disease. Most people with ALS die from respiratory failure, typically within 3 to 5 years of their first symptoms — though it's important to know that about 10 percent of people with ALS live for 10 or more years. **Reference:** <http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/ALS.htm> ---
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Care planAnal FissureAn anal fissure is a small cut or tear in the delicate lining of the anus. This break in the skin can cause significant pain and bright red bleeding during and after bowel movements. In some cases, the tear is deep enough to expose the underlying muscle tissue. An anal fissure is generally not a serious condition. It can affect people of all ages, and it's especially common in infants and young children, for whom constipation is a frequent challenge. In most cases, the tear heals on its own within four to six weeks. If it lingers beyond eight weeks, it is classified as a chronic fissure. Several treatments can support healing and ease discomfort, including stool softeners and topical pain relievers. If an anal fissure doesn't respond to these measures, surgery may be needed — or your doctor may investigate whether an underlying condition is contributing to the problem. --- ## Understanding Anal Fissures ### Symptoms An anal fissure may produce one or more of the following signs: - A visible tear in the skin around the anus - A skin tag, or small lump of skin, next to the tear - Sharp pain in the anal area during bowel movements - Streaks of blood on stools or on toilet paper after wiping - Burning or itching in the anal area ### What Causes an Anal Fissure? Anal fissures most commonly occur when passing large or hard stools. Chronic constipation or frequent diarrhea can also cause tearing of the sensitive skin around the anus. Other frequent causes include: - Straining during childbirth or bowel movements - Inflammatory bowel disease (IBD), such as Crohn's disease - Decreased blood flow to the anorectal area - Overly tight or spastic anal sphincter muscles **In rare cases, an anal fissure may develop due to:** - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes ### Who Is at Risk? Anal fissures are particularly common in infancy. Older adults are also more susceptible, largely because blood flow to the anorectal area naturally decreases with age. Women are at increased risk during and after childbirth due to the physical demands of delivery. People living with IBD also face a higher risk, as the chronic inflammation of the intestinal lining makes the tissue around the anus more vulnerable to tearing. Those who struggle with constipation on a regular basis are likewise at greater risk — straining and passing large, hard stools remain the most common culprits behind anal fissures. ### How Is an Anal Fissure Diagnosed? In most cases, a doctor can diagnose an anal fissure simply by visually examining the area around the anus. A short rectal exam may also be performed to confirm the diagnosis. During this exam, your doctor may gently insert a thin instrument called an anoscope into the rectum. This tool provides a clearer view of the anal canal and can help identify the exact location and extent of the tear. An anoscope can also help rule out other sources of anal or rectal pain, such as hemorrhoids. In some cases, an endoscopy may be recommended for a more thorough evaluation. ### How Is an Anal Fissure Treated? The good news is that most anal fissures don't require aggressive treatment. Several straightforward home remedies can support healing and bring meaningful relief. These include: - Using over-the-counter stool softeners - Drinking more fluids - Taking fiber supplements (**[Dynamic Fiber](https://nutridyn.com/dynamic-fiber)**) and eating more fibrous foods, such as raw fruits and vegetables - Taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area - Applying a Vitamin E ointment, or a nitroglycerin ointment to promote blood flow to the area, or a hydrocortisone cream such as Cortizone 10 to help with inflammation - Applying topical pain relievers, such as lidocaine, to the anus to ease discomfort If your symptoms haven't improved within two weeks of starting treatment, it's time to check in with your doctor for a closer look. Your doctor can confirm the diagnosis and explore additional treatment options. A calcium channel blocker ointment can help relax the sphincter muscles, giving the fissure the opportunity to heal. Botox injections into the anal sphincter are another option — by temporarily reducing muscle activity, these injections allow healing to occur while helping prevent new fissures from forming. When other treatments haven't done the trick, your doctor may recommend a procedure called an **anal sphincterotomy**. This involves making a small incision in the anal sphincter to relieve muscle tension, which in turn allows the fissure to heal. It's worth knowing that not all anal fissures stem from a low-fiber diet or constipation. Fissures that are slow to heal or that appear in an unusual location — outside the posterior midline area — may point to an underlying condition worth investigating. If you have concerns about a fissure that isn't responding to at-home care, don't hesitate to reach out to your doctor to discuss whether further testing is warranted. ### How Can an Anal Fissure Be Prevented? While there's no guaranteed way to prevent an anal fissure, the following habits can meaningfully reduce your risk: - Keeping the anal area dry - Cleansing the anal area gently with mild soap and warm water - Drinking plenty of fluids, eating fibrous foods, and exercising regularly to avoid constipation - Treating diarrhea promptly - Changing infants' diapers frequently ### Key Takeaways Anal fissures can cause sharp pain and small amounts of bright red bleeding with bowel movements. When a fissure becomes chronic, skin tags may develop in the affected area alongside a persistent local infection. Conditions associated with anal fissures include prior anal surgeries, inflammatory bowel disease, local cancers, and sexually transmitted infections. Some of the most direct triggers are those that cause physical trauma to the area — including vaginal delivery, anal intercourse, or passing hard stools. **Source:** <https://www.healthline.com/health/anal-fissure#symptoms> **References:** - Anal fissures. (n.d.). <https://www.ucsfhealth.org/education/anal_fissures/> - Anal fissures. (2014). <https://my.clevelandclinic.org/health/diseases_conditions/hic_Anal_Fissures> - Nasr M, et al. (2010). Botulinum toxin injection versus lateral internal sphincterotomy in the treatment of chronic anal fissure: A randomized controlled trial. doi: 10.1007/s00268-010-0736-5 - Schlichtemeier S, et al. (2016). Anal fissure. doi: 10.18773/austprescr.2016.007 ---
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Care planAnemia**Red cell distribution width (RDW) measures how much your red blood cells vary from one another in size.** Red blood cells are the cells responsible for carrying oxygen throughout your body. A low RDW (below 10.2%) means your red blood cells are remarkably uniform in size — they don't vary much at all. One reason for a low RDW is macrocytic anemia. **Macrocytic anemia** is a blood disorder in which your body isn't producing enough red blood cells, but the ones it does produce are abnormally large. Another cause of a low RDW is microcytic anemia. **Microcytic anemia** is a condition in which your red blood cells are abnormally small. In both of these disorders, the red blood cells tend to be uniform in size — either consistently small or consistently large — which is precisely what drives the RDW down. Macrocytic anemia signals that red blood cells aren't maturing the way they should. Normally, as red blood cells develop, they shed their nucleus and shrink down to their characteristic shape — a biconcave disc, like a flattened donut. Without the right nutrients, this process goes wrong, and cells never achieve their proper form. **The most common culprit behind macrocytic anemia is a deficiency of Vitamin B12 or folate (another B vitamin).** It can also be a side effect of certain chemotherapy drugs, and is frequently seen in people with heavy alcohol use. **Macrocytosis** is simply the medical term for red blood cells that are larger than normal. Anemia, in turn, means you don't have enough properly functioning red blood cells circulating in your body. Put the two together, and macrocytic anemia describes a condition in which your blood is short on red blood cells — and the ones you do have are oversized. **Microcytic anemia** refers to the presence of abnormally small red blood cells (RBCs) detected in a lab sample. This finding usually goes hand-in-hand with reduced hemoglobin inside those cells — a condition known as "hypochromic anemia," because the cells appear paler than normal under the microscope. Microcytic anemia is formally defined as a Mean Cell Volume (MCV) of less than 80 cubic mm, though each laboratory sets its own reference range, so this number can vary slightly. The most common cause of microcytic anemia is iron deficiency. Iron is a critical building block of hemoglobin, so when it runs low, red blood cells come out small (microcytic) and pale (hypochromic). Your body stores iron in the bone marrow, drawing on those reserves when daily intake falls short. But if iron stores continue to dwindle without replenishment, your body's ability to produce new red blood cells — a process called erythropoiesis — becomes seriously compromised. ### Anemia From Ongoing Blood Loss **In adults, microcytic anemia is often the first clue that chronic internal bleeding is occurring — most commonly somewhere in the gastrointestinal tract.** Further testing is needed to pinpoint the source of the bleed. In women who haven't yet reached menopause, heavy menstrual periods can contribute to microcytic anemia — but other causes of internal bleeding should always be investigated and ruled out. Peptic ulcers are another frequent source of slow, ongoing blood loss. ---
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Care planAngina PectorisAngina is chest pain caused by reduced blood flow to the heart muscle. When your heart isn't getting enough oxygen-rich blood — most often because of narrowed or blocked arteries — it sends out a distress signal in the form of pain or pressure in your chest. This discomfort can also radiate to your shoulders, arms, neck, jaw, or back. Angina is frequently a warning sign of underlying coronary heart disease or another heart condition. Think of it as your heart's way of telling you it's working harder than its blood supply can support. ### What Does Angina Feel Like? Many people mistake angina for indigestion — particularly with the most common form, stable angina. Symptoms can include any of the following: - Pain or discomfort in the chest (typically with a sensation of squeezing or pressure), possibly accompanied by pain in the arms, neck, jaw, shoulder, or back - Nausea - Fatigue - Shortness of breath - Anxiety - Sweating - Dizziness ### What Causes Angina? In most people, angina is caused by atherosclerosis — the gradual buildup of fatty deposits (called plaque) inside the walls of the arteries that feed the heart. When this buildup becomes significant enough to restrict blood flow, it becomes a potentially life-threatening condition that requires prompt medical attention. There are three main types of angina, each with its own pattern and triggers: - **Stable angina** — tends to flare up during periods of physical exertion or stress - **Unstable angina** — doesn't follow a pattern and may signal an impending heart attack - **Variant angina** — typically occurs during periods of rest Stable angina is the most common form of the condition. Each type of angina requires a different type of medical treatment — which is why a proper diagnosis is so important. ### How Is Angina Treated? Any worsening of angina symptoms can be a sign that your heart health is deteriorating or that a heart attack may be on the horizon. It's essential to track your symptoms carefully and report any changes to your doctor right away. If your chest pain lasts longer than a few minutes and does not improve after taking your angina medication, seek emergency medical care immediately. Standard medical treatments for angina include the use of medication (such as nitrates, beta-blockers, and ACE inhibitors) and medical procedures (such as angioplasty and coronary artery bypass grafting). Doctors also recommend making lifestyle changes (such as following a heart-healthy diet and a safe exercise program) to help control angina. ### Natural Support for Angina Because angina is a serious medical condition, partnering closely with your physician is absolutely essential. Proven medical treatments tailored to your individual situation have been shown to save lives when used appropriately. That said, there are evidence-based natural approaches worth discussing with your doctor — either for mild cases of angina or as complementary support alongside your prescribed treatment plan. **Coenzyme Q10 (CoQ10).** This powerful antioxidant can benefit heart health by influencing the mitochondria — the tiny powerhouses found in heart cells and throughout the body — where energy metabolism occurs. In this way, CoQ10 may help lower the heart's oxygen demands by improving its energy efficiency. It is known for protecting the blood vessels and heart from oxidative stress, and may help improve exercise performance for those with stable angina, according to a study published in the *American Journal of Cardiology*. **Reference:** *Am J Cardiol.* 1985 Aug 1;56(4):247–51. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. **Hawthorn (*Crataegus oxycantha*).** This herbal preparation made from the leaves and flowers of a species of hawthorn tree may help relieve angina symptoms by increasing coronary artery blood flow. The starting dose is 500 mg a day of an extract standardized to 2% vitexen-2 rhamnoside. > 📝 **NOTE:** Hawthorn should only be used under the supervision of a physician. **Reference:** Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. *Am J Health Syst Pharm.* 2002;59(5):417–22. **L-Carnitine.** The amino acid L-carnitine can help relieve angina symptoms by improving heart muscle metabolism. In a systematic review and meta-analysis published in *Mayo Clinic Proceedings*, L-carnitine is associated with a **27% reduction in mortality**, a **65% reduction in ventricular arrhythmias**, and a **40% reduction in angina symptoms** for those experiencing myocardial infarction. **Reference:** *Mayo Clin Proc.* 2013 Jun;88(6):544–51. doi: 10.1016/j.mayocp.2013.02.007. L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. **Fish Oil.** The omega-3 fatty acids in fish and fish oil supplements have been shown to be an effective preventive strategy against heart disease. They can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy. In a multi-center, double-blind, placebo-controlled trial, patients with acute myocardial infarction treated with high-dose omega-3 fatty acids for six months experienced an overall reduction of adverse cardiac events, including myocardial fibrosis, systemic inflammation, and ventricular remodeling. **Reference:** *Circulation.* 2016 Aug 2;134(5):378–91. doi: 10.1161/CIRCULATIONAHA.115.019949. Effect of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction: The OMEGA-REMODEL Randomized Clinical Trial. **L-Arginine.** In the body, the amino acid arginine converts into nitric oxide (NO). Some evidence shows that arginine may help improve blood flow in the arteries of the heart — which may improve symptoms of clogged arteries, chest pain or angina, and coronary artery disease. **References:** - *Oxid Med Cell Longev.* 2009 Sep–Oct;2(4):231–7. doi: 10.4161/oxim.2.4.9233. Oral administration of L-arginine in patients with angina or following myocardial infarction may be protective by increasing plasma superoxide dismutase and total thiols with reduction in serum cholesterol and xanthine oxidase. - Tripathi P, Chandra M, Misra MK. Protective role of L-arginine against free-radical mediated oxidative damage in patients with unstable angina. *Indian J Clin Biochem.* 2010;25(3):302–6. ### Lifestyle Strategies That Make a Real Difference: The good news: meaningful lifestyle changes can actually help reverse the arterial insufficiency that drives angina. A heart-healthy diet, mind-body practices like yoga and meditation, group support, and moderate exercise can all play a powerful role. And if you smoke, stopping is one of the most important things you can do for your heart. To slow or reverse the atherosclerosis that underlies angina: - **Get more exercise.** This will help maintain the health of the vessels leading to the heart, as well as strengthen the heart muscle itself. Even mild and moderate exercise can help in many ways. Not only is exercising a great way to reduce stress, a recent study published in *Scientific Reports* indicates that rehabilitation exercise after a cardiac event leads to improvement in angina-related chest pains, longer exercise time, and better exercise tolerance. Be sure to talk with your doctor first before starting an exercise program. - **Stop smoking, and avoid secondhand smoke.** Smoking increases your risk for several kinds of cancer, chronic obstructive pulmonary disease (COPD), atherosclerosis, and coronary heart disease — all of which can cause angina chest pains. <https://www.who.int/en/news-room/fact-sheets/detail/tobacco> - **Control your blood pressure.** Angina can be related to high blood pressure in at least two ways: 1. High blood pressure can cause damage to the coronary arteries, leading to blockages and abnormal blood flow to the heart, which causes angina or chest pain due to inadequate circulation. 2. High blood pressure puts a lot of strain on the heart — the pressure the heart must exert to pump blood against this elevated resistance requires more blood flow and oxygen, causing angina when coronary disease is already present and blood flow cannot increase adequately. - **Reduce stress.** Stress and anxiety can induce chest pains in those with angina pectoris. The Mayo Clinic recommends that people with angina find a way to relax and avoid stress as much as possible. Learning to incorporate natural stress relievers into your daily routine is vital for overall heart health. Meditation, cognitive behavioral therapy, deep breathing exercises, journaling, and spending more time outdoors or being social may all help induce relaxation. ---
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Care planAnkylosing SpondylitisAnkylosing spondylitis is a long-term, inflammatory form of arthritis that primarily targets the spine. It typically announces itself through back pain and stiffness that begin during the teenage years or early adulthood. Over time, the bones of the spine (vertebrae) gradually fuse together, progressively limiting movement. This process of bony fusion is what gives the disease its name — "ankylosis" simply means abnormal joining of bones. The first signs of ankylosing spondylitis usually trace back to inflammation in the joints where the pelvic bones (the ilia) meet the base of the spine (the sacrum). These are called the sacroiliac joints, and their inflammation — sacroiliitis — is often the earliest clue that something is wrong. From there, inflammation can spread upward into the joints between the vertebrae, a condition called spondylitis. The disease can also involve other joints, including the shoulders, hips, and, less commonly, the knees. As it advances, ankylosing spondylitis can affect the joints connecting the spine to the ribs, making it harder to take a deep breath. People with advanced disease are also at a higher risk of spinal fractures. Ankylosing spondylitis affects the eyes in up to 40 percent of cases, triggering episodes of eye inflammation called acute iritis — which can cause eye pain and heightened sensitivity to light (photophobia). In rare cases, the disease can lead to serious complications involving the heart, lungs, and nervous system. ## Understanding Ankylosing Spondylitis ### Other Names for Ankylosing Spondylitis - AS - Bechterew Disease - Marie-Struempell Disease - Ankylosis Spondylitis - Spondylarthritis Ankylopoietica - Spondylitis Ankylopoietica - Spondylitis, Ankylosing - Spondyloarthritis Ankylopoietica ### How Common Is Ankylosing Spondylitis? Ankylosing spondylitis belongs to a family of related conditions known as spondyloarthropathies. In the United States, these conditions collectively affect 3.5 to 13 out of every 1,000 people. ### What Genes Are Linked to Ankylosing Spondylitis? Ankylosing spondylitis is most likely caused by a combination of genetic and environmental factors, many of which researchers are still working to identify. That said, scientists have discovered variations in several genes that appear to influence a person's risk of developing the condition. One of the most important is the HLA-B gene, which carries instructions for making a protein that plays a key role in the immune system. This gene is part of a larger network of genes called the human leukocyte antigen (HLA) complex — essentially the immune system's way of telling the difference between the body's own proteins and foreign threats like viruses and bacteria. The HLA-B gene comes in many normal variations, which is what allows each person's immune system to recognize a wide variety of foreign proteins. One particular version, called **HLA-B27**, is known to increase the risk of developing ankylosing spondylitis. Importantly, though, most people who carry the HLA-B27 variation never actually develop the disease — and exactly how HLA-B27 raises the risk remains an open question in research. Variations in several other genes — including **ERAP1**, **IL1A**, and **IL23R** — have also been linked to ankylosing spondylitis. While these genes all play important roles in immune function, it's still unclear precisely how their variations affect individual risk. Researchers believe additional, as-yet-unidentified genes also play a role — both in whether someone develops ankylosing spondylitis and in how the disease progresses over time. Some of these genes likely involve the immune system; others may serve entirely different functions. The search to identify and understand these genes is ongoing. ### Is Ankylosing Spondylitis Inherited? While ankylosing spondylitis can run in families, it is not a purely inherited disease. Both genetic and environmental factors work together to shape a person's risk. This means that carrying a gene variation associated with the disease does not guarantee that someone will develop it — even in families where multiple members are affected. As a striking example, about 80 percent of children who inherit the HLA-B27 variation from a parent with ankylosing spondylitis never go on to develop the disorder themselves. ### Exercise Guidance Standard medical treatments for ankylosing spondylitis cannot halt the disease's progression on their own. Consistent stretching and deliberate attention to good posture are essential tools for preserving as much mobility as possible over the long term. The goal of exercise is to build strength in the muscle groups that work against the directions in which the body is most likely to become deformed — in other words, strengthening muscles that extend and open the body rather than those that flex and close it. **Recommended Spondylitis Exercises:** - Lie on your back with your hands behind your head; bend your knees and draw them up toward your abdomen; then raise your feet with some force; relax and lower them back down - Lying on your back, stretch your arms out overhead; use the momentum of your arms to swing yourself up to a sitting position - Lying face down, extend your arms out to the sides, then lift them up over your back as if you were flying - While standing, slowly move your neck through its full range of motion - While standing, slowly bend your trunk to the right, then to the left - Repeat each of the above exercises 10 times, once or twice a day ---
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Care planAntibiotic Therapy SupportTaking a probiotic alongside your antibiotic prescription is one of the most well-supported, practical steps you can take to protect your gut health. Research consistently shows that pairing probiotics with antibiotics helps your treatment work better and significantly lowers your chances of experiencing one of the most common — and uncomfortable — side effects: antibiotic-associated diarrhea (AAD). The key is simple: take your probiotic **at least one hour apart** from each antibiotic dose. (For example, if you take your antibiotic in the morning, take your probiotic at least an hour later in the day.)
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Care planAnti-Inflammatory Diet## Understanding Fat and Inflammation **Arachidonic acid** is a type of fat that fuels inflammation in the body. Leading medical organizations, such as the American College of Rheumatology, encourage eating certain fish and foods rich in omega-3 fatty acids, based on growing evidence that these healthy fats can help reduce the pain and inflammation of RA. The American Heart Association (AHA) recommends at least two servings of these foods per week for heart health benefits as well. The good news: eating more omega-3 fatty acids naturally lowers the amount of arachidonic acid in your body. Combined with a low-glycemic diet, research supports keeping arachidonic acid intake to no more than **60 mg per day.** Below is a list of animal foods (meat, poultry, and fish) that contain 60 mg or less of arachidonic acid per 3.5 oz serving. Please choose only from the options on this list for this food category. Keep in mind: if you eat more than 3–4 oz at one time, you will need to account for the additional arachidonic acid in your daily total. > ⚠️ **IMPORTANT NOTE:** Egg yolks are high in arachidonic acid (70 mg per yolk) and should be avoided. Soy and dairy products contain no significant arachidonic acid. | **Food** | **Arachidonic Acid Content (mg per 3.5 oz)** | |---|---| | **Meat and Poultry** || | Ham, sliced boiled | 0 | | Pork tenderloin | 30 | | Turkey breast, roast | 40 | | Beef, flank steak | 40 | | Ground beef, 5% fat | 50 | | Chicken breast | 60 | | **Fish** || | Mahi mahi | 0 | | Pacific mackerel | 10 | | Pink salmon | 10 | | Pacific cod | 20 | | Sockeye salmon | 30 | | Atlantic cod | 30 | | Haddock | 30 | | Snapper | 40 | | Yellowfin tuna | 40 | | White tuna, canned in water | 50 | | Flounder | 50 | | Atlantic mackerel | 50 | | Grouper | 60 | --- *These statements have not been evaluated by the Food and Drug Administration, and are not intended to diagnose, treat, cure, or prevent any disease.*
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Care planAnxiety DisordersFear and anxiety are woven into the fabric of being human. You might feel your heart race before a big exam or sense a chill walking down a dark street at night. In those moments, anxiety is actually working *for* you — sharpening your focus, quickening your reflexes, keeping you safe. And once the moment passes, so does the feeling. But for millions of people across the United States, the anxiety never really leaves. It lingers, deepens, and grows — bringing with it chest pain, nightmares, and sometimes a fear so consuming that leaving home feels impossible. These people are living with anxiety disorders. Types include: - Panic disorder - Obsessive-compulsive disorder (OCD) - Post-traumatic stress disorder - Phobias - Generalized anxiety disorder Anxiety disorders are the most common emotional disorders in existence, affecting more than 25 million Americans. They can take many forms, and their symptoms may include: - Overwhelming feelings of panic and fear - Uncontrollable obsessive thoughts - Painful, intrusive memories - Recurring nightmares - Physical symptoms such as feeling sick to your stomach, "butterflies" in your stomach, heart pounding, startling easily, and muscle tension Anxiety disorders are a very different experience from ordinary nervousness. Left untreated, they can drive people to go to great lengths to avoid anything that might trigger their symptoms. People with anxiety disorders are also more likely to develop depression, and many turn to alcohol or other substances in search of relief. The ripple effects can touch every corner of life — work performance, school, and the relationships we treasure most. --- ## Understanding the Different Types of Anxiety Disorders ### Panic Disorder At the heart of panic disorder is the panic attack — a sudden, overwhelming wave of physical and psychological distress. During an attack, several of these symptoms may strike at once: - Pounding heart or chest pain - Sweating, trembling, shaking - Shortness of breath, sensation of choking - Nausea or abdominal pain - Dizziness or lightheadedness - Feeling unreal or disconnected - Fear of losing control, "going crazy," or dying - Numbness - Chills or hot flashes Because these symptoms can be so intense and physical, many people in the middle of a panic attack are convinced they are having a heart attack or another life-threatening emergency. ### Phobias A phobia is an intense, persistent, and disproportionate fear of a specific object, situation, or activity. These fears cause real suffering — enough that some people will dramatically reshape their lives to avoid whatever frightens them. There are three types of phobias: - **Specific phobia** — An extreme or excessive fear of an object or situation that is generally not harmful. Patients know their fear is excessive, but they can't overcome it. Examples are fear of flying or fear of spiders. - **Social phobia (also called social anxiety disorder)** — Significant anxiety and discomfort about being embarrassed or looked down on in social or performance situations. Common examples are public speaking, meeting people, or using public restrooms. - **Agoraphobia** — This is the fear of being in situations where escape may be difficult or embarrassing or help might not be available in the event of panic symptoms. Untreated agoraphobia can become so serious that a person may refuse to leave the house. A person can only receive a diagnosis of phobia when their fear is intensely upsetting, or if it significantly interferes with their normal daily activities. ### Generalized Anxiety Disorder People with generalized anxiety disorder (GAD) carry a constant, heavy burden of tension that seeps into every corner of daily life. They worry relentlessly — about work responsibilities, family health, or even small things like errands, car repairs, or appointments — and feel powerless to stop. This ongoing worry often comes with physical symptoms, too: trouble sleeping, muscle aches and tension, shakiness, weakness, and headaches. People with GAD may also be irritable and find it difficult to concentrate or work productively. ### What Causes Anxiety Disorders? The precise causes of anxiety disorders remain unknown, though research continues to offer important clues. Certain regions of the brain involved in processing fear may play a role in some anxiety disorders. These conditions can also run in families, pointing to a combination of genetic vulnerability and environmental stressors. Scientists are also actively investigating the role that brain chemistry plays in driving these disorders. As many as 18% of US adults¹ and upwards of 30% of young people² suffer from some form of anxiety, making it the most prevalent mental health disorder in the country. The ability of practitioners to identify and help address anxiety early on with diet modification and nutrition is imperative as anxiety often goes undiagnosed, and therefore untreated, especially in children and adolescents. Left untreated, it can lead to chronic and debilitating mental and physical illness. **Some of us face a higher risk of developing an Anxiety Disorder:** - **Being female.** Women are more likely than men to be diagnosed with an anxiety disorder. - **Trauma.** Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders. - **Stress due to an illness.** Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future. - **Stress buildup.** A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family or ongoing worry about finances. - **Personality.** People with certain personality types are more prone to anxiety disorders than others. - **Other mental health disorders.** People with other mental health disorders, such as depression, often experience anxiety disorder as well. - **Having blood relatives with an anxiety disorder.** Anxiety disorders can run in families. - **Drugs or alcohol.** Drug or alcohol use, abuse, or withdrawal can cause or worsen anxiety. - **Artificial sweeteners.** New developments in the so-called sugar-free paradox have further called into question whether artificial sweeteners represent a healthy way to cut calories or a potentially dangerous option. Recent findings have explored connections between various sugar alternatives and cardiovascular health risks and anxiety, among other concerns. **References:** - Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. *N Engl J Med*. 2005;352:2515–2523. - Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication — Adolescent Supplement (NCS-A). *J Am Acad Child Adolesc Psychiatry*. 2010;49:980–989. - <https://reference.medscape.com/viewarticle/989122?ecd=mkm_ret_230902_mscpmrk_psych_anxiety_etid5811850&uac=149193PV&impID=5811850> ---
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Care planAscending Aortic AneurysmAn **ascending aortic aneurysm** is a vulnerable, weakened segment at the top of your aorta — the body's largest and most vital artery. This weakened area balloons outward and, if left unchecked, can tear or burst open, triggering a life-threatening crisis. Roughly 60% of all aneurysms in the thoracic aorta (the portion running through your chest) occur in this ascending segment. ## Understanding Ascending Aortic Aneurysm ### What Exactly Is an Ascending Aortic Aneurysm? Think of your aorta as a high-pressure garden hose running through your chest and abdomen — it's the main pipeline delivering oxygen-rich blood from your heart to the rest of your body. An ascending aortic aneurysm is a bubble-like bulge that forms in the very first stretch of this pipeline, just as it leaves your heart. Like a weak spot on that garden hose, the wall here is thinner and more fragile than it should be. If that bulge tears or bursts — a medical emergency called a rupture — it can cause rapid, severe internal bleeding. Because these aneurysms sit in the chest, they're also known as ascending thoracic aortic aneurysms, or ATAAs. ### Who Is at Risk? Certain factors can raise your chances of developing an ATAA. The more of these that apply to you, the more important it is to stay in close contact with your healthcare provider: - Being a man over 60 or a woman over 70 - Having a family history of aortic aneurysms - Having a bicuspid aortic valve or a connective tissue disorder - Heart disease - High blood pressure - Smoking ### How Common Are Ascending Aortic Aneurysms? Approximately 60% of all thoracic aortic aneurysms affect the ascending aorta. Ascending aortic aneurysms affect about 10 out of 100,000 people each year. ### What Causes an Ascending Aortic Aneurysm to Develop? ATAAs take shape when the wall of the aorta loses its strength and resilience. As we age, or when heart disease is present, the aorta naturally becomes stiffer and less flexible. Each heartbeat pushes blood against this compromised wall — and over time, that relentless pressure causes the weakened section to stretch and bow outward. A number of specific conditions can set this process in motion: - Aortitis, or inflammation of the aorta - Atherosclerosis (plaque buildup inside your arteries) - Bicuspid aortic valve disease (two aortic valve flaps instead of the normal three) - Loeys–Dietz syndrome, a genetic disorder that can cause an enlarged aorta - Marfan syndrome, a connective tissue disorder that can affect blood vessel walls - Traumatic injuries, which can cause tears in the artery wall - Turner syndrome, a genetic disorder that can cause cardiovascular problems ### Will I Feel Any Symptoms? Here's the challenge: most people with ATAAs feel completely normal and have no idea anything is wrong. That said, certain warning signs should never be ignored. Contact your healthcare provider right away if you notice any of the following: - Chest pain or pain high in your back - Coughing or wheezing - Difficulty swallowing - Hoarseness - Shortness of breath ### How Is an Ascending Aortic Aneurysm Diagnosed? Because ATAAs so rarely cause noticeable symptoms, they're genuinely difficult to catch — and are often discovered quite by accident during an imaging test ordered for an entirely different reason. Once an aneurysm is found, your healthcare provider will likely use one or more of the following imaging tools to understand its size, location, and severity: - **Chest X-ray:** This quick imaging exam can show an enlarged aorta, but a chest X-ray isn't detailed enough to show smaller aneurysms. - **Transthoracic echocardiogram (TTE):** This test uses sound waves to show how blood flows through your heart. A TTE can also identify problems with your heart valves. - **Chest CT scan:** A chest CT scan uses X-rays to create 3D pictures of your chest. It's detailed enough to show even small aneurysms and dissections in your aorta, particularly if contrast is administered through an IV during the scan. - **MR angiography:** Performs an MRI of the chest and heart. Angiography can assess how well your left ventricle and aortic valve are working. ### What Are the Treatment Options? Your treatment plan will be tailored to the aneurysm's size, how quickly it's growing, and what's driving its development. Aneurysms that are smaller than 5.5 centimeters don't usually need surgery right away unless you have additional risk factors (such as family history, connective tissue disorder, or bicuspid aortic valve). Depending on your situation, your healthcare provider may recommend: - **Medications** to manage your blood pressure and reduce force against the artery wall. - **Imaging exams** about every six months to monitor the size of the aneurysm, then every few years if the aneurysm isn't growing quickly. - **Lifestyle adjustments** such as diet, exercise, and not smoking. Talk to your healthcare provider about safe, low-impact physical activities that won't put too much pressure on your arteries. Aneurysms larger than 5.5 centimeters typically need surgery, but there are exceptions. For instance, people with Marfan syndrome, a bicuspid aortic valve, or a family history of aneurysms may need surgery sooner. Studies suggest these conditions make it more likely an aneurysm will rupture at a smaller size. Your healthcare provider will make recommendations for surgery based on your individual needs. ### How Does Surgery Repair an Ascending Aortic Aneurysm? During aneurysm repair surgery, a surgeon makes an incision (cut) in your chest to access your aorta. They remove the aneurysm bulge by cutting it out and sew a graft (a tube made of strong, synthetic material) in its place. Depending on the location of the aneurysm, your surgeon may need to detach and reattach your two coronary arteries. This type of open procedure requires cardiopulmonary bypass — a procedure where a machine takes over your heart and lung function during surgery. People with a bicuspid aortic valve or aortic valve disease may also have aortic valve surgery along with aneurysm repair. A surgeon uses a graft with an attached artificial aortic valve, or can sometimes repair the bicuspid valve. Both open and minimally invasive surgeries require general anesthesia. ### What Can I Expect Long-Term? Studies show that 79% of people who have elective (non-emergency) surgery for ATAAs survive for at least 10 years after treatment. But the outlook is much worse if an aneurysm dissects or ruptures. About half of these people don't survive if they don't have emergency surgery within 48 hours. **Source:** <https://my.clevelandclinic.org/health/diseases/21949-ascending-aortic-aneurysm> **References:** - Isselbacher EM. Thoracic and Abdominal Aortic Aneurysms. *Circulation*. 2005 Feb;111:816–828. <https://www.ahajournals.org/doi/full/10.1161/01.cir.0000154569.08857.7a> - Merck Manual (Consumer Version). Thoracic Aortic Aneurysms. <https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/aneurysms-and-aortic-dissection/thoracic-aortic-aneurysms> - Lavall D, Schäfers HJ, Böhm M, Laufs U. Aneurysms of the Ascending Aorta. *Dtsch Arztebl Int*. 2012 Mar;109(13):227–233. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334714/> - Prakash P, Patni R, Asghar NM, Chan KMJ, Antanas M. Ascending aortic aneurysms: pathophysiology and indications for surgery. *e-J Cardiol Pract*. 2011 Oct;10(7). <https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-10/Ascending-aortic-aneurysms-pathophysiology-and-indications-for-surgery> - Saliba E, Sia Y. The ascending aortic aneurysm: When to intervene? *Int J Cardiol Heart Vasc*. 2015 March;6:91–100. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497177/> ---
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Care planAsthmaAsthma is a disease in which airway inflammation restricts the flow of air in and out of your lungs. The word "asthma" comes from the Greek word for "panting" — and that panting, wheezing sound so characteristic of asthma is the direct result of air struggling to pass through narrowed airways. Normally, when you breathe in an irritant or push your body with exercise, your airways relax and open wide — helping your lungs clear out irritants or draw in more oxygen. But in a person with asthma, the muscles surrounding the airways tighten, and the lining of the air passages becomes swollen and inflamed. The immune system jumps in, but rather than solving the problem, it becomes part of it — driving even more inflammation. According to the Centers for Disease Control and Prevention, asthma affects 8.6% of children and 7.4% of adults in the United States. While boys are more likely than girls to develop asthma in childhood, adult women are nearly twice as likely to have asthma as adult men. African Americans carry the highest burden of the disease, with a prevalence of 9.9%. Globally, asthma rates have climbed sharply in recent decades and may now affect more than 300 million people. Asthma attacks are a leading cause of emergency room visits and hospitalizations — placing a significant and ongoing burden on our healthcare system. --- ## Understanding Asthma ### What Causes Asthma? The exact causes of asthma are still not fully understood, but they likely involve a combination of environmental exposures and genetic susceptibility. Because asthma is such a complex and varied disease, pinpointing a single cause is enormously difficult. In people who already have asthma, triggers like airborne substances, physical activity, pollution, and emotional stress can set off an attack. Repeated, long-term exposure to these same triggers may also increase the likelihood that someone will develop asthma in the first place, according to the Mayo Clinic. Most experts believe asthma results from a combination of many interacting factors. In individuals who are genetically predisposed, things like allergens, infections, dietary patterns, exercise, cigarette smoke, and stress can all be enough to bring on an asthma attack. ### The Role of Inflammation in Asthma While asthma shows up differently in different people, it is fundamentally rooted in chronic airway inflammation and a phenomenon called airway hyper-responsiveness — meaning the airways of someone with asthma are far more sensitive to triggers than they should be. A 2010 review explained that, "An eosinophilic or neutrophilic infiltrate is a common feature of allergic airway inflammation and this has been correlated clinically with [airway hyper-responsiveness]." This hypersensitivity sets off an immune chain reaction in the airways, locking the body into a state of persistent, chronic inflammation. ### Signs and Symptoms Most people with asthma experience periodic attacks separated by symptom-free stretches. Some live with chronic shortness of breath punctuated by episodes of worsening breathlessness. Asthma attacks can last anywhere from minutes to days — and if airflow becomes severely restricted, they can be life-threatening. **The hallmark symptoms of asthma include:** - Shortness of breath - Wheezing — usually begins suddenly; may be worse at night or early in the morning; aggravated by exposure to cold air, exercise, heartburn; and relieved with the use of bronchodilators (drugs that open the airways) - Chest tightness - Cough (dry or with sputum) — sometimes this is the only symptom > ⚠️ **IMPORTANT NOTE:** Call 911 immediately if you or someone around you experiences any of these serious warning signs: > > - Extreme difficulty breathing or cessation of breathing > - Bluish color to the lips and face (called cyanosis) > - Severe anxiety > - Rapid pulse > - Profuse sweating > - Decreased level of consciousness (such as drowsiness or confusion) **Other symptoms that may accompany an asthma attack include:** - Flared nostrils - Abnormal breathing pattern, in which exhalation takes more than twice as long as inhalation - Use of the muscles between the ribs (called intercostals) to help with the increased work of breathing - Coughing up blood (called hemoptysis) ### Risk Factors The following factors may increase the risk of developing asthma: - **Allergies** — children with asthma often have allergies as well - **Family history** of asthma or allergies - **Cigarette smoke**, including secondhand smoke from parents or a spouse - **Food allergies** — a true food allergy, particularly one that induces asthma, is difficult to identify and, therefore, it is not clear exactly how frequently (or infrequently) this contributes to asthma; it seems to be more common in children than in adults and the responsible foods include eggs, milk, wheat, soy, peanuts, fish, shellfish, and sulfite food preservatives - **Sugary drink exposure before and shortly after birth** — children of mothers who drink large amounts of sugary beverages during pregnancy and those with high dietary intake of fructose in early childhood may be at increased risk of developing asthma in midchildhood, according to a [2017 study](https://www.atsjournals.org/) published in the *Annals of the American Thoracic Society* - **Living in a Western or industrialized country** — some experts believe that dietary habits (more processed foods, less fruits and vegetables), indoor living (resulting in overexposure to indoor allergens), energy-efficient homes (trapping allergenic dust mites inside), immunizations, and possibly declining rates of breastfeeding contribute to the rising rates of asthma - **Urban living / air quality** - **Gender** — among younger children, asthma develops twice as frequently in boys as in girls, but after puberty it may be more common in girls - **Obesity** — controversial; a recent study suggests that asthma is over-diagnosed among obese people - **Acetaminophen or paracetamol use** — risk for wheeze in kids is increased with antibiotics and acetaminophen (preschool wheeze as a marker for childhood asthma). *Acta Paediatrica.* 2011;100:1561–1566, 1567–1571. - **Common household cleaning products** — fumes from cleaning products such as bleach, glass cleaner, detergents, and air fresheners exacerbated asthma-related symptoms, and reduced lung function lasted until the morning after exposure, in some cases getting worse with time. *Occup Environ Med* 2015. ### Triggers Childhood asthma in particular can be triggered by nearly all of the same things that trigger allergies, including: - **Airborne allergens**, such as dust, cockroach waste, animal dander, indoor mold, and pollens - **Passive smoke exposure** associated with wheeze and asthma in children. *Pediatrics.* 2012;129:735–744. - **Respiratory infections** - **Air pollutants**, such as smoke from tobacco or a fireplace, aerosols, perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone levels, and fumes from paint, cleaning products, and gas stoves - **Weather changes**, especially shifts in temperature (particularly cold) and humidity - **Antibiotic use** — risk for wheeze in kids increased with antibiotics and acetaminophen. *Acta Paediatrica.* 2011;100:1561–1566, 1567–1571. Additional triggers include: - **Activities that affect your breathing** (exercising, laughing, crying, yelling) - **Stress** ### Getting a Diagnosis Asthma symptoms can look a lot like several other conditions, so your doctor will need to take a thorough history to rule out other causes. Expect questions about how and when your symptoms occur, whether you have a family history of allergies or asthma, and whether you've been exposed to chemicals at work. If asthma is suspected, you'll likely undergo pulmonary function tests — measurements that assess your lung volume and how much air you can exhale. Other tests may include chest and sinus x-rays, blood tests, or allergy testing. ### Preventive Care While there is no guaranteed way to prevent asthma from developing, there are a number of practical steps parents can take to help lower their child's risk. **These include:** - **Breastfeeding exclusively for the first 3 to 6 months of life** — this remains a topic of some debate, though the most recent and largest study suggests that breastfeeding through the first 6 months of life offers meaningful protection for the child. - **Waiting until age 6 months to introduce solid foods** - **Creating a healthier home environment** — avoiding smoking during pregnancy or around infants, and eliminating common household allergens like dust mites and cockroaches. To cut down on dust mite exposure, use allergen-impermeable covers on mattresses and pillows, and remove carpets from bedrooms. - **Being mindful of early medication exposures** — maternal use of acetaminophen during pregnancy or giving a newborn broad-spectrum antibiotics during the first week of life was associated with an increased risk of wheezing in preschoolers, whereas introducing fish into a child's diet before age 9 months was associated with a reduction in risk, according to Swedish researchers in 2 studies published online July 27 and 30 and in the December 2011 print issue of *Acta Paediatrica*. - **Diet and antioxidant foods** — according to certain studies on adults, apples and selenium-rich food in the diet may protect against asthma, and moderate consumption of red wine may be associated with less severe asthma attacks. These foods are high in antioxidants (namely, flavonoids). It is too early to say definitively that these nutrients protect against asthma. Note that in certain individuals, red wine may actually induce asthma symptoms if you have an allergy to sulfites or other substances found in wine — wine labels often indicate if sulfites are present. Key steps in preventing asthma attacks include identifying the allergens and triggers that bring on or worsen your symptoms and working to eliminate or avoid them. Sometimes it takes exposure to more than one factor before an episode is triggered; keeping a diary to determine triggers may be helpful. - **Allergy desensitization** — if you have a known allergy, desensitization therapy may reduce the number of asthma attacks you experience, lessen the intensity of each attack, and lower the amount of medication you need. ### Common Asthma Triggers and How to Minimize Your Exposure - **Viral infections** (colds, flu, bronchitis, pneumonia) — stay away from people who you know are ill - **Sinusitis and allergic rhinitis (hay fever or year-round allergies)** — avoid seasonal allergens by staying indoors in air conditioning as much as possible and eliminating indoor allergens; fewer allergy attacks generally means fewer cases of sinusitis and asthma - **Gastro-esophageal reflux (heartburn)** — avoid provoking foods, medications, and mealtime habits **Things to avoid entirely:** - If sensitive or allergic: aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) - Beta-blockers (such as acebutolol, atenolol, esmolol, labetalol, metoprolol, nadolol, pindolol, propranolol, and timolol) — including those in eye medication - If sensitive or allergic: processed potatoes, shrimp, dried fruit, beer, and wine — these often contain sulfite food preservatives ### Treating & Preventing Asthma Attacks A key insight from asthma research is that chronic inflammation can take hold when the body loses its ability to put the brakes on the inflammatory response — when the natural "stop signs" go missing. When those stop signs are absent and allergens keep coming, attacks become more frequent and more severe. We now understand that resolving inflammation is an active process: it requires removing the triggering stimulus, dialing down pro-inflammatory signals, and clearing out damaged cells. Without this active resolution, inflammation becomes a permanent fixture. The central goals of asthma treatment are avoiding attacks, reducing inflammation, and protecting your lungs from long-term damage. Achieving these goals means learning everything you can about your asthma, working closely with your doctor to understand its severity and build a personalized plan, and sticking with your recommendations. Adjusting your environment to reduce exposure to allergens and irritants is equally important. Certain nutritional strategies — particularly increasing omega-3 fatty acids while cutting back on omega-6 fatty acids — as well as acupuncture may serve as helpful additions to your overall approach. ---
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Care planAtaxiaAtaxia is a condition marked by a loss of muscle control or coordination during everyday voluntary movements — things like walking across a room or picking up a glass of water. Rather than being a disease in itself, ataxia is a sign that something else is going on beneath the surface. It can affect a wide range of movements and cause real difficulties with speech, eye movement, and swallowing. When ataxia persists, it's usually because of damage to the part of your brain responsible for keeping your movements smooth and coordinated — a region called the **cerebellum**. Many different conditions can lead to ataxia, including long-term alcohol use, certain medications, stroke, brain tumors, cerebral palsy, progressive brain degeneration, and multiple sclerosis. In some cases, ataxia is inherited through faulty genes passed down in families. How ataxia is treated depends entirely on what's causing it. While there may not always be a cure, assistive tools — like walkers or canes — can go a long way in helping you stay independent. Physical therapy, occupational therapy, speech therapy, and regular aerobic exercise can also make a meaningful difference in daily life. ## Understanding Ataxia ### What to Watch For Ataxia can creep up gradually or appear without warning. As a symptom of various neurological conditions, it can show up in many ways, including: - Poor coordination - An unsteady, stumbling walk - Trouble with fine motor tasks, like eating, writing, or buttoning a shirt - Changes in speech - Rapid, involuntary back-and-forth eye movements (nystagmus) - Difficulty swallowing ### When It's Time to See a Doctor If you don't already have a diagnosed condition known to cause ataxia — such as multiple sclerosis — it's important to see your doctor as soon as possible if you notice any of the following: - Loss of balance - Loss of muscle coordination in a hand, arm, or leg - Difficulty walking - Slurred speech - Difficulty swallowing ### What Causes Ataxia? Ataxia develops when nerve cells in your cerebellum — the brain region that oversees smooth, coordinated movement — are damaged, degenerate, or are lost entirely. Your cerebellum sits at the base of your brain, just above the brainstem, and consists of two lobes of folded tissue. Beyond coordinating movement, it also helps regulate balance, eye movements, swallowing, and speech. Diseases that damage the spinal cord and the peripheral nerves connecting your cerebellum to your muscles can also trigger ataxia. Here's a closer look at the most common culprits: - **Head trauma.** Damage to your brain or spinal cord from a blow to your head, such as might occur in a car accident, can cause acute cerebellar ataxia, which comes on suddenly. - **Stroke.** Either a blockage or bleeding in the brain can cause ataxia. When the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients, brain cells die. - **Cerebral palsy.** This is a general term for a group of disorders caused by damage to a child's brain during early development — before, during or shortly after birth — that affects the child's ability to coordinate body movements. - **Autoimmune diseases.** Multiple sclerosis, sarcoidosis, celiac disease and other autoimmune conditions can cause ataxia. - **Infections.** Ataxia can be an uncommon complication of chickenpox and other viral infections such as HIV and Lyme disease. It might appear in the healing stages of the infection and last for days or weeks. Normally, the ataxia resolves over time. - **Paraneoplastic syndromes.** These are rare, degenerative disorders triggered by your immune system's response to a cancerous tumor (neoplasm), most commonly from lung, ovarian, breast or lymphatic cancer. Ataxia can appear months or years before the cancer is diagnosed. - **Abnormalities in the brain.** An infected area (abscess) in the brain may cause ataxia. A growth on the brain, cancerous (malignant) or noncancerous (benign), can damage the cerebellum. - **Toxic reaction.** Ataxia is a potential side effect of certain medications, especially barbiturates, such as phenobarbital; sedatives, such as benzodiazepines; antiepileptic drugs, such as phenytoin; and some types of chemotherapy. Vitamin B-6 toxicity also may cause ataxia. These causes are important to identify because the effects are often reversible. Also, **some medications** you take can cause problems as you age, so you might need to reduce your dose or discontinue the medication. - **Alcohol and drug intoxication;** heavy metal poisoning, such as from lead or mercury; and solvent poisoning, such as from paint thinner, also can cause ataxia. - **Vitamin E, vitamin B-12 or thiamine deficiency.** Not getting enough of these nutrients, because of the inability to absorb enough, alcohol misuse or other reasons, can lead to ataxia. - **Thyroid problems.** Hypothyroidism and hypoparathyroidism can cause ataxia. - **COVID-19 infection.** This infection may cause ataxia, most commonly in very severe cases. For some adults who develop ataxia without a clear trigger, no specific cause is ever identified. This so-called sporadic ataxia can take several forms, one of which is multiple system atrophy — a progressive, degenerative condition. ### When Ataxia Runs in the Family Some forms of ataxia are inherited. If you have one of these hereditary types, you were born with a mutation in a specific gene that leads to the production of abnormal proteins. These abnormal proteins interfere with the normal function of nerve cells — particularly in your cerebellum and spinal cord — causing them to progressively break down. As the disease advances, coordination problems tend to worsen over time. Hereditary ataxia can be passed down in two ways: through a dominant gene from just one parent (autosomal dominant) or through a recessive gene inherited from both parents (autosomal recessive). In the recessive case, neither parent may actually have the condition themselves — meaning there may be no obvious family history to clue you in. Different gene defects give rise to different types of ataxia, most of which are progressive. While poor coordination is a common thread running through all of them, each type has its own distinctive features and timeline. ### Autosomal Dominant Ataxias These include: - **Spinocerebellar ataxias.** Researchers have identified more than 40 autosomal dominant ataxia genes, and the number continues to grow. Cerebellar ataxia and cerebellar degeneration are common to all types, but other signs and symptoms, as well as age of onset, differ depending on the specific gene mutation. - **Episodic ataxia (EA).** There are eight recognized types of ataxia that are episodic rather than progressive — EA1 through EA7, plus late-onset episodic ataxia. EA1 and EA2 are the most common. EA1 involves brief ataxic episodes that may last seconds or minutes. The episodes are triggered by stress, being startled or sudden movement, and often are associated with muscle twitching. EA2 involves longer episodes, usually lasting from 30 minutes to six hours, which also are triggered by stress. You might have dizziness (vertigo), fatigue and muscle weakness during your episodes. In some cases, symptoms resolve in later life. Episodic ataxia doesn't shorten life span, and symptoms might respond to medication. ### Autosomal Recessive Ataxias These include: - **Friedreich's ataxia.** This common hereditary ataxia involves damage to your cerebellum, spinal cord and peripheral nerves. Peripheral nerves carry signals from your brain and spinal cord to your muscles. In most cases, signs and symptoms appear well before age 25. The rate of disease progression varies. The first indication generally is difficulty walking (gait ataxia). The condition typically progresses to the arms and trunk. Muscles weaken and waste away over time, causing deformities, particularly in your feet, lower legs and hands. Other signs and symptoms that might develop as the disease progresses include slow, slurred speech (dysarthria); fatigue; rapid, involuntary eye movements (nystagmus); spinal curvature (scoliosis); hearing loss; and heart disease, including heart enlargement (cardiomyopathy) and heart failure. Early treatment of heart problems can improve quality of life and survival. - **Ataxia-telangiectasia.** This rare, progressive childhood disease causes degeneration in the brain and other body systems. The disease also causes immune system breakdown (immunodeficiency disease), which increases susceptibility to other diseases, including infections and tumors. It affects various organs. Telangiectasia is the formation of tiny red "spider" veins that might appear in the corners of your child's eyes or on the ears and cheeks. Delayed motor skill development, poor balance and slurred speech are typically the first indications of the disease. Recurrent sinus and respiratory infections are common. Children with ataxia-telangiectasia are at high risk of developing cancer, particularly leukemia or lymphoma. Most people with the disease need a wheelchair by their teens and die before age 30, usually of cancer or lung (pulmonary) disease. - **Congenital cerebellar ataxia.** This type of ataxia results from damage to the cerebellum that's present at birth. - **Wilson's disease.** People with this condition accumulate copper in their brains, livers and other organs, which can cause neurological problems, including ataxia. Early identification of this disorder can lead to treatment that will slow progression. ### Getting a Diagnosis When ataxia is present, your doctor's first goal is to look for an underlying cause that can be treated. In addition to a thorough physical and neurological exam — which checks things like memory, concentration, vision, hearing, balance, coordination, and reflexes — your doctor may order a series of tests, including: - **Imaging studies.** A CT scan or MRI of your brain might help determine potential causes. An MRI can sometimes show shrinkage of the cerebellum and other brain structures in people with ataxia. It may also show other treatable findings, such as a blood clot or benign tumor, that could be pressing on your cerebellum. - **Lumbar puncture (spinal tap).** A needle is inserted into your lower back (lumbar region) between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. The fluid, which surrounds and protects your brain and spinal cord, is sent to a laboratory for testing. - **Genetic testing.** Your doctor might recommend genetic testing to determine whether you or your child has the gene mutation that causes one of the hereditary ataxic conditions. Gene tests are available for many but not all of the hereditary ataxias. ### Treatment Options There's currently no treatment designed specifically to reverse ataxia. In some cases, addressing the root cause — such as stopping a medication that's triggering it — can resolve the problem. In others, like ataxia brought on by chickenpox or another viral illness, the condition may clear up on its own with time. Your doctor may recommend therapies to help manage specific symptoms like depression, stiffness, tremor, fatigue, or dizziness, and can also point you toward assistive devices or rehabilitation programs tailored to your needs. ### Assistive Devices When ataxia stems from a condition like multiple sclerosis or cerebral palsy, a direct cure may not be available — but that doesn't mean you're without options. Your doctor can help identify assistive devices suited to your situation, such as: - Hiking sticks or walkers for walking - Modified utensils for eating - Communication aids for speaking ### Therapeutic Approaches Several types of therapy may offer meaningful benefit, including: - Physical therapy to help your coordination and enhance your mobility - Occupational therapy to help you with daily living tasks, such as feeding yourself - Speech therapy to improve speech and aid swallowing Research has shown that transcranial magnetic stimulation may help improve gait and postural control in people with ataxia, but more research is needed. Some studies have indicated that aerobic exercise also may be beneficial for some people with idiopathic ataxic syndromes. ### Living With Ataxia: Finding Support Navigating life with ataxia — or raising a child who has it — can feel isolating at times, and it's not uncommon to experience depression or anxiety along the way. Speaking with a counselor or therapist can be genuinely helpful. You might also find comfort and connection through a support group focused on ataxia or on your specific underlying condition, such as cancer or multiple sclerosis. Support groups aren't the right fit for everyone, but for many people, they're a rich source of practical information. Members often stay up to date on the latest treatment advances and are willing to share what's worked — and what hasn't — from their own experience. Ask your doctor if there's a group in your area that might be a good match for you. **Source:** <https://www.mayoclinic.org/diseases-conditions/ataxia/diagnosis-treatment/drc-20355655> ---
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Care planAthletic NutritionThis protocol was developed from sports nutrition seminars led by three clinicians who have worked side-by-side with elite athletes across every level of competition — from high school fields to professional arenas — and have trained physicians and coaches throughout the U.S. on how smart nutrition can elevate athletic performance. - **Dr. Robert A. Rakowski, DC, CCN, DACBN, DIBAK** — A chiropractor, clinical nutritionist, kinesiologist, and AFMCP graduate. He directs the Natural Medicine Center in Houston and has over 20 years of experience lecturing globally on natural medicine. His patients range from elite athletes to critically ill individuals. - **Dr. Robert G. Silverman, DC, DACBN, MS, CCN, CNS, CSCS** — A chiropractor and certified clinical nutritionist specializing in sports injury and performance. Based in White Plains, NY, he works with elite endurance athletes and serves on medical teams for major triathlons, marathons, and Ironman events. - **Dr. Scott Bergman, DC, CTN, DAAIM** — A Certified Functional Medicine Practitioner and naturopath who leads Chiro Kinetics, a multidisciplinary clinic in California. He has consulted for professional athletes, contributed to the *First Line Therapy* manual, and served as Functional Medicine Director for an NFL Pre-Combine training facility. ---
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Care planAutism Spectrum Disorder (ASD)Autism spectrum disorder (ASD) is a developmental disability that can significantly affect the way a person connects with others, communicates, and navigates daily life. Most people with ASD look no different from anyone else — the differences lie in how they experience and engage with the world. People with ASD may think, learn, communicate, and behave in ways that are unique to them. Their intellectual abilities span a wide range, from profoundly gifted to significantly impaired. Some individuals with ASD require substantial support in their everyday lives; others live quite independently. An ASD diagnosis today encompasses several conditions that were once diagnosed as separate entities: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These are now unified under the single umbrella of autism spectrum disorder. --- ## Understanding Autism Spectrum Disorder ### Signs and Symptoms People with ASD often experience challenges with social connection, emotional expression, and communication. They may gravitate toward familiar routines and repetitive behaviors, and resist change in their daily lives. Many also process sensory information, attention, and learning differently from neurotypical individuals. Signs of ASD typically emerge in early childhood and, for most people, persist throughout life. **Children or adults with ASD might:** - Not point at objects to show interest (for example, not point at an airplane flying over) - Not look at objects when another person points at them - Have trouble relating to others or not have an interest in other people at all - Avoid eye contact and want to be alone - Have trouble understanding other people's feelings or talking about their own feelings - Prefer not to be held or cuddled, or might cuddle only when they want to - Appear to be unaware when people talk to them, but respond to other sounds - Be very interested in people, but not know how to talk, play, or relate to them - Repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language - Have trouble expressing their needs using typical words or motions - Not play "pretend" games (for example, not pretend to "feed" a doll) - Repeat actions over and over again - Have trouble adapting when a routine changes - Have unusual reactions to the way things smell, taste, look, feel, or sound - Lose skills they once had (for example, stop saying words they were using) ### How Is ASD Diagnosed? Diagnosing ASD is a nuanced process — there is no single blood test or imaging scan that can confirm it. Instead, doctors carefully observe a child's behavior and track their developmental milestones to arrive at a diagnosis. ASD can sometimes be identified as early as 18 months of age. By age 2, a diagnosis made by an experienced clinician is considered highly reliable. Despite this, many children are not diagnosed until considerably later — a delay that can mean missing out on the early support that makes the greatest difference. ### Treatment and Support There is currently no cure for ASD. However, research consistently shows that early intervention can meaningfully improve a child's development and long-term trajectory. Early intervention services — designed for children from birth through 3 years of age (up to 36 months) — focus on building foundational skills in communication, movement, and social interaction through therapies tailored to each child's needs. ### What Causes ASD? Risk Factors to Know The full picture of what causes ASD remains incomplete. What we do know is that ASD likely has multiple causes across its many subtypes, shaped by a mix of environmental, biological, and genetic influences. - Most scientists agree that genes are one of the risk factors that can make a person more likely to develop ASD. - Children who have a sibling with ASD are at a higher risk of also having ASD. - Individuals with certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis, can have a greater chance of having ASD. - When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASD. - University of Toledo researchers have found that pyrethroids, which have both commercial and industrial uses for controlling mosquitoes and other insects, may be linked to an increased risk of neurodevelopmental disorders (NDD), such as autism. - There is some evidence that the critical period for developing ASD occurs before, during, and immediately after birth. - Children born to older parents are at greater risk for having ASD. ### Who Is Affected by ASD? ASD occurs across all racial, ethnic, and socioeconomic groups, but is about 4 times more common among boys than among girls. For over a decade, CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network has been estimating the number of children with ASD in the United States. We have learned a lot about how many U.S. children have ASD. It will be important to use the same methods to track how the number of children with ASD is changing over time in order to learn more about the disorder. **Sources:** - <https://www.cdc.gov/ncbddd/autism/facts.html> - <https://news.utoledo.edu/index.php/04_25_2023/utoledo-research-links-common-insecticide-to-neurodevelopmental-disorders> ---
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Care planAutoimmune Hemolytic Anemia (AHA)**Autoimmune Hemolytic Anemia (AHA)** is a family of disorders in which your own immune system mistakenly targets and destroys your red blood cells (RBCs). These uncommon conditions arise when antibodies — the very proteins designed to shield you from viruses and infections — go rogue and latch onto your own RBCs by mistake. Under normal circumstances, RBCs live for about 120 days before being naturally retired. But when antibodies mistakenly tag RBCs as threats, the immune system steps in and destroys them long before that natural lifespan is up — a process called premature destruction. Your body will typically try to compensate by ramping up the production of new RBCs. Over time, however, the rate of destruction outpaces the rate of replacement. As the overall number of RBCs falls, the result is a shortage called anemia. AHA can strike suddenly, or it can creep up gradually over time. ### What Causes Autoimmune Hemolytic Anemia? The various forms of AHA are grouped by what triggers them. In roughly half of all cases, no clear cause is ever found — these are called idiopathic cases. In other instances, AHA develops alongside an existing illness. Conditions known to trigger AHA include: - **[Leukemia](/plans/206bd072-284b-59ba-aca4-c4dc343c25e5)** - **Systemic Lupus Erythematosus (SLE, or Lupus)** - **[Infectious Mononucleosis (Mono)](/plans/8fa72beb-6d7e-5e0a-8f47-c83f773ea96d)** > 📝 **NOTE:** AHA can also be triggered by certain medications. Antibiotics such as penicillin and sulfonamides have been known to cause this condition. ### Who Is at Risk for Autoimmune Hemolytic Anemia? According to the National Organization for Rare Disorders, women are more likely than men to develop AHA. Additional factors that can raise your risk include: - a family history of hemolytic anemia - having leukemia or other cancers - a recent viral infection - having certain autoimmune diseases - taking medications known to cause AHA AHA tends to be more common in middle-aged and older individuals. ### What Are the Symptoms of Autoimmune Hemolytic Anemia? Not everyone with AHA will feel sick. When symptoms do appear, they can vary widely from person to person and may include: - excessive fatigue and weakness - pale skin - a fast heart rate - shortness of breath - jaundice (yellow skin) - dark-colored urine - discomfort or fullness in your abdomen - muscle pain - headaches - diarrhea, nausea, or vomiting ### How Is Autoimmune Hemolytic Anemia Diagnosed? Diagnosing AHA begins with a thorough conversation and physical examination by your doctor. From there, a series of tests will likely follow. Your doctor will also check whether your spleen has become enlarged — an important clue in the diagnostic process. ### Blood and Urine Tests Blood tests can reveal telltale signs that your RBCs are being destroyed. Your doctor can count the number of young, immature RBCs circulating in your blood — elevated counts suggest your body has been working overtime to compensate for the loss. Urine hemoglobin tests can confirm that RBCs are actively breaking down. The direct Coombs test is a specialized blood test designed specifically to detect AHA; it looks for abnormally high levels of antibodies clinging to your RBCs. A cold agglutinins test screens for elevated levels of antibodies linked to infections that are known triggers of AHA, such as *Mycoplasma pneumoniae* — a type of bacteria that infects the lungs and causes a form of pneumonia that most often affects people under the age of 40. ### The Spleen's Role in AHA The spleen is a vital organ in your lymphatic system, acting as a filter that clears aging and damaged red blood cells from your bloodstream. Tucked behind your stomach on the left side of your abdomen, the spleen becomes enlarged when it is overwhelmed by an excess of worn-out or damaged RBCs. Your doctor will check for spleen enlargement both by physically feeling your abdomen and, if needed, by using an ultrasound to measure the spleen's size more precisely. ### How Is Autoimmune Hemolytic Anemia Treated? If your symptoms are mild or your condition appears to be improving on its own, treatment may not be immediately necessary. If your anemia is severe, a blood transfusion may be needed — though this provides only temporary relief, and further treatment will still be required. When an underlying illness is driving your AHA, treatment focuses on managing that root condition. If a medication is to blame, stopping it is usually the necessary first step. Steroids are typically the first line of treatment when anemia is causing symptoms or is worsening. If steroids prove ineffective, your doctor may recommend surgical removal of the spleen — one of the primary sites in your body where RBC destruction takes place. If spleen removal is not successful or is not a suitable option, immunosuppressant medications may be considered. These drugs dial down your immune system's activity, preventing antibodies from continuing to attack your RBCs. The tradeoff, however, is an increased vulnerability to infections — some people do get sick more frequently as a result of this treatment. Your doctor will carefully weigh the potential risks against the expected benefits before recommending this path. ### What Can You Expect in the Long Run? For some people, AHA resolves completely on its own and may require little or no treatment. For others, it becomes a chronic condition that can flare and subside over many years. Whatever your situation, your doctor will work with you to develop a personalized treatment plan designed to give you the best possible outcome. **Source:** <https://www.healthline.com/health/autoimmune-hemolytic-anemia#outlook> **References:** - Anemia, hemolytic, acquired autoimmune. (2004) - Brender E, Burke A, Glass RM. The spleen. *Journal of the American Medical Association*. 2005;294(20):2660. <http://jama.jamanetwork.com/article.aspx?volume=294&issue=20&page=2660> - What is hemolytic anemia? (2014, March 21). <http://nhlbi.nih.gov/health/health-topics/topics/ha/> ---
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Care planAvascular NecrosisAvascular necrosis is a condition in which bone tissue dies because it isn't receiving enough blood. Also known as osteonecrosis, it can cause tiny stress fractures to develop inside the bone — and if left untreated, the bone can eventually collapse. Bone injuries such as fractures or dislocated joints can disrupt the blood supply to nearby bone. Avascular necrosis is also linked to long-term use of high-dose steroid medications and heavy alcohol consumption. Anyone can develop this condition, but it most commonly affects people between the ages of 30 and 50. ## Understanding Avascular Necrosis ### What Does It Feel Like? In the early stages, many people with avascular necrosis have no symptoms at all. As the condition progresses, you may begin to notice pain in the affected joint — at first only when bearing weight on it, but eventually even while resting or lying down. The pain can range from mild to severe and typically comes on gradually. When the hip is affected, pain is often felt in the groin, thigh, or buttock. Other commonly affected areas include the shoulder, knee, hand, and foot. In some cases, avascular necrosis develops on both sides of the body at once — for example, in both hips or both knees simultaneously. ### What Causes It? Avascular necrosis develops when the blood supply to a bone is cut off or significantly reduced. Common causes include: - **Joint or bone trauma.** An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels. - **Fatty deposits in blood vessels.** The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones. - **Certain diseases.** Medical conditions, such as sickle cell anemia and Gaucher's disease, also can cause diminished blood flow to bone. In roughly 25 percent of people with avascular necrosis, no clear cause for the interrupted blood flow is ever found. ### Who Is Most at Risk? Several factors can increase your likelihood of developing avascular necrosis: - **Trauma.** Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones. - **Steroid use.** Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow. - **Excessive alcohol use.** Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels. - **Bisphosphonate use.** Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer. - **Certain medical treatments.** Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis. Medical conditions also linked to avascular necrosis include: - Pancreatitis - Diabetes - Gaucher's disease - HIV/AIDS - Systemic lupus erythematosus - Sickle cell anemia ### What Happens If It Goes Untreated? Without treatment, avascular necrosis steadily worsens over time. The bone can eventually collapse, and as its smooth surface deteriorates, severe arthritis can develop in the surrounding joint. ### Can It Be Prevented? The following steps can help lower your risk of avascular necrosis while also supporting your overall health: - **Limit alcohol.** Heavy drinking is one of the top risk factors for developing avascular necrosis. - **Keep cholesterol levels low.** Tiny bits of fat are the most common substance blocking blood supply to bones. - **Monitor steroid use.** Make sure your doctor knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids. - **Don't smoke.** Smoking increases the risk. ### How Is It Diagnosed? During a physical exam, your doctor will likely press around your joints to check for tenderness and may move them through various positions to assess whether your range of motion has been reduced. **Imaging studies** are often used because many conditions can cause joint pain. Options include: - **X-rays.** They can reveal bone changes that occur in the later stages of avascular necrosis. In the condition's early stages, X-rays usually appear normal. - **MRI and CT scan.** These tests produce detailed images that can show early changes in bone that might indicate avascular necrosis. - **Bone scan.** A small amount of radioactive material is injected into your vein. This tracer travels to the parts of your bones that are injured or healing and shows up as bright spots on the imaging plate. ### How Is It Treated? The primary goal of treatment is to stop further bone loss. **Medications and therapy:** When caught early, symptoms may be managed with a combination of medications and therapeutic interventions. Your doctor might recommend: - **Nonsteroidal anti-inflammatory drugs.** Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve the pain associated with avascular necrosis. - **Osteoporosis drugs.** Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed. - **Cholesterol-lowering drugs.** Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis. - **Blood thinners.** If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), might be recommended to prevent clots in the vessels feeding your bones. - **Rest.** Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months. - **Exercises.** A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint. - **Electrical stimulation.** Electrical currents might encourage your body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area, or it can be administered through electrodes attached to your skin. **Surgical and other procedures:** Because symptoms often don't appear until the condition is fairly advanced, surgery may be necessary. Surgical options include: - **Core decompression.** The surgeon removes part of the inner layer of your bone. Besides reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels. - **Bone transplant (graft).** This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of your body. - **Bone reshaping (osteotomy).** A wedge of bone is removed above or below a weight-bearing joint to help shift your weight off the damaged bone. Bone reshaping might enable you to postpone joint replacement. - **Joint replacement.** If your diseased bone has collapsed or other treatments aren't helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts. - **Regenerative medicine treatment.** Bone marrow aspirate and concentration is a newer procedure that might be appropriate for early-stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery, a core of dead hipbone is removed and stem cells inserted in its place, potentially allowing for growth of new bone. More study is needed. **Source:** <https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859> **References:** 1. Jones LC, et al. Osteonecrosis (avascular necrosis of bone). <https://www.uptodate.com/contents/search>. Accessed Feb. 23, 2018. 2. AskMayoExpert. Avascular necrosis of the hip. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. 3. Patient fact sheet: Osteonecrosis. American College of Rheumatology. <https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis>. Accessed Feb. 23, 2018. 4. Osteonecrosis (ON). Merck Manual Professional Version. <http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on>. Accessed Feb. 23, 2018. ---
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Care planAxillary Temperature Test## Understanding Your Results **Normal Range: 97.6° F to 98.2° F** - Averages **below** this range may suggest an underactive thyroid (hypothyroidism). - Averages **above** this range may suggest an overactive thyroid (hyperthyroidism). ---
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Care planBariatric Surgery**Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery** — work by reshaping your digestive system to help you lose weight. Bariatric surgery is considered when diet and exercise alone haven't been enough, or when your weight is putting your health at serious risk. Some procedures limit how much food you can eat at one time. Others reduce how well your body absorbs nutrients. And some do both. Bariatric surgery can offer life-changing benefits — but make no mistake, these are major operations that carry real risks and side effects. Lasting success also requires a lifelong commitment to healthy eating and regular physical activity. Bariatric surgery will touch nearly every part of your life — your body, your relationship with food, your health, and your daily routines. The good news is that with the right preparation and a strong support system, these changes can truly be for the better. --- ## Understanding Bariatric Surgery ### Your Surgical Options: Types of Bariatric Surgery Each type of bariatric surgery comes with its own set of advantages and trade-offs. It's worth having an open conversation with your doctor about which approach makes the most sense for you. Here's an overview of the most common procedures: - **Roux-en-Y (roo-en-wy) gastric bypass.** This is the most widely performed gastric bypass procedure, and it is generally permanent. It works on two fronts: shrinking the amount of food your stomach can hold at one time and reducing how many nutrients your body absorbs. During the procedure, your surgeon divides the stomach near its top, creating a small pouch — roughly the size of a walnut — that holds only about an ounce of food, compared to the roughly 3 pints a typical stomach can accommodate. The surgeon then cuts the small intestine and attaches a portion of it directly to this new stomach pouch. Food travels into this tiny pouch and flows straight into the connected segment of small intestine, bypassing the majority of the stomach and the first stretch of the small intestine, entering instead at the intestine's midpoint. - **Sleeve gastrectomy.** In this procedure, approximately 80% of the stomach is surgically removed, leaving behind a narrow, tube-shaped pouch. This smaller stomach holds less food — and it also produces lower levels of ghrelin, the hormone that signals hunger, which can help curb your appetite. Key advantages of this approach include meaningful weight loss, no rerouting of the intestines, and a shorter hospital stay compared to most other bariatric procedures. - **Biliopancreatic diversion with duodenal switch.** This is a two-stage procedure. The first stage resembles a sleeve gastrectomy. In the second stage, the far end of the small intestine is connected directly to the duodenum — the first part of the small intestine just beyond the stomach — bypassing the bulk of the intestinal tract. This surgery is highly effective because it both limits food intake and significantly reduces nutrient absorption. However, that same power comes with greater risk, including a higher likelihood of malnutrition and vitamin deficiencies. The right procedure for you is a personal decision that your surgeon will help guide. They will weigh a range of factors — including your body mass index, eating patterns, existing health conditions, prior surgeries, and the specific risks each option carries. --- ## Understanding the Risks Like any major surgery, bariatric procedures carry potential health risks — both in the immediate aftermath and over the longer term. **Short-term surgical risks can include:** - Excessive bleeding - Infection - Adverse reactions to anesthesia - Blood clots - Lung or breathing problems - Leaks in your gastrointestinal system - Rarely, death **Longer-term risks and complications vary by procedure type and can include:** - Bowel obstruction - Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea or vomiting - Gallstones - Hernias - Low blood sugar, called hypoglycemia - Malnutrition - Ulcers - Vomiting - Acid reflux - The need for a second, or revision, surgery or procedure - Rarely, death ---
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Care planBarrett's Esophagus**Barrett's Esophagus** is a potentially serious complication of GERD — gastroesophageal reflux disease. In Barrett's esophagus, the normal tissue lining the esophagus (the tube that carries food from your mouth to your stomach) gradually transforms into tissue that resembles the lining of the intestine. About 10% of people who suffer from chronic GERD symptoms will develop Barrett's esophagus. Barrett's esophagus has no symptoms of its own, though people who have it may still experience the familiar discomforts of GERD. What makes it worth taking seriously is that it raises the risk of developing esophageal adenocarcinoma — a dangerous, potentially life-threatening cancer of the esophagus. That said, even with Barrett's esophagus, this cancer remains rare — fewer than 1 in 100 people with the condition will ever develop it. Still, a diagnosis of Barrett's esophagus is your cue to stay proactive. With regular monitoring, your doctor can catch precancerous or cancerous changes early, when they're most treatable and before they have a chance to spread. ## Understanding Barrett's Esophagus ### What Is GERD, and How Does It Lead to Barrett's Esophagus? GERD can cause a range of uncomfortable symptoms: heartburn, a sour or burning sensation at the back of the throat, a persistent cough, laryngitis, and nausea. Under normal circumstances, when you swallow food or liquid, it travels down the esophagus — a hollow, muscular tube connecting your throat to your stomach. At the bottom of the esophagus, where it meets the stomach, a ring of muscle called the **lower esophageal sphincter (LES)** acts like a one-way valve, keeping stomach contents from flowing back up. Your stomach produces acid to break down food and is naturally equipped to handle it — but the esophagus is not. With GERD, stomach contents flow backward into the esophagus, a process called reflux. Most people with acid reflux will never develop Barrett's esophagus. However, in people with frequent, ongoing reflux, the normal cells lining the esophagus can gradually be replaced by cells that more closely resemble those found in the intestine — and that transformation is what defines Barrett's esophagus. ### Does GERD Always Lead to Barrett's Esophagus? No. Having GERD does not mean you will develop Barrett's esophagus — and interestingly, not everyone with Barrett's esophagus even has GERD. That said, long-term GERD is the single greatest risk factor for developing the condition. While anyone can develop Barrett's esophagus, white males with a long history of GERD are at the highest risk. Other contributing factors include developing GERD at a younger age and a history of smoking — current or past. ### How Is Barrett's Esophagus Diagnosed? Because Barrett's esophagus typically causes no specific symptoms on its own, the only way to diagnose it is through an upper endoscopy combined with a biopsy. The American Gastroenterological Association recommends screening for people with multiple risk factors, which include being over age 50, being male, being white, having a hiatal hernia, long-standing GERD, and carrying excess weight — particularly around the midsection. During an endoscopy, a specialist called a gastroenterologist gently guides a long, flexible tube with a tiny camera on its tip down your throat and into your esophagus — after giving you a sedative to help you relax. The procedure may feel slightly uncomfortable, but it is not painful, and most people tolerate it without difficulty. Once the tube is in place, the doctor can directly visualize the lining of your esophagus. Barrett's esophagus has a distinctive appearance on camera, but a formal diagnosis requires a biopsy — the removal of a small tissue sample to be examined under a microscope in the laboratory. That same tissue sample will also be checked for any precancerous or cancerous cells. If Barrett's esophagus is confirmed, your doctor will likely recommend a follow-up endoscopy and biopsy to examine additional tissue for the earliest signs of cancer development. If Barrett's esophagus is found but no cancer or precancerous changes are detected, your doctor will still most likely recommend periodic endoscopies going forward. This ongoing surveillance is important because cancer can develop in Barrett tissue years after the initial diagnosis. If precancerous cells are found, your doctor will walk you through your treatment and monitoring options. ### Can Barrett's Esophagus Be Treated? A primary goal of treatment is to prevent or slow the progression of Barrett's esophagus by managing the underlying acid reflux. This is achieved through a combination of lifestyle changes and medication. Helpful lifestyle modifications include: - Adjust your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint are known to aggravate reflux. - Cut back on or eliminate alcohol, caffeinated beverages, and tobacco. - Lose weight if needed. Carrying extra weight increases your risk for reflux. - Elevate the head of your bed while sleeping. Raising your head can help keep stomach acid from flowing back up into the esophagus during the night. - Avoid lying down for at least 3 hours after eating. - Take all medications with a full glass of water. Your doctor may also recommend medications to help keep acid reflux under control. These may include: - **Proton pump inhibitors** — which reduce the amount of acid your stomach produces - **Antacids** — which neutralize stomach acid - **H2 blockers** — which dial down the release of stomach acid - **Promotility agents** — drugs that help move food more quickly from your stomach into your intestines ### Are There Treatments That Directly Target Barrett's Esophagus? Yes — several options, including surgery, are designed specifically to address the abnormal tissue itself. These include: - **Radiofrequency ablation (RFA)** uses radio waves delivered through an endoscope to destroy abnormal cells while leaving the healthy tissue beneath them intact. - **Photodynamic therapy (PDT)** uses laser light delivered through an endoscope to destroy abnormal cells without harming surrounding healthy tissue. Before the procedure, the patient takes a medication called **Photofrin**, which makes cells sensitive to light. - **Endoscopic spray cryotherapy** is a newer technique that uses cold nitrogen or carbon dioxide gas, delivered through the endoscope, to freeze and destroy abnormal cells. - **Endoscopic mucosal resection (EMR)** lifts the abnormal lining away from the wall of the esophagus and removes it through the endoscope. The goal is to eliminate any precancerous or cancerous cells contained within the lining. If cancer is present, an ultrasound is performed first to confirm it hasn't spread deeper into the esophageal wall. - **Surgery** to remove most of the esophagus may be considered when severe precancer (dysplasia) or cancer has been diagnosed. The sooner surgery is performed after diagnosis, the better the chances for a cure. **A few important points to keep in mind:** - GERD is extremely common among American adults. - Only a small fraction of people with GERD — fewer than 1 in 10 — will go on to develop Barrett's esophagus. - Fewer than 1% of people with Barrett's esophagus develop esophageal cancer each year. A diagnosis of Barrett's esophagus is not cause for panic. While the condition can lead to precancerous changes in a small number of people and does carry an elevated cancer risk, it is largely manageable. Think of the diagnosis as a call to action — a reason to partner with your doctor, stay vigilant, and take good care of your health. **Source:** <https://www.webmd.com/heartburn-gerd/guide/barretts-esophagus-symptoms-causes-and-treatments> **References:** - National Digestive Diseases Information Clearinghouse: "Barrett's Esophagus." - MedlinePlus Medical Encyclopedia: "Barrett's esophagus." - American Society for Gastrointestinal Endoscopy: "GERD, Barrett's Esophagus, and the Risk for Esophageal Cancer." - Smith K., et al. *Clinical Gastroenterology and Hepatology*. August 2009; vol 7: pp 840–848. - National Heartburn Alliance: "What You Should Know About Heartburn and Esophageal Cancer." - Ferri: *Practical Guide to the Care of the Medical Patient*, 8th ed. - Feldman: *Sleisenger and Fordtran's Gastrointestinal and Liver Disease*, 9th ed. ---
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Care planBell’s PalsyBell's palsy is a condition that causes sudden, temporary weakness or paralysis of the muscles on one side of your face. It happens when the nerve responsible for controlling your facial muscles becomes inflamed, swollen, or compressed — think of it like a pinched garden hose that can no longer carry water the way it should. When this happens, one side of your face may droop or feel stiff, and everyday actions like smiling or closing your eye can become surprisingly difficult. The good news is that Bell's palsy is almost always temporary, with most people making a full recovery within a matter of weeks. Bell's palsy can strike at any age, but it tends to be most common between ages 16 and 60. The condition takes its name from the 19th-century Scottish anatomist Charles Bell, who was the first physician to formally describe it. --- ## Understanding Bell's Palsy ### What Does Bell's Palsy Feel Like? Recognizing the Symptoms Symptoms of Bell's palsy often appear quite suddenly — sometimes overnight. You might wake up one morning and notice that something feels "off" with your face, or the change may become apparent when you try to eat or drink. Symptoms commonly develop one to two weeks after a cold, ear infection, or eye infection. The hallmark sign is a drooping or sagging appearance on one side of the face, along with difficulty opening or closing the eye on that side. In very rare instances, both sides of the face may be affected. Other symptoms you might notice include: - Drooling - Difficulty eating and drinking - An inability to make facial expressions, such as smiling or frowning - Facial weakness - Muscle twitches in the face - Dry eye and mouth - Headache - Sensitivity to sound - Irritation of the eye on the involved side If you notice any of these symptoms, contact your doctor right away — do not try to diagnose yourself. Because Bell's palsy shares symptoms with more serious conditions like stroke or brain tumors, it is critical to get a professional evaluation as soon as possible. ### What Causes Bell's Palsy? Bell's palsy occurs when the seventh cranial nerve — the nerve running from your brain to your face — becomes swollen or compressed, disrupting its ability to send signals to your facial muscles. While the precise trigger is not fully understood, most medical researchers believe a viral infection is the most likely culprit. The following viruses and bacteria have been linked to the development of Bell's palsy: - Herpes simplex, which causes cold sores and genital herpes - HIV, which damages the immune system - Sarcoidosis, which causes organ inflammation - Herpes zoster virus, which causes chickenpox and shingles - Epstein-Barr virus, which causes mononucleosis - Lyme disease, which is a bacterial infection caused by infected ticks ### Who Is Most at Risk? While anyone can develop Bell's palsy, your risk is higher if you: - Are pregnant - Have diabetes - Have a lung infection - Have a family history of the condition ### How Is Bell's Palsy Diagnosed? Your doctor will begin with a hands-on physical examination to assess the degree of weakness in your facial muscles, and will ask you detailed questions about your symptoms — when they started, how quickly they came on, and what you were experiencing in the days or weeks before they appeared. From there, your doctor may order blood tests to check for signs of bacterial or viral infection, or imaging studies — such as an MRI or CT scan — to get a closer look at the nerves in your face and rule out other causes. ### How Is Bell's Palsy Treated? Here is the reassuring part: in most cases, Bell's palsy improves on its own, even without treatment. That said, regaining full strength in your facial muscles can take several weeks or even months. The following approaches may help speed your recovery and ease your symptoms along the way. **Medication:** - Corticosteroid drugs, which reduce inflammation - Antiviral or antibacterial medication, which may be prescribed if a virus or bacteria caused your Bell's palsy - Over-the-counter pain medications, such as ibuprofen or acetaminophen, which can help relieve mild pain - Eye drops **Home Treatment:** - An eye patch (for your dry eye) - A warm, moist towel over your face to relieve pain - Facial massage - Physical therapy exercises to stimulate your facial muscles ### Could There Be Complications? The vast majority of people with Bell's palsy recover fully and without complications. In more severe cases, however, the following complications are possible: - You may have damage to the seventh cranial nerve. This nerve controls your facial muscles. - You may have excessive dryness in the eye, which can lead to eye infections, ulcers, or even blindness. - You may have synkinesis, which is a condition in which moving one body part causes another to move involuntarily. For example, your eye may close when you smile. ### What Can You Expect Long-Term? The long-term outlook for Bell's palsy is genuinely encouraging. Recovery timelines vary depending on how much nerve damage occurred, but most people begin to notice improvement within two weeks of their first symptoms. A full recovery typically happens within three to six months. Those with more severe cases may take longer, and in rare instances, symptoms may recur or become permanent — but these outcomes are the exception, not the rule. **Sources:** - <https://www.healthline.com/health/bells-palsy#outlook> - Bell's palsy. (2015). <http://kidshealth.org/teen/diseases_conditions/brain_nervous/bells_palsy.html> - Bell's palsy information page. (2015). <https://www.ninds.nih.gov/Disorders/All-Disorders/Bells-Palsy-Information-Page> - Mayo Clinic Staff. (2014). Bell's palsy. <http://www.mayoclinic.com/health/bells-palsy/DS00168> ---
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Care planBipolar DisorderBipolar disorder (BPD) — historically called manic-depressive disorder — is one of the three great classic psychiatric illnesses. Major depressive disorder (MDD) and schizophrenia complete this somber trio, a group of conditions that has likely shadowed humanity since the very beginning of recorded history. Bipolar disorder as we understand it today is really a modern concept, taking shape only over the last century. Like MDD, it features recurring episodes of profound depression — but what sets bipolar disorder apart is that these depressive episodes alternate with periods of manic psychosis, creating a cycle unlike anything seen in classic depression alone. The causes of bipolar disorder aren't always straightforward. It tends to run in families, and differences in brain structure and function appear to play a role as well. Bipolar disorder most often emerges in the late teenage years or early adulthood — though children and older adults can be affected too. Once it takes hold, it is typically a lifelong condition. ## Understanding Bipolar Disorder ### A New Form of Bipolar Disorder Emerges Over the past 50 years, clinicians began encountering a growing number of people with extreme mood swings punctuated by hypomania rather than full-blown mania. Hypomania shares many features with manic psychosis — rapid speech, impulsive decisions, excessive spending, reduced need for sleep — but crucially, it never crosses into outright psychosis. People in a hypomanic state can still hold things together, more or less, even as the wheels wobble. The diagnostic authorities at the DSM — the official handbook that defines all mental health conditions — ultimately decided to call this newer pattern bipolar II, while the original, psychosis-associated form became bipolar I. Over the past 40–50 years, the overall incidence of bipolar disorder has risen dramatically, reaching a lifetime risk of around 4% in the United States — yet only 1% of the population meets the criteria for bipolar I. That means nearly all of this increase is being driven by bipolar II, and this is especially true among children and teenagers. Bipolar I is almost never diagnosed in children, but bipolar II is now experiencing what can only be described as a mini-epidemic among young people. This is particularly concerning because the standard treatments for bipolar disorder involve powerful — and sometimes toxic — antipsychotic medications. ### Important Context to Keep in Mind **Antidepressant use in patients hospitalized with bipolar depression (BD) is ineffective at best, and at worst may be harmful to some patients**, according to research by investigators at Brown University in Providence, Rhode Island, presented at the American Psychiatric Association's 2013 Annual Meeting. Abstract NR5-06; presented May 19, 2013. **A Healthy Gut May Matter More Than You Think.** What is now being called "Gut and Psychology Syndrome" (GAP Syndrome or GAPS) may be a meaningful contributor to the growing number of children — and adults — we are seeing with both mental and physical challenges, including autism, hyperactivity, attention deficit, dyslexia, dyspraxia, depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder, eating disorders, and more. Supporting a healthy gut microbial community may be yet another important avenue worth exploring. ### Bipolar Disorder and the Gut Microbiome The microbiome — the vast community of microorganisms living in and on the human body — is one of the most exciting frontiers in biomedical research, and it is increasingly relevant to mental health. The bacteria residing in the gut communicate with the brain in both directions through what scientists call the gut–brain axis, and they produce compounds that can influence how the body functions — including short-chain fatty acids like butyrate. Understanding how the gut microbiome differs in people with bipolar disorder (BD) could open doors to new diagnostic markers and treatment strategies. **METHODOLOGY:** A PubMed search was performed on January 7, 2020 using terms "bipolar AND (microbiome OR microbiota)", for articles in English in which the study population included a distinct BD group and the gut microbiota/microbiome was assessed. **KEY FINDINGS:** Thirteen articles met the inclusion criteria. In four of five studies that reported on group comparisons with respect to diversity, lower α-diversity was observed in bipolar disorder relative to healthy controls (HC). The most convergent taxonomic finding was that in four studies, one particular clade distinguished gut microbiota between BD and HC: family Ruminococcaceae, genus *Faecalibacterium*, and species *Faecalibacterium prausnitzii*. Members of this clade, known for butyrate production, were reduced in BD relative to HC in three studies but elevated in a fourth. Additionally, genera *Bacteroides* or *Bacteroides–Prevotella* group species were elevated in bipolar disorder in two studies but lower in a third. **WHAT IT MEANS:** Despite few studies and modest sample sizes, salient findings suggest that low α-diversity and dysbiosis with respect to abundance of *Faecalibacterium* and *Bacteroides* may characterize BD in both a trait and state-dependent fashion. Decreased richness and butyrate production also foster inflammation, which may be a hitherto unrecognized part of the pathophysiology underlying bipolar disorder. **Reference:** *Bipolar Disorders.* First published: 29 January 2021. Bipolar disorder and the gut microbiome: A systematic review. doi: 10.1111/bdi.13049. <https://onlinelibrary.wiley.com/doi/abs/10.1111/bdi.13049> ### The Bipolar–Metabolic Connection One of the more troubling — and still poorly understood — aspects of bipolar disorder is its strong association with metabolic conditions like obesity, metabolic syndrome, and type 2 diabetes. Estimates suggest that up to **80%** of people diagnosed with bipolar disorder carry some degree of excess weight. Obesity is what we might call a "gateway" illness — one that dramatically raises the risk of life-threatening conditions like heart disease, high blood pressure, and stroke. To make matters more complicated, most medications used to treat bipolar disorder are themselves known to cause or worsen weight gain. **According to Bill Wilson, MD (The CARB Syndrome Project), in Bipolar II:** 1. **Eliminate high glycemic carbohydrates**, excessive fructose mainly from added sugars and omega-6 fatty acids from your diet and eat a reasonable amount of real food loaded with healthy saturated fats and omega-3 fatty acids. 2. **When necessary, use low dose medications** to control key symptoms and improve compliance. 3. **Take supplements to enhance brain neurotransmitter levels and to maintain healthy brain function.** L-tyrosine, 5-HTP, vitamin D, omega-3 fatty acids to get your AA/EPA ratio to between 1 and 3. Also consider checking a homocysteine level — if it is above 7, a combination of B vitamins can be used to lower it into the ideal range. 4. **Exercise your body and mind.** 5. **Get plenty of restful sleep.** 6. **Maintain as many healthy relationships as possible.** ### A Clinical Pearl: Managing Lithium Toxicity with Essential Fatty Acids *From Jonathan Wright, MD:* "Over a decade ago, a woman visited Tahoma Clinic on the advice of her psychiatrist. She was 'severely bipolar,' requiring a maximum dose of lithium carbonate to keep her symptoms under control. Despite close monitoring of serum lithium levels to maintain a safe range, she was starting to show many signs of lithium toxicity, including hypertension, tremor, nausea, and proteinuria. She and her psychiatrist had tried other medications, but none provided the control of her bipolar symptoms that lithium did. She asked, 'Is there an alternative to either the psych ward or the medical wing?' Fortunately, there was, and is. Without changing her lithium dose, she was asked to start on **flaxseed oil, one tablespoon (15 cc's) three times daily along with 800 IUs of vitamin E (mixed tocopherols).** One month later, her blood pressure had normalized, her tremor and nausea were gone, and there was no further protein in the urine. Her bipolar symptoms remained under control. She was advised to cut the flaxseed oil to one tablespoon daily along with 400 IUs of vitamin E. Several years later, her lithium toxicity hasn't returned. We're grateful to Dr. David Horrobin for this clinical tip. During a lecture years ago on fatty-acid metabolism, he pointed out in passing that lithium could inhibit a vital step, but that this could be overcome by providing more 'precursor' fatty acid to overwhelm that inhibition. This simple procedure works well in vivo as well as in vitro. To be on the safe side, a daily amount of flaxseed oil (or other essential fatty acid), along with vitamin E, should be recommended for anyone taking lithium. With low-dose lithium, a teaspoonful or two daily is usually sufficient." ---
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Care planBlood ClotsBlood clots affect millions of people worldwide — but here's the encouraging truth: they are largely preventable, and there are natural, evidence-informed strategies that can support long-term vascular health. ## Understanding Blood Clots Blood is your body's lifeline — it delivers oxygen and nutrients to every tissue and carries waste products away for disposal. It travels through two types of vessels: arteries, which carry blood outward from the heart, and veins, which return it back. When you injure yourself or experience trauma, your bloodstream dispatches specialized proteins called clotting factors to the damaged site to stop the bleeding and seal the wound. Like most things in biology, there's a critical balance at play. Too few clotting factors and bleeding continues unchecked — a problem sometimes caused by medications like aspirin or warfarin, or by underlying conditions like genetic disorders, cancer, or nutritional deficiencies. On the other end of the spectrum, when the clotting process goes into overdrive, the consequences can be life-threatening — including **deep venous thrombosis (DVT)**, where clots form in the leg veins, and **pulmonary embolism (PE)**, where clots travel to the lungs. ### What Puts You at Risk? In short, most unhealthy lifestyle habits raise the likelihood of developing a dangerous blood clot such as a DVT or PE. Common risk factors include: - Obesity - Smoking - Physical inactivity - Prolonged immobility (following surgery, or during long car or plane trips) - Sleep apnea - Cancer - Low vitamin D (often from inadequate sun exposure) - Genetic variants such as Factor V Leiden, Prothrombin Gene mutation, MTHFR and elevated homocysteine, Lp(a), and others One important note: varicose veins and spider veins visible on the skin are not medically dangerous — they are primarily a cosmetic concern, though they can sometimes signal suboptimal liver or kidney function. They don't require further investigation and often improve with targeted nutritional support. ### Recognizing the Symptoms The most telltale sign of a DVT is pain or swelling in one or both legs. A PE more often presents with sudden shortness of breath, though chest pain can also occur. An ultrasound of the legs is the go-to diagnostic tool for DVT. If there's concern that a clot has traveled to the lungs, a CT scan can confirm the diagnosis. ### Conventional Medical Treatment There are two main categories of pharmaceutical blood thinners: vitamin K antagonists (such as warfarin/Coumadin) and the newer non-vitamin K anticoagulants, including Pradaxa, Xarelto, and Eliquis. In more serious cases — when a leg clot is large and the risk of a severe pulmonary embolism is high — a physician may recommend an IVC (inferior vena cava) filter to physically intercept clots before they reach the lungs. ---
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Care planBlood Interpretation--- ## Understanding Your Cholesterol Cholesterol values should only be analyzed after a 12-hour fast. It's also important to know that your body position before the blood draw matters. If you've been lying down for more than 20 minutes, cholesterol values may read up to 15% lower than your true level. Cholesterol is a blood fat that serves as the essential building block for making hormones, enzymes, and antibodies — working alongside iodine and protein to keep these systems running. Much of what applies to cholesterol also applies to triglycerides. In general, cholesterol tends to rise when endocrine glands or organs are underperforming, and fall when they are overactive. ### According to Dr. Mark Houston, the most common underlying reasons for dyslipidemia are: - Chronic inflammation - Immune dysfunction - Oxidative stress of the vascular system These are all protective responses — the body's way of defending and correcting itself. ### The most common triggers driving these vascular responses: 1. Chronic inflammatory macro- and micro-nutrient intake 2. Chronic infections (all types including bacteria, virus, fungi, TB, and parasites) 3. Toxins, POPs (persistent organic pollutants), and heavy metals 4. Metabolic, inflammatory, immune, and infectious endotoxemia The optimal cholesterol value is 160–180 mg/dL. ### When Cholesterol is Too Low Some of the sickest patients actually have low cholesterol. The first warning sign is a value below 140. When cholesterol is low, your clinician will consider: - Ruling out an overactive thyroid (hyperthyroidism) - Ruling out a sluggish, fatty liver (indicated by low SGPT) - Possible autoimmune disease — tests such as ANA, SED rate, C-reactive protein, and rheumatoid factor may be ordered - Free radical damage (which may point to cancer or other chronic degenerative diseases) — especially when low cholesterol occurs alongside a normal or low white blood cell count, low albumin, high globulin, high ferritin, high platelets, and high LDH or SGPT (which may not be elevated in early stages), and sometimes a low lymphocyte count - Uremia (fluid retention with an elevated BUN) - Hemolytic jaundice (elevated total bilirubin) - Acute infections (which burn through cholesterol and elevate white blood cell counts) - Vegetarian diets - Other causes: protein malnutrition, anemia, anorexia, intestinal obstruction, epilepsy - Medications that can lower cholesterol: thyroxine, heparin, and statins (especially when overused) ### Nutritional Support for Low Cholesterol **If a fatty liver is suspected:** - **[Lipo-Flow](https://nutridyn.com/lipo-flow)** — 1–2 tablets twice daily. - **[LiverCare®](https://nutridyn.com/livercarer)** — 1–2 capsules twice daily. > 📝 **NOTE:** 80% of all circulating cholesterol is manufactured by the liver. **If an overactive thyroid is suspected,** your clinician may check your vitamin D levels and treat accordingly: - **[D3 5000 with K2](https://nutridyn.com/d3-5000-with-k2)** — 1 or more softgels daily as indicated by serum analysis. - **[Organo Iodine Drops](https://nutridyn.com/organo-iodine-dropstm)** — 2–6 drops 3 times daily, if indicated by iodine skin test. If low cholesterol stems from another underlying condition (such as cancer or advanced degenerative disease), that condition will be addressed directly. ### When Cholesterol is Too High - An underactive thyroid may be involved (low thyroid function: low T3, T4, and/or T7; or TSH greater than 4.0; and/or a basal temperature below 97.6°F) - If elevated with a TSH below 2.5, and low T3 and T4, a sluggish pituitary gland may be the culprit - If elevated with a normal TSH, a diet high in carbohydrates and saturated fat may be to blame - If blood sugar is also elevated, excess insulin (hyper-insulinemia) is possible - Excess dietary protein may be a factor if cholesterol is elevated alongside an increased BUN/creatinine ratio with normal triglycerides - Liver or bile duct overactivity — especially if GGT, SGPT, or SGOT is greater than 30 - Conditions such as diabetes, nephrosis, atherosclerosis, multiple sclerosis, leukemia, eclampsia, pregnancy, and immune dysfunction may also raise cholesterol ### Nutritional Support for High Cholesterol - **[Cardio Essentials Cholestin Support](https://nutridyn.com/cardio-essentials-cholestin-support-r170)** — Take one packet twice daily with food (with the two largest meals of the day). **If a fatty liver is suspected:** - **[Lipo-Flow](https://nutridyn.com/lipo-flow)** — 1–2 tablets twice daily. - **[LiverCare®](https://nutridyn.com/livercarer)** — 1–2 capsules twice daily. > 📝 **NOTE:** 80% of all circulating cholesterol is manufactured by the liver. **If an overactive thyroid is suspected,** your clinician may check your vitamin D levels and treat accordingly. Iodine may also be considered if hyperthyroidism is suspected: - **[D3 5000 with K2](https://nutridyn.com/d3-5000-with-k2)** — 1 or more softgels daily as indicated by serum analysis. - **[Organo Iodine Drops](https://nutridyn.com/organo-iodine-dropstm)** — 2–6 drops 3 times daily, if indicated by iodine skin test. ---
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Care planBone FractureA fracture is a break in a bone. When the broken bone pierces through the skin, it is called an open or compound fracture. Fractures most often result from car accidents, falls, or sports injuries. They can also occur when bones have been weakened by low bone density or osteoporosis. Repetitive stress on a bone can lead to stress fractures — tiny cracks that develop from overuse. ### Signs and Symptoms of a Fracture - A limb or joint that looks out of place or deformed - Swelling, bruising, or bleeding - Severe pain - Numbness and tingling - Difficulty or inability to move a limb ---
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Care planBurning Mouth SyndromeBurning mouth syndrome is the medical term for ongoing (chronic) or recurring burning sensations in the mouth that have no clear, identifiable cause. This discomfort can affect your tongue, gums, lips, the inner lining of your cheeks, the roof of your mouth (palate), or virtually anywhere inside your mouth. The sensation can be intense — similar to the feeling of having scalded your mouth on something too hot. Burning mouth syndrome often strikes suddenly, though it can also creep up gradually over time. Pinpointing a specific cause is frequently difficult — and sometimes impossible. While that can make treatment more complicated, partnering closely with your healthcare team gives you the best chance of finding meaningful relief. ### What Does Burning Mouth Syndrome Feel Like? People with burning mouth syndrome commonly experience: - A burning or scalding sensation most often affecting the tongue, but potentially involving the lips, gums, palate, throat, or the entire mouth - A feeling of persistent dry mouth accompanied by increased thirst - Changes in how things taste, such as a lingering bitter or metallic flavor - A reduced or absent sense of taste - Tingling, stinging, or numbness inside the mouth The pattern of discomfort can vary quite a bit from person to person. For some, it may: - Start mild in the morning and intensify throughout the day - Begin the moment you wake up and persist all day long - Come and go unpredictably Regardless of its pattern, burning mouth syndrome can persist for months or even years. In rare instances, symptoms resolve on their own or gradually ease without any treatment. Eating or drinking may temporarily bring relief from the discomfort. Notably, burning mouth syndrome typically does not cause any visible changes to the appearance of your tongue or the inside of your mouth. ### When Should You See a Doctor? If you're experiencing persistent discomfort, burning, or soreness of your tongue, lips, gums, or anywhere else in your mouth, it's worth seeing your doctor or dentist. In many cases, both may need to collaborate to identify the underlying cause and put together a treatment plan that actually works for you. ### What Causes Burning Mouth Syndrome? The causes of burning mouth syndrome fall into two main categories: primary and secondary. **Primary Burning Mouth Syndrome** When thorough clinical evaluation and laboratory testing come up empty — no identifiable abnormalities — the condition is classified as primary, or idiopathic, burning mouth syndrome. Emerging research points toward disruptions in the taste and sensory nerve pathways of either the peripheral or central nervous system as a likely contributor. (See also: **[Peripheral Nerve Disorders — Neuritis | Peripheral Neuritis | Peripheral Neuropathy](/plans/cf0b3e0f-69dd-55ab-afec-5e1913f0b8b3)**) **Secondary Burning Mouth Syndrome** When an identifiable underlying medical condition is responsible for the burning sensation, the condition is referred to as secondary burning mouth syndrome. Conditions and factors that may contribute to secondary burning mouth syndrome include: - **Dry mouth (xerostomia)**, which can be triggered by various medications, health conditions, impaired salivary gland function, or the side effects of cancer treatment (see also: **[Dry Mouth (Xerostomia)](/plans/ca0405d6-20ca-5265-aadf-c3858eea5737)**) - **Other oral conditions**, such as oral thrush (a fungal infection of the mouth), oral lichen planus (an inflammatory condition affecting the mouth's lining), or geographic tongue (a condition that gives the tongue a map-like appearance) (see also: **[Mold / Fungus Exposure](/plans/790c9f67-1690-55b4-b68a-d05651563481)**) - **Nutritional deficiencies**, including inadequate levels of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6), and cobalamin (vitamin B-12) — **[B-Complex](https://nutridyn.com/b-complex)** (1–2 capsules three times daily with meals) - **Allergic reactions or sensitivities** to foods, food flavorings, additives, fragrances, dyes, or dental materials (see also: **Allergy — Modifying the Allergy / Sensitivity / Intolerance Symptom Response**) - **Stomach acid that refluxes back into the mouth** (gastroesophageal reflux disease, or GERD) (see also: **[Acid Reflux — Gastroesophageal Reflux Disease / GERD / Heartburn / Reflux Esophagitis](/plans/3f7554f7-da86-548a-9ee4-da6ebfb50103)**) - **Certain medications**, particularly those used to treat high blood pressure - **Oral habits**, including tongue thrusting, biting the tip of the tongue, or teeth grinding (bruxism) - **Endocrine disorders** such as diabetes or an underactive thyroid (hypothyroidism) (see also: **[Blood Sugar Metabolism](/plans/938e59a3-3081-550f-b1ca-0289b0d6ac50)** and/or **Thyroid Conditions**) - **Excessive mouth irritation** from over-brushing the tongue, using harsh or abrasive toothpastes, overusing mouthwash, or regularly consuming highly acidic beverages - **Psychological factors**, including anxiety, depression, or chronic stress - **Wearing dentures** — even well-fitting ones — doesn't typically cause burning mouth syndrome, but ill-fitting dentures may worsen existing symptoms ### Who Is Most at Risk? Burning mouth syndrome is relatively uncommon, but certain groups face a higher risk: - Women, in general - Women who are perimenopausal or postmenopausal - Adults over the age of 50 In most cases, burning mouth syndrome appears without any obvious trigger. That said, certain factors may raise your likelihood of developing it, including: - A recent illness - Chronic medical conditions such as fibromyalgia, Parkinson's disease, autoimmune disorders, or neuropathy - Prior dental procedures - Food allergies - Certain medications - Traumatic life events - Chronic stress - Anxiety - Depression ### Potential Complications The complications of burning mouth syndrome are largely tied to the burden of living with ongoing, unrelenting discomfort. They may include: - Difficulty falling or staying asleep - Difficulty eating - Depression - Anxiety ### Can It Be Prevented? There is currently no known way to prevent burning mouth syndrome outright. However, avoiding tobacco, acidic foods, spicy foods, carbonated beverages, and excessive stress may help reduce the intensity of symptoms or keep them from getting worse. **Source:** <https://www.mayoclinic.org/diseases-conditions/burning-mouth-syndrome/symptoms-causes/syc-20350911> **References:** 1. Brown AB. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Oct. 9, 2018. 2. Burning mouth syndrome. National Institute of Dental and Craniofacial Research. <https://www.nidcr.nih.gov/health-info/burning-mouth>. Accessed Jan. 19, 2019. 3. Burning mouth syndrome. American Academy of Oral Medicine. <https://maaom.memberclicks.net/index.php?option=com_content&view=article&id=81:burning-mouth-syndrome&catid=22:patient-condition-information&Itemid=120>. Accessed Jan. 19, 2019. 4. Feller L, et al. Burning mouth syndrome: Aetiopathogenesis and principles of management. *Pain Research and Management*. 2017. <https://www.hindawi.com/journals/prm/2017/1926269/>. Accessed Jan. 17, 2019. 5. Yoo HS, et al. The role of psychological factors in the development of burning mouth syndrome. *International Journal of Oral and Maxillofacial Surgery*. 2018;47:374. 6. AskMayoExpert. Burning mouth syndrome (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. 7. deSouza IF, et al. Treatment modalities for burning mouth syndrome: A systematic review. *Clinical Oral Investigations*. 2018;22:1893. 8. Vellappally S. Burning mouth syndrome: A review of the etiopathologic factors and management. *Journal of Contemporary Dental Practice*. 2016;17:171. 9. Moor Verenzuela CS, et al. Burning mouth syndrome: Results of screening tests for vitamin and mineral deficiencies, thyroid hormone, and glucose levels — Experience at Mayo Clinic over a decade. *International Journal of Dermatology*. 2017;56:952. 10. Liu YF, et al. Burning mouth syndrome: A systematic review of treatments. *Oral Diseases*. 2018;24:325. 11. Lewis AK, et al. An overview of burning mouth syndrome for the dermatologist. *Clinical and Experimental Dermatology*. 2016;41:119. 12. Salerno C, et al. An overview of burning mouth syndrome. *Frontiers in Bioscience (Elite edition)*. 2016;8:213. 13. Klasser GD, et al. Burning mouth syndrome. *Oral and Maxillofacial Surgery Clinics of North America*. 2016;28:381. 14. Moghadam-Kia S, et al. A diagnostic and therapeutic approach to primary burning mouth syndrome. *Clinics in Dermatology*. 2017;35:453. 15. Coping with chronic pain. American Psychological Association. <http://www.apa.org/helpcenter/chronic-pain.aspx>. Accessed Jan. 21, 2019. 16. Torgerson RR (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 22, 2019. ---
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Care planBursitisBursitis is an inflammation of the bursae — small, fluid-filled sacs that act as cushions between your bones, tendons, and muscles. Think of them as your body's built-in shock absorbers: they keep everything gliding smoothly around your joints. When they become inflamed, that smooth movement becomes painful. Bursitis can be triggered by a number of things, including physical trauma, repetitive motion, underlying conditions like arthritis or gout, or even infection. While bursitis can affect many joints — including the elbow, knee, hip, and tailbone — the shoulder is the most common site. Left untreated, bursitis tends to become a persistent, recurring problem. The pain itself can cause your surrounding muscles to tighten and spasm, which in turn squeezes the already-irritated bursa — creating a frustrating cycle. In advanced cases, particularly in the shoulder, significant scarring can develop and lead to what is commonly known as a "frozen shoulder," where movement becomes severely restricted. ### What Does Bursitis Feel Like? - **Acute (sudden onset):** Pain; decreased range of motion; local tenderness on palpation; swelling and redness is visualized if the bursa is superficial (e.g. olecranon and prepatellar). - **Chronic (long-standing):** Thickened bursa wall; formation of adhesion, calcareous deposits, muscle atrophy from disuse; various degrees of pain, tenderness, swelling, muscle weakness; typically, range of motion is quite decreased. - **Shoulder-specific patterns:** Bicipital tendinitis: tenderness over the bicipital groove and pain with elbow flexion; Subacromial bursitis: pain and tenderness locally and pain with all movements, especially rotation; Supraspinatus tendinitis: no rotational pain but pain when abduction reaches 40 degrees. ---
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Care planCalcificationCalcification occurs when calcium accumulates in body tissues, blood vessels, or organs — gradually hardening those areas and interfering with their normal function. Calcium travels through your bloodstream and exists in virtually every cell of your body, which means calcification can develop almost anywhere. According to the National Academy of Medicine (formerly the Institute of Medicine), about 99 percent of your body's calcium is in your teeth and bones. The other 1 percent is in the blood, muscles, fluid outside the cells, and other body tissues. Certain conditions cause calcium to settle in places where it simply doesn't belong. Over time, this unwanted accumulation can snowball into real health problems. If you have excess calcium buildup, your doctor may recommend treatment to head off complications before they arise. --- ## Understanding Calcification ### Where Can Calcification Occur? Calcium deposits can develop in many locations throughout your body, including: - Small and large arteries - Heart valves - Brain, where it's known as cranial calcification - Joints and tendons, such as knee joints and rotator cuff tendons - Soft tissues like breasts, muscles, and fat - Kidney, bladder, and gallbladder Not all calcium buildup is cause for alarm. Many deposits are simply your body's response to inflammation, injury, or normal biological processes. That said, some calcifications can impair organ function or compromise blood vessel health. According to the Division of Cardiology at UCLA School of Medicine, most adults older than 60 have calcium deposits in their blood vessels. ### What Causes Calcification? Calcification is rarely the result of a single cause — it's usually a combination of factors working together. These include: - Infections - Calcium metabolism disorders that cause hypercalcemia (too much calcium in the blood) - Genetic or autoimmune disorders affecting the skeletal system and connective tissues - Persistent inflammation According to Harvard University, a common misconception is that calcifications are caused by a calcium-rich diet. However, researchers haven't found a link between dietary calcium and a higher risk for calcium deposits. The same holds true for kidney stones. Most kidney stones are composed of calcium oxalate. People who develop calcium oxalate stones excrete more calcium in their urine than those who don't — and this difference exists regardless of how much calcium they consume in their diet. ### How Is Calcification Diagnosed? Calcifications are most commonly discovered through X-rays — a quick, painless imaging test that uses electromagnetic radiation to capture pictures of your internal structures. In many cases, your doctor can identify calcium buildup right away on these images. Your doctor may also order blood tests. If kidney stones are a concern, for example, these tests can give a clearer picture of how well your kidneys are functioning overall. Sometimes calcium deposits are discovered in areas associated with cancer. In these situations, your doctor will typically order a biopsy — usually performed with a fine needle — to collect a small tissue sample for laboratory analysis. If no cancer cells are found, the calcification is classified as benign, meaning it's not harmful. ### Breast Calcifications Breast calcifications develop when calcium accumulates within the soft tissue of the breast. There are two main types: macrocalcifications (larger deposits) and microcalcifications (smaller, more numerous deposits). According to the National Cancer Institute, macrocalcifications in the breasts are most common in women over 50 years old. Men can get breast calcifications too, but it's not as common. Breast calcifications can arise from a variety of causes, including breast injuries, cellular secretions, infections, and inflammation. They may also develop following breast cancer treatment or radiation therapy. The good news is that most breast calcifications are not cancerous — this is especially true for macrocalcifications. Microcalcifications are also frequently benign, though certain patterns of microcalcifications may signal early-stage breast cancer and warrant closer attention. Breast calcifications are too small to detect during a routine breast exam. They're typically identified during a mammogram. If any deposits need monitoring, your doctor will schedule a follow-up appointment to keep a close eye on them. If calcifications appear suspicious, your doctor may recommend a biopsy for further analysis, or in some cases, minor surgery to remove them for a more thorough evaluation. Staying current with regular mammograms — starting at the age your doctor recommends — is one of the most effective ways to track breast calcifications over time. The earlier any concerning changes are caught, the better your chances of a positive outcome. ### How Is Calcification Treated? Treatment for calcification is not one-size-fits-all. Your doctor will tailor an approach based on several key factors: - Where do the calcium deposits occur? - What is their underlying cause? - What, if any, complications arise? Once calcifications are identified, your doctor will schedule regular follow-up visits to watch for any developing complications. Minor artery calcifications are generally not considered dangerous. When calcium builds up on heart valves, however, the stakes are higher. If the deposits are severe enough to impair valve function, surgery may be needed to open or replace the affected valve. For kidney stones, treatments are designed to help break down calcium buildup in the kidneys. Your doctor may also prescribe a type of diuretic called thiazide to reduce the likelihood of future calcium kidney stones — it works by signaling the kidneys to hold onto more calcium rather than releasing it into the urine. Calcium deposits in joints and tendons don't always cause pain, but they can limit your range of motion and lead to significant discomfort over time. Common treatments include anti-inflammatory medications and ice therapy. If these measures don't provide adequate relief, surgery may be considered. ### Can Calcification Be Prevented? If you're over 65, it's important to see your doctor regularly for blood tests that monitor your calcium levels alongside other routine screenings. If you're under 65 and were born with a heart defect or kidney-related condition, you may be at higher risk for calcifications than others your age. Let your doctor know about these conditions so they can determine whether testing for calcifications makes sense for you. Certain medications can influence your body's calcium levels. Cholesterol medications, blood pressure medications, and hormone replacement therapy are among the most common culprits. If you're taking any of these — or undergoing related treatments — talk to your doctor about how they may be affecting your calcium balance. If you regularly take calcium carbonate supplements (such as Tums), be aware that excessive use can push your calcium levels too high. Kidney problems or issues with the parathyroid glands — four small glands located behind the thyroid — can have the same effect. The right amount of daily calcium varies depending on your age. Talk to your doctor about the appropriate dose for you, taking into account your age, sex, and any existing health conditions. Smoking is associated with increased calcifications in the heart and major arteries. Given that smoking is already a well-established risk factor for heart disease, these calcifications may be yet another piece of that puzzle. Quitting smoking offers meaningful benefits — both short- and long-term — for your heart, blood vessels, and brain. There is no guaranteed way to prevent calcifications entirely, since they result from a wide range of biological processes. That said, quitting smoking and adjusting your diet may help slow or reduce calcification in certain areas of the body. Kidney stones, for instance, may develop less frequently with targeted dietary changes. Talk to your doctor about building a healthy, sustainable diet that works for your specific needs. ### What's the Outlook for Someone with Calcification? Calcifications don't typically cause symptoms on their own — they're often discovered incidentally during imaging done for an entirely different reason. That said, it's worth discussing your overall health picture with your doctor, especially if you have underlying conditions like heart disease or kidney disease, or if you smoke, as these factors can increase your risk. Your long-term outlook depends largely on where the calcifications are located and how significant they are. Hardened deposits can disrupt critical functions in the brain and heart, and calcifications in the blood vessels can contribute to coronary heart disease. Working closely with your doctor is the best way to stay ahead of any health concerns that might raise your risk for calcification. ### The Bottom Line Calcification is the buildup of calcium in body tissue — and it can lead to hardened deposits in soft tissues, arteries, and beyond. Some calcifications are harmless and symptom-free; others can lead to serious complications if left unaddressed. Treatment is guided by where the deposits are, how severe they are, and what's driving them in the first place. **Source:** <https://www.healthline.com/health/calcification#bottom-line> **References:** - Calcium: Fact sheet for health professionals. (2016). <ods.od.nih.gov/factsheets/calcium-HealthProfessional/> - Çiftçioğlu N, et al. (2010). Pathological calcification and replicating calcifying-nanoparticles: General approach and correlation. <nature.com/pr/journal/v67/n5/full/pr201089a.html> - Demer LL, et al. (2008). Vascular calcification: Pathobiology of a multifaceted disease. <circ.ahajournals.org/content/117/22/2938.full> - Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. (1997). <ncbi.nlm.nih.gov/books/NBK109827/> - Glassman LM. (2009). Pathology of the male breast. <radiologyassistant.nl/en/p49a3cce262026/pathology-of-the-male-breast.html> - Jairam PM, et al. (2013). Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants. <ncbi.nlm.nih.gov/pmc/articles/PMC3688769/> - Lopez-Jimenez F. (2017). Aortic calcification: An early sign of heart valve problems? <mayoclinic.org/diseases-conditions/aortic-stenosis/expert-answers/aortic-valve-calcification/faq-20058525> - Mayo Clinic Staff. (2018). Breast calcifications: When to see a doctor. <mayoclinic.org/symptoms/breast-calcifications/basics/when-to-see-doctor/sym-20050834> - Soft tissue calcifications. (n.d.). <rad.washington.edu/about-us/academic-sections/musculoskeletal-radiology/teaching-materials/online-musculoskeletal-radiology-book/soft-tissue-calcifications/> - Understanding breast changes: A health guide. <cancer.gov/types/breast/breast-changes/understanding-breast-changes.pdf> ---
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Care planCancer Prevention and TreatmentPlant nutrients work against cancer at every stage of its development. **A growing body of evidence — from both population-level studies and laboratory research — supports a clear link between regularly eating fruits and vegetables and a lower risk of cancer.** Leading health organizations — including the WHO, the American Cancer Society, the American Institute of Cancer Research (AICR), and the National Cancer Institute (NCI) — have all developed dietary guidelines to help people meaningfully reduce their cancer risk. Phytochemicals are naturally occurring, non-nutritive compounds found in plant-based foods (the prefix "phyto" comes from the Greek word for plant) that carry powerful anticancer and anti-mutagenic properties. These chemopreventive plant compounds can block the earliest steps of cancer development, or help reverse early-stage cancer promotion. They may also slow or stop the transformation of precancerous cells into full-blown malignancies. **References:** - Doll, R. & Peto, R. The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today. *J. Natl Cancer Inst.* 66, 1191–1308 (1981). - Manson, M. M. Cancer prevention: The potential for diet to modulate molecular signalling. *Trends Mol. Med.* 9, 11–18 (2003). - Manson, M. M. et al. Blocking and suppressing mechanisms of chemoprevention by dietary constituents. *Toxicol. Lett.* 112–113, 499–505 (2000). --- ## Understanding Diet, Nutrition, and Cancer Risk ### Diet and Nutrition as Leading Drivers of Cancer According to the National Academy of Sciences, **at least 60% of all cancers in women and at least 40% of all cancers in men may be rooted in dietary and nutritional factors. It has been estimated that more than two-thirds of all human cancers could be prevented through the right lifestyle changes.** Researchers Richard Doll and Richard Peto have reported that between 10–70% (averaging around 35%) of cancer deaths in humans can be traced back to diet. Diet, nutritional factors, exposure to environmental toxins, and impaired detoxification are considered the leading drivers of cancer initiation and progression today. In the words of Samuel Epstein, M.D., Professor of Occupational and Environmental Medicine at the University of Illinois School of Public Health: > *"Many cancer-causing pesticides and industrial chemicals found in the environment end up in the food we consume, the water we drink, and the air that we breathe, and tend to accumulate in fatty tissues, whether in fish, cattle, fowl, or people."* **Equally important, diet, nutritional factors, phytonutrients, and a well-functioning detoxification system are among the most powerful defenses we have against cancer — and they are areas where individuals have the greatest degree of personal control.** ### Poor Diet Linked to 80,000 Cancer Cases in the United States **"Nutrition is one of the cornerstones for cancer prevention and control. Unfortunately, nutrition is not typically integrated into the delivery of optimal care for cancer patients."** **Source:** *Cancer.* Published online October 13, 2015. The number of cancers linked to poor diet is comparable to those associated with alcohol consumption, estimated to account for 4% to 6% of all cancers. Additionally, excess body weight is associated with 7% to 8% of the cancer burden, and physical inactivity with 2% to 3%. > *"Our study findings lend further support to the growing evidence by estimating the cancer burden associated with suboptimal diet at the national level. It underscores the opportunity to reduce cancer burden and disparities in the US by improving food intake."* > > — Fang Fang Zhang, MD, PhD, Associate Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. **Reference:** *JNCI Cancer Spectrum.* Published online May 22, 2019. "Preventable Cancer Burden Associated with Poor Diet in the United States." <https://doi.org/10.1093/jncics/pkz034> ---
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Care planCancer Prevention LifestyleCancer begins in your cells — the microscopic building blocks that make up every tissue and organ in your body. Under normal circumstances, your body creates new cells only as needed, replacing aging or damaged cells that naturally die off. But sometimes this orderly process breaks down. New cells form when they shouldn't, and old cells refuse to die when they should. This surplus of cells can clump together into a mass called a tumor. Tumors come in two varieties: benign (non-cancerous) and malignant (cancerous). Benign tumors stay put and don't invade surrounding tissue. Malignant tumors, on the other hand, can invade nearby tissues — and they can break away and travel to distant parts of the body. Cancer is not a single disease; it's actually a family of more than 100 distinct diseases. Most cancers are named for where they originate. Lung cancer starts in the lung. Breast cancer starts in the breast. When cancer spreads from its original location to somewhere else in the body, this process is called metastasis. Symptoms and treatment depend on the type of cancer and how far it has progressed. Most treatment plans include some combination of surgery, radiation, and/or chemotherapy. Others may involve hormone therapy, biologic therapy, or stem cell transplantation. *NIH: National Cancer Institute* ---
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Care planCancer Therapy Nutritional SupportThis protocol is based on recommendations from Dr. Robert Rakowski's seminar series, *"Nutrition and Cancer — New Strategies to Win the War on Cancer — Essential Information for the 563,700+ New Cancer Patients Who Will be Diagnosed This Year."* **Chemotherapy** works by targeting and destroying cells that are growing and dividing rapidly. Unlike most normal, healthy cells — which divide slowly and steadily — cancer cells multiply at an accelerated pace, piling up into tumors and spreading (metastasizing) to other parts of the body. Chemotherapy is designed to poison and eliminate these fast-dividing cells. Unfortunately, chemotherapy cannot tell the difference between fast-dividing cancer cells and fast-dividing healthy cells — like those that make up your hair follicles, nails, and the lining of your stomach — which also get caught in the crossfire. This is why so many people going through chemotherapy experience hair loss and bouts of nausea and vomiting. **Radiation therapy** uses high-energy radiation to shrink tumors and kill cancer cells. X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment. Radiation therapy kills cancer cells by damaging their DNA — the molecules inside cells that carry genetic information and pass it from one generation to the next. Radiation therapy can either damage DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and eliminated by the body's natural processes. Radiation therapy can also damage normal healthy cells, leading to side effects. ---
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Care planCandida AlbicansCandidiasis is a fungal infection caused by a yeast called *Candida*. In most people, it stays on the surface — affecting the skin or mucous membranes — but in some cases it can spread throughout the body and become a serious, life-threatening illness. Here's something that might surprise you: *Candida albicans*, the yeast responsible for most Candida infections, is already living in virtually every person on the planet. It quietly inhabits the mucous membranes, the digestive tract, the vagina, and the skin. Under normal, healthy conditions, it causes absolutely no harm — it simply coexists with the rest of your body's microscopic community. So the real question isn't whether you have *Candida* — you almost certainly do — but rather: what causes a peaceful, harmless coexistence to turn into an infection? Understanding that shift is the key to understanding, diagnosing, and treating Candida overgrowth. Most researchers agree that the root cause of Candida overgrowth is a disruption of the gut's delicate microbial ecosystem — a breakdown in the balance of beneficial bacteria that normally keep *Candida* in check. This imbalance is most often driven by: - The overuse of antibiotics — both in medicine and in the animals we eat - Diets high in red meat, fat, and sugar and low in fiber - The use of birth control pills, cortisone, cortisone-like medications, and immune-suppressing drugs When these factors collide, the microscopic community inside your body — your microbiome — is thrown into disarray. *Candida* and other harmful organisms seize the opportunity to multiply. The yeast transforms into a more aggressive fungal form that can produce up to 70 neurotoxins. This, in turn, irritates the lining of the gut until it becomes permeable — meaning large molecules that have no business entering the bloodstream can slip through, including *Candida* itself, its toxins, and potential allergens. This is why identifying and treating Candida overgrowth with a thoughtful, comprehensive plan is so important. Candidiasis is by far the most common form of yeast overgrowth in humans. Of the more than 20 species of *Candida*, *Candida albicans* is the most prevalent. These fungi naturally live on every surface of the human body, and problems only arise when conditions allow them to multiply unchecked — particularly in areas that are warm and moist. Common examples include vaginal yeast infections, thrush (a fungal infection of the mouth and throat), skin rashes, diaper rashes, and nail infections. - *Candida* thrives in warm, moist areas of the body — like the underarms. While healthy skin is an effective barrier, any cuts, scrapes, or skin breakdown can give the organism a way in. - In babies, the most commonly affected areas are the mouth and the diaper region. - Vaginal yeast infection — the most common form of vaginitis — is also known as vaginal candidiasis. - In adults, oral yeast infections become more frequent with age. Adults can also develop Candida infections around dentures, in skin folds beneath the breasts or lower abdomen, in the nailbeds, and under other skin folds. Most of these are superficial and respond well to treatment — though nail infections often require a longer course of therapy. - In some cases, a yeast infection can spread throughout the entire body. When *Candida* enters the bloodstream and disseminates systemically, the condition can be fatal in up to 45% of cases. Even seemingly minor infections of the mouth or vagina can, in vulnerable individuals, become serious and difficult to treat. --- ## Understanding Candida Overgrowth ### What Causes a Candida Yeast Infection? In women, yeast infections are the second most common cause of vaginal burning, itching, and discharge. Yeast is found in the vaginas of 20% to 50% of healthy women and can overgrow when the vaginal environment is disrupted. The most common triggers are antibiotic and steroid use — but pregnancy, menstruation, diabetes, and birth control pills can also contribute. Yeast infections become more common after menopause. In people whose immune systems are weakened — whether from cancer treatment, long-term steroid use, or diseases like AIDS — Candida can spread throughout the entire body and become life-threatening. The blood, brain, eyes, kidneys, and heart are the organs most frequently affected, though *Candida* can also take hold in the lungs, liver, and spleen. In people living with AIDS, *Candida* is one of the leading causes of esophagitis — a painful inflammation of the swallowing tube. People with compromised immune systems are at risk for systemic candidiasis, where the infection enters the bloodstream through breaks in the skin or mucous membranes. *Candida* can also proliferate in the intestinal tract when antibiotics wipe out the beneficial bacteria that normally keep it under control. Medical devices that penetrate the skin — such as urinary catheters and intravenous (IV) ports — can also provide a direct pathway for yeast to enter the body. People who inject drugs with contaminated needles may introduce *Candida* directly into the bloodstream or deep tissues. ### Recognizing a Candida Yeast Infection: Symptoms and Signs The signs and symptoms of a Candida infection vary depending on where in the body the infection occurs. In women, a vaginal yeast infection typically produces a thick, white discharge that is often described as resembling cottage cheese. The infection usually causes itching and irritation of the vagina and the surrounding external tissues. Occasionally, there may be pain during sexual intercourse or a burning sensation when urinating. **Genital yeast infection in men:** Men can develop symptoms of a genital yeast infection after sexual contact with a woman who has a vaginal yeast infection. That said, yeast infections are not classified as a sexually transmitted disease (STD), because women can carry the yeast naturally without having acquired it from a partner. In men, symptoms may include itching and burning of the penis, along with a rash on the penile skin. **In both infants and adults, a Candida infection can show up in many different ways.** Oral candidiasis is called thrush. It appears as thick, white, lacy patches on a red base — forming on the tongue, the roof of the mouth, or elsewhere inside the oral cavity. These patches can look like milk curds, but unlike milk, they don't wipe away easily. If you do remove them with a blade or cotton swab, the underlying tissue may bleed. Sometimes thrush causes the tongue to appear red without any white coating at all. Thrush can be painful and make eating difficult — and it's important to ensure that someone with thrush stays adequately hydrated. (Thrush was previously called moniliasis, based on an older name for *Candida albicans* — *Monilia*.) *Candida* organisms naturally inhabit the skin, but when the outer skin barrier breaks down, the yeast can overgrow. This most commonly happens in warm, moist environments — such as diaper areas and skin folds. A superficial Candida skin infection appears as a flat, red rash with sharply defined, scalloped edges. Smaller patches of similar-looking rash often appear nearby — these are called "satellite lesions." The rash may itch or cause discomfort. In people with weakened immune systems, Candida can invade internal organs, causing pain or impaired organ function. Those with suppressed immunity — due to AIDS, chemotherapy, or other conditions — may develop a Candida infection of the esophagus called esophagitis. This infection behaves like a more severe form of thrush, extending from the mouth down through the esophagus and into the stomach. It can cause painful ulcers throughout the gastrointestinal (GI) system, making it excruciating to swallow even liquids. If the infection reaches the intestines, nutrients may be poorly absorbed, and dehydration becomes a real danger. Associated symptoms can include pain near the breastbone, upper abdominal pain, nausea, and vomiting. If *Candida* enters the bloodstream, the person may become ill — with or without fever. If the infection reaches the brain, it can cause sudden changes in mental clarity or behavior. ### Common Warning Signs of Candida Overgrowth **Brain and Nervous System:** - Headache - Depression - Lethargy - Agitation - Hyper-irritability - Memory loss - Difficulty concentrating **Digestive Tract:** - Chronic heartburn - Gastritis - Colitis - Bloating and distension - Gas - Constipation **Urinary and Reproductive Tract:** - Vaginal yeast infections - Irregular menstrual cycles - Cramping - Endometriosis - Cystitis - Urethritis - Kidney and bladder infections **Whole-Body Symptoms:** - Fatigue - Joint pain and stiffness - Cold hands and feet - Increased body hair - Numbness and tingling - Food cravings - Loss of libido **Allergy-Like Symptoms:** - Hay fever - Sinusitis - Earaches - Hives - Asthma - Food and chemical sensitivities Use the **[Candida | Yeast Questionnaires](https://www.dropbox.com/s/tafcjhillatlqtd/Yeast%20Questionnaire%20%E2%80%94%20Adult%20%26%20Child.pdf?dl=0)** to help assess whether a systemic Candida treatment program is appropriate for you. ### How Is Candida Overgrowth Identified? - Dr. Crook's symptom questionnaires for candidiasis are excellent starting-point indicators. - The Candida antibody blood test and the cytoplasmic antigen-antibody test are used by many practitioners, but appear to carry approximately a 60% error rate. - KBMO Diagnostics \<[info@kbmodiagnostics.com](mailto:info@kbmodiagnostics.com)\> does a Gut Barrier Test that checks for Candida, Zonulin, and Occludin which is available through NutriDyn. - Dark-field microscopy identification of yeast forms offers a high degree of accuracy and reliability. - Applied Kinesiology testing correlates well with dark-field microscopy findings and Dr. Crook's symptom questionnaires. ### Treatment The conventional medical approach to Candida has been aptly described as a "silver bullet" strategy — the idea of finding something that simply wipes out *Candida albicans*. But this approach has a fundamental flaw. Even if you could eliminate all the *Candida* in your body, it would return the moment treatment stopped, because the organism is virtually everywhere in our environment. You can't prevent it from re-entering the body. A far more rational approach is to create an internal environment that keeps *Candida* at a healthy, natural population level — and, just as importantly, keeps it in its harmless yeast form rather than allowing it to transform into the more aggressive fungal form. That is precisely the goal of the nutritional treatment protocols described below. Following the **[Candida Albicans Dietary Guide](/plans/7700c488-0674-5397-916e-1d85ee27e715)** or the **[Low-FODMAP Diet](/plans/ea6aae41-9fd2-5b58-89a6-ecd230097d7e)** can be a valuable complement to any treatment plan, helping to reduce yeast overgrowth and strengthen immune function through dietary changes. > 📝 **NOTE:** In moderate to severe systemic candidiasis, clinical feedback documents the necessity of the entire 90-Day program. ---
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Care planCandida Albicans Dietary Guide
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Care planCanker SoreCanker sores are small, round ulcers that form inside your mouth — on the inner cheeks, under the tongue, or at the back of the throat. They typically have a red border and a grayish center, and they can be surprisingly painful. It's worth knowing that canker sores are completely different from cold sores, which are caused by the herpes simplex virus. Canker sores are not contagious — you can't catch them from someone else. They can show up during or after a viral illness, but they're also commonly triggered by stress, food sensitivities, nutritional deficiencies, hormonal fluctuations, or your menstrual cycle. Sometimes, there's no clear cause at all. Known medically as **aphthous ulcers** or **aphthae**, canker sores are the most frequent cause of recurring sores inside the mouth and, occasionally, on the genitals (areas lined with mucous membranes). Factors that can make them worse include stress, poor sleep, physical injury to the mouth, and possibly certain nutritional deficiencies, toothpaste ingredients, or foods. People with anemia or conditions that weaken the immune system may be especially prone to developing them. Canker sores affect roughly 1 in 4 people. They're more common in women and tend to first appear during childhood or the teenage years. People living with HIV/AIDS are often significantly and severely impacted by canker sores. ### 3 Types of Canker Sore: - **Minor aphthae** (80% of cases) — heal within 1–2 weeks - **Major aphthae** (Sutton disease, approximately 10% of cases) — extremely painful, last from 2–4 weeks, and generally cause scars after they heal - **Herpetiform aphthae** (10% of cases) — progress in a way that is similar to minor aphthous ulcers --- ## Understanding Canker Sores ### Who Gets Canker Sores? - Canker sores affect approximately 25% of the general population. They are more common in women, and they usually start to appear in children or teens. - People infected with HIV/AIDS are often severely affected with canker sores. ### What Do They Look and Feel Like? - **Minor aphthae** appear as one or several small sores, each 1.0 cm or less in diameter. - **Major aphthae** are deeper ulcers greater than 2.0 cm in diameter. - **Herpetiform aphthae** appear as clusters of multiple small ulcerations. - Canker sores most commonly form inside the lips or cheeks or on the tongue, though the genitals can occasionally be affected as well. The base of the sore may appear white, gray, or yellow. ### What You Can Do at Home Most canker sores resolve on their own without any treatment. That said, if you have one, there are several steps you can take to ease the pain, reduce irritation, and encourage faster healing: - Over-the-counter topical gels, medicated mouthwashes, and certain oral medications can help relieve pain and reduce inflammation. - Steer clear of acidic foods (like citrus fruits) and spicy foods, which can aggravate the sore and delay healing. - If your doctor identifies a nutritional deficiency through blood testing, take any recommended supplements as directed. - When brushing, be gentle and use a soft-bristled toothbrush to avoid irritating the sore. - Switch to a toothpaste and mouthwash that does not contain sodium lauryl sulfate, a foaming agent that may aggravate canker sores. - A simple home remedy: mix equal parts hydrogen peroxide and water to create an antiseptic solution, then dab it directly onto the sore with a cotton swab. Afterward, apply a small amount of milk of magnesia over the sore three to four times a day to soothe discomfort and support healing. - Another home option is to mix milk of magnesia with liquid Benadryl and use the mixture as a mouth rinse. - Additional natural remedies worth considering include a goldenseal mouth rinse, deglycyrrhizinated licorice (DGL) dissolved in warm water as a gargle, and simple saltwater rinses. ### What Your Doctor May Prescribe Your doctor may recommend medications applied directly to the affected area to help speed healing. Options may include: - Topical calcineurin inhibitors (tacrolimus or pimecrolimus) - Prednisone in severe cases - Other oral medications — dapsone and colchicine — may be used in more severe cases when repeated outbreaks continue for years. ---
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Care planCarcinoid SyndromeCarcinoid syndrome develops when a rare type of cancer — called a carcinoid tumor — releases certain chemicals into your bloodstream, triggering a range of signs and symptoms. These tumors arise most commonly in the gastrointestinal tract or the lungs. Carcinoid syndrome typically appears in people whose carcinoid tumors have already progressed to an advanced stage. The primary approach to treatment focuses on fighting the cancer itself. However, because most carcinoid tumors don't produce carcinoid syndrome until they're already advanced, a complete cure may not always be achievable. In those situations, medications can help ease your symptoms and improve your quality of life. --- ## Understanding Carcinoid Syndrome ### What Does Carcinoid Syndrome Look and Feel Like? The signs and symptoms of carcinoid syndrome vary depending on which chemicals your carcinoid tumor is releasing into your bloodstream. The most common signs and symptoms include: - **Skin flushing.** The skin on your face and upper chest feels hot and changes color — ranging from pink to purple. Flushing episodes may last from a few minutes to a few hours or longer. Flushing may happen for no obvious reason, though sometimes it can be triggered by stress, exercise, or drinking alcohol. - **Facial skin lesions.** Purplish areas of spiderlike veins may appear on your nose and upper lip. - **Diarrhea.** Frequent, watery stools sometimes accompanied by abdominal cramps may occur in people who have carcinoid syndrome. - **Difficulty breathing.** Asthma-like signs and symptoms, such as wheezing and shortness of breath, may occur at the same time you experience skin flushing. - **Rapid heartbeat.** Periods of a fast heart rate could be a sign of carcinoid syndrome. ### What Causes Carcinoid Syndrome? Carcinoid syndrome is caused by a carcinoid tumor that releases serotonin or other chemicals directly into your bloodstream. These tumors tend to develop in the lungs or the gastrointestinal tract — including your stomach, small intestine, appendix, colon, and rectum. Only a small fraction of carcinoid tumors actually release the chemicals responsible for carcinoid syndrome. And even when they do, your liver typically neutralizes those chemicals before they can travel through your body and cause symptoms. The problem arises when an advanced tumor spreads (metastasizes) to the liver itself — at that point, it can release chemicals that bypass the liver's filtering process and reach the bloodstream directly. Most people who develop carcinoid syndrome have advanced cancer that has spread to the liver. That said, some carcinoid tumors don't need to be advanced to cause carcinoid syndrome. Carcinoid tumors in the lungs, for example, release chemicals into the blood at a point that comes before the liver in circulation — so the liver never gets a chance to process and clear them. Carcinoid tumors in the intestine, on the other hand, release chemicals into blood that must first pass through the liver before reaching the rest of the body — and the liver usually neutralizes them before they can cause widespread effects. What ultimately causes carcinoid tumors to form in the first place remains unclear. ### Potential Complications Carcinoid syndrome can give rise to the following complications: - **Carcinoid heart disease.** Some people with carcinoid syndrome develop carcinoid heart disease. Carcinoid syndrome causes a thickening of the heart valves, making it difficult for them to function properly. As a result, the heart valves may leak. Signs and symptoms of carcinoid heart disease include fatigue and shortness of breath during physical activity. Carcinoid heart disease can eventually lead to heart failure. Your doctor may recommend medications for your heart. Surgical repair of damaged heart valves may be an option in advanced carcinoid heart disease. - **Bowel obstruction.** Cancer that spreads to the lymph nodes next to your small intestine can cause narrowing and kinking of your intestine, leading to a bowel obstruction. Signs and symptoms of a bowel obstruction include severe, cramping abdominal pain and vomiting. Surgery may be necessary to relieve the obstruction. - **Carcinoid crisis.** Carcinoid crisis causes a severe episode of flushing, low blood pressure, confusion, and breathing difficulty. > ⚠️ **IMPORTANT NOTE:** Carcinoid crisis can occur when people with carcinoid tumors are exposed to certain triggers, including anesthetic used during surgery. Carcinoid crisis can be fatal. Your doctor may give you medications before surgery to reduce the risk of carcinoid crisis. ---
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Care planCardiomyopathyCardiomyopathy (\ˈkär-dē-ō-mī-ˈä-pə-thē\) is an umbrella term for diseases that primarily affect the heart muscle itself. There are several distinct forms: - **Alcoholic cardiomyopathy** — A form of cardiomyopathy caused by chronic, heavy alcohol use, leading to an enlarged heart and reduced pumping ability. Heart disease related to beriberi (a thiamine/vitamin B1 deficiency) is also closely tied to alcoholism. - **Congestive cardiomyopathy** — A condition marked by an enlarged heart — particularly the left ventricle — weakened heart muscle, and the buildup of fluid throughout the body known as congestive heart failure. - **Infiltrative cardiomyopathy** — Heart muscle disease caused by the abnormal buildup of foreign substances within heart tissue, as can occur in conditions like amyloidosis, hemochromatosis, and other systemic disorders. --- ## Understanding Cardiomyopathy ### The Hidden Link Between Heavy Metals, Toxins, and Heart Disease Patients with severe heart failure have been found to carry **12,000 times more antimony** in their heart muscle cells than healthy individuals — and a staggering **22,000 times more mercury**. A wide range of toxins — particularly heavy metals such as lead, copper, iron, mercury, aluminum, cadmium, and others — can accumulate in heart tissue. Once there, they directly damage heart muscle cells and impair function, making them a significant and underappreciated contributor to heart failure. Key findings on heavy metals and heart disease: - Heavy metals like mercury, cadmium, and copper directly damage the mitochondria — the tiny powerhouses inside your cells responsible for generating energy - Antimony exposure has been linked to heart and cardiovascular problems, and it also acts like estrogen in the body, potentially contributing to chronic diseases including cancer - The heart appears to be a preferential destination for heavy metal accumulation — and this buildup plays a significant role in heart failure - In a November 2023 article, Dr. Thomas Levy, contributing editor for the Orthomolecular Medicine News Service, pointed out that the heart is "the preferred collection site" for most heavy metals, and as such, heavy metal toxicity is a common contributor to, and sometimes direct cause of, heart failure As reported by Levy: > *"Many different toxins, including many heavy metals, have been either linked to heart failure or clearly shown to be the direct cause. Furthermore, one or more of these toxins is nearly always present in high concentrations in the affected heart muscle. A partial list of such agents includes the following: Lead, Copper, Iron, Mercury, Aluminum, Cobalt/Chromium, Cadmium, Gold/Silver, Chemotherapy, COVID spike protein."* > > **Reference:** Orthomolecular Medicine News Service, November 3, 2023 Levy cites research demonstrating exactly how each of these toxic agents harms your heart and erodes cardiac function over time. Lead, for example, has been linked to acute heart failure and myocarditis; excess copper to hypertrophic cardiomyopathy; iron overload to congestive heart failure; and mercury to idiopathic dilated cardiomyopathy (IDCM) — a condition where the heart becomes enlarged and weakened for no otherwise identifiable reason. **Identifying and treating heavy metal toxicity can lead to dramatic improvements in heart function.** (See **[Heavy / Toxic Metal Detoxification](/plans/85f07fee-b34a-57a3-8936-2b1829ed61c2)**) > 📝 **NOTE:** Routine phlebotomy (therapeutic blood removal) is recommended for managing elevated iron levels and may also help reduce your body's microplastic burden. --- ### Think Twice Before Reaching for That Plastic Bottle In February 2022, the organization Defend Our Health tested 20 popular beverages for the presence of antimony. Every single beverage was bottled in PET plastic — and every single one contained detectable levels of antimony. Eight of the 20 samples (40%) had antimony concentrations exceeding California's Public Health Goal for drinking water of 1 part per billion (ppb), and 18 of the 20 samples (90%) exceeded the stricter 0.25 ppb limit recommended by Defend Our Health. According to the "Problem Plastic" report: > *"The highest concentration was found in the Campbell's V8 vegetable juice sample, which had 3.45 parts per billion (ppb) of antimony, more than three times California's public health goal for antimony in drinking water.* > > *The soda sample with the highest antimony concentration was Coca Cola (packaged in 100% recycled PET) at 2.2 ppb. Nestle's Perrier water had the highest concentration of antimony among the sampled bottled waters, at 1.58 ppb.* > > *The plastic from 11 bottles had concentrations of antimony in the range of 216 to 321 parts per million (ppm). These concentrations fall within or slightly above the previously documented range of 172 to 261 ppm in PET bottles known to use an antimony catalyst.* > > *Three bottles tested had undetectable concentrations of antimony. These PET samples were Simply Lemonade, Mountain Dew, and 7up bottles. Titanium concentrations for these PET samples were found to be six to seven times higher than in the other tested bottle samples … Aluminum levels were also elevated in the plastic from two of these samples (Simply Lemonade and 7-up), suggesting that these bottles may have been produced using a titanium- and/or aluminum-based catalyst."* > > **Reference:** Defend Our Health, *Problem Plastics*, July 2022 --- ### Nanoplastics Linked to Heart Attacks and Stroke Adding to these concerns, emerging research has now linked nanoplastics — plastic particles too small to see with the naked eye — to an increased risk of heart attacks and stroke. The landmark study, published in the *New England Journal of Medicine*, examined tissue from 257 patients who underwent a surgical procedure to clear blockages from the carotid arteries in the neck. The arterial plaques removed from these patients were found to contain several types of nanoplastics, including polyethylene — detected in 58.4% of patients — and polyvinyl chloride, found in 12.1%. Perhaps most alarming: patients with microplastics or nanoplastics in their carotid artery tissue faced a **fourfold higher risk** of experiencing a cardiovascular event — such as a heart attack or stroke — over the following three years, compared to those without detectable plastics. They were also more likely to die from any cause during that period. **Reference:** *New England Journal of Medicine*, March 6, 2024 --- ### Powering Your Heart: Why Cellular Energy Is Central to Heart Failure Treatment Together, your heart and brain consume nearly one-third of all the energy your body produces. The brain, which makes up just 2% of your body weight, accounts for 20% of your total energy use. Your heart, at only 0.5% of your body weight — about 75% lighter than your brain — still demands 7% to 8% of your body's energy. Pound for pound, that's actually 50% more energy than your brain requires. When your cells can't generate enough energy, your heart simply doesn't have the fuel it needs to keep pumping effectively. **Sources and References:** 1. <https://pubmed.ncbi.nlm.nih.gov/10334427/> — *J Am Coll Cardiol* 1999 May;33(6):1578–83 2. <https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.643972/full> — *Front Pharmacol* April 12, 2021; 12 3. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349094/> — *Scientific World Journal* April 24, 2012; 136063 4. <https://web.archive.org/web/20231202083447/http://orthomolecular.org/resources/omns/v19n41.shtml> — Orthomolecular Medicine News Service November 3, 2023 (Archived) 5. <https://www.drugs.com/mtm/deferoxamine.html> — Drugs.com Deferoxamine 6. <https://pubmed.ncbi.nlm.nih.gov/31542421> — *Toxicology* 427:152289 7. <https://defendourhealth.org/wp-content/uploads/2022/07/PET-Report-Part1-070622d-1.pdf> — Defend Our Health, Problem Plastics July 2022 8. <https://www.nejm.org/doi/full/10.1056/NEJMoa2309822> — *New England Journal of Medicine* March 6, 2024 9. <https://www.fda.gov/food/consumers/advice-about-eating-fish> — FDA Advice about Eating Fish 10. <https://www.zerohedge.com/medical/boiling-hard-tap-water-removes-90-percent-microplastics-study> — ZeroHedge March 8, 2024 ---
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Care planCarpal Tunnel SyndromeCarpal tunnel syndrome occurs when the median nerve — a key nerve that runs from your forearm into your hand — gets compressed as it travels through a narrow passageway in your wrist called the carpal tunnel. This tunnel is formed by the wrist bones on three sides and a tough band of tissue called the transverse carpal ligament on the fourth. When the tunnel narrows or its contents swell, the nerve gets pinched, leading to pain, numbness, tingling, and weakness in the hand. In some cases, the tendons that bend your fingers can also be affected. A wide variety of conditions can cause the carpal tunnel to narrow, putting pressure on the median nerve. These include hormonal and metabolic disorders like acromegaly (excess growth hormone) and myxedema (severe low thyroid); inflammatory conditions like rheumatoid arthritis and tendon sheath inflammation (tenosynovitis) triggered by repetitive wrist movements such as sewing, typing, or even repeated lifting of drinks; bone problems like a dislocated wrist bone (the lunate), Paget's disease, or a healed wrist fracture (Colles' fracture); wrist sprains or strains; fluid retention from pregnancy or hormonal shifts before menstruation; and less common conditions like gout, tuberculosis, and amyloidosis. It's also worth knowing that irritation of the median nerve anywhere along its path — from the nerve network in the neck and shoulder (the brachial plexus) down to the elbow — can make the nerve more vulnerable to compression at the wrist. This is called the **"double crush phenomenon"**: when a nerve is already stressed at one point, even mild pressure at another point can trigger symptoms. Without treatment, carpal tunnel syndrome tends to slowly worsen over time. Conventional medicine typically offers surgical release of the pressure by cutting the tight ligament — a procedure that works well for many people, but is not 100% effective, and sometimes the other hand eventually develops the same problem. ### Known Causes of Carpal Tunnel Syndrome - Genetic predisposition - History of repetitive wrist movements, such as typing or machine work - Obesity - Pregnancy - Autoimmune disorders - Inflammation also plays a central role in the pain-related symptoms caused by carpal tunnel syndrome ### Symptoms to Watch For - Pain in the hands, elbows, shoulders, or knees - Stiffness in the fingers upon waking in the morning - Difficulty bending the fingers fully - Temporary numbness or "dead arm" sensation at night - Tingling or "pins and needles" in the hands (and sometimes the face) - Pain when moving the thumb inward toward the palm - Weak grip strength - Intermittent swelling in the hands, feet, or ankles - Reduced ability to feel texture or touch with the fingertips - Tenderness or soreness over the wrist where the carpal tunnel sits - Frequently dropping objects - Nighttime muscle cramps in the arms or legs ### A Simple Self-Check You Can Do Right Now 1. Hold both hands out in front of you with your palms facing up 2. Bend only the two outer sets of finger joints, keeping the knuckles closest to your palm flat and level with your wrists 3. Curl your fingertips down to touch the creases at the base of your fingers, where your fingers meet your palm 4. If any of these 16 joints cannot bend fully and painlessly, carpal tunnel syndrome may be a concern worth discussing with your doctor ---
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Care planCataractsA cataract is a clouding of the eye's natural lens — the clear tissue that sits just behind your pupil. Under normal circumstances, light passes through this lens and lands precisely on the retina, the light-sensitive layer at the back of the eye that sends visual information to the brain. When proteins in the lens begin to clump together, the lens becomes hazy, and your vision suffers. Cataracts typically develop gradually over many years and are one of the most common consequences of aging. When the cloudiness becomes significant enough to interfere with everyday activities — like driving, reading, or watching television — surgery to remove the cataract is recommended. ### Signs & Symptoms - Blurred or dimmed vision (many patients describe it as looking through a foggy window) - Double vision - Halos around lights - "Second sight" — a curious phenomenon in which someone who normally needs reading glasses suddenly finds they can read without them - Brown or darkened spots in the field of vision ### What Causes Cataracts? A cataract forms when proteins in the lens begin to cluster together, blocking light from reaching the retina. Exactly why this happens isn't fully understood, but many researchers believe it is linked to chemical changes in the lens that occur naturally with age. Others point to additional contributing factors, including smoking, diabetes, and long-term overexposure to sunlight. > *"Statin therapy significantly elevates the risk of developing cataracts severe enough to warrant surgery."* > > **Reference:** Wise SJ, Nathoo NA, Etminan M, et al. Statin use and risk for cataract: A nested case-control study of 2 populations in Canada and the United States. *Can J Cardiol.* 2014;30:1613–1619. ### Statin Medications: A Hidden Link to Type 2 Diabetes and Cataracts The connection between statin use and type 2 diabetes (T2D) has been recognized for more than a decade. In 2012, the U.S. Food and Drug Administration updated statin drug labels to include a warning about reports of elevated blood glucose and glycosylated hemoglobin (A1c) levels in people taking these medications. That warning sparked considerable debate, and numerous analyses have been conducted in the years since — yet the conclusion has remained largely consistent across clinicians and major medical guidelines. The most recent investigation (September 2023) comes from an analysis of the LODESTAR randomized controlled trial, which followed 4,400 patients with coronary artery disease across 12 hospitals in Korea and examined the relative risks associated with specific types of statins. "The percentages of new-onset diabetes and cataract are in line with previous studies regarding statin therapy in patients with atherosclerotic cardiovascular disease," Senior author Myeong-Ki Hong, MD, PhD, said. "Additional research specifically focusing on these outcomes is required, with more frequent measurement of glucose and A1c levels to detect new-onset diabetes and regular ophthalmologic examinations to detect cataracts." "When using a statin medication, we…emphasize the importance of meticulous monitoring and appropriate lifestyle interventions to mitigate the risk of new-onset diabetes or cataracts." **Source:** <https://www.medscape.com/viewarticle/997884?ecd=WNL_trdalrt_pos1_231031_etid6011805&uac=149193PV&impID=6011805#vp_1> **Reference:** *BMJ.* 2023;383:e075837. doi: <https://doi.org/10.1136/bmj-2023-075837> (Published 18 October 2023). Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. <https://www.bmj.com/content/383/bmj-2023-075837> **Cataracts come in several distinct forms:** - **Age-related cataracts** — the most common type, developing gradually as part of the natural aging process - **Congenital cataracts** — present at birth or appearing in early childhood, typically affecting both eyes - **Secondary cataracts** — arising in people with underlying medical conditions such as diabetes, or in those taking steroid medications - **Traumatic cataracts** — resulting from a physical injury to the eye ### Prevention - Protect your eyes outdoors by wearing sunglasses that block ultraviolet (UV) light - Quit smoking, or never start — it is one of the most modifiable risk factors for cataracts - Certain medications may help slow the development of cataracts, especially in people with diabetes or other high-risk conditions — though none are known to reverse cataracts once they have formed ### Lifestyle Guidance - Try eliminating common food allergens — including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and artificial food additives — to see if symptoms improve. Your healthcare provider can test you for specific food allergies. - Load up on antioxidant-rich foods, particularly dark green leafy vegetables and colorful peppers, as well as berries such as blueberries, cherries, and raspberries — all of which contain powerful antioxidants that support eye health. - Minimize refined foods such as white breads, pasta, and sugar, which offer little nutritional value and may contribute to inflammation. - Reduce red meat consumption and favor leaner protein sources — such as grass-fed meats, cold-water fish, tofu (if no soy allergy), or beans. - Choose healthy cooking oils, such as coconut oil, olive oil, or vegetable oil. - Cut back on or eliminate trans-fatty acids, which are commonly found in commercially baked goods like cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine. - Avoid stimulants such as alcohol and tobacco. - Stay well-hydrated by drinking 6–8 glasses of filtered water each day. - Aim for moderate exercise at least 5 days per week, as tolerated. ---
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Care planCelluliteCellulite is an incredibly common and harmless skin condition that creates a lumpy, dimpled appearance on the thighs, hips, buttocks, and abdomen. It affects the vast majority of women at some point in their lives. Many people seek to improve their skin's appearance through weight loss, exercise, massage, and over-the-counter creams marketed as cellulite solutions — with mixed results. Medically proven treatment options do exist, though it's important to know that results are rarely immediate or permanent. ### What Does Cellulite Look Like? Cellulite appears as dimpled or bumpy skin — often compared to the texture of cottage cheese or an orange peel. Mild cellulite may only be visible when you pinch the skin in an affected area, such as your thighs. More significant cellulite gives the skin a rougher, uneven appearance with a landscape of peaks and valleys. Cellulite most commonly appears on the thighs and buttocks, but it can also show up on the breasts, lower abdomen, and upper arms. ### Quick Facts About Cellulite Cellulite most often affects the buttocks and thighs, but it can appear elsewhere on the body. - Between 80 and 90 percent of women will probably experience cellulite. - Cellulite is also known as orange-peel skin, due to its texture. - Numerous treatments are available, but the effect is mostly temporary. - A diet low in fat, smoking cessation, and an active lifestyle may help reduce the incidence of cellulite. ### How Severe Is Your Cellulite? Understanding the Grading Scale A cellulite severity scale, published in 2009, ranks the condition using three grades: - **Grade 1, or mild:** There is an "orange-peel" appearance, with between 1 and 4 superficial depressions, and a slightly "draped" or sagging appearance to the skin. - **Grade 2, or moderate:** There are between 5 and 9 medium-depth depressions, a "cottage cheese" appearance, and the skin appears moderately draped. - **Grade 3, or severe:** There is a "mattress" appearance, with 10 or more deep depressions, and the skin is severely draped. ### What Causes Cellulite? The exact cause of cellulite isn't fully understood, but it appears to arise from an interaction between the connective tissue layer just beneath the skin's surface and the layer of fat directly below it. Think of it this way: fibrous cords tether your skin down to the underlying muscle, with fat cells nestled in between. As those fat cells accumulate and press upward against the skin, the tough cords pull downward — creating that characteristic uneven, dimpled surface. Hormones also play a significant role in cellulite development, and genetics influence skin structure, texture, and body type. Other factors like weight and muscle tone can matter too — though even highly fit individuals can have cellulite. ### Who Is Most at Risk? Cellulite is far more common in women than in men. In fact, most women develop some degree of cellulite after puberty — largely because women tend to store fat in the thighs, hips, and buttocks, which are the most common sites for cellulite. The risk also increases with age, as skin naturally loses elasticity over time. Weight gain can make cellulite more visible, but even lean individuals can have it. Cellulite tends to run in families, suggesting that genetics may be the single most important factor. A sedentary lifestyle and pregnancy can also increase your chances of developing it. ### The Role of Genetics Certain genes appear to be necessary for cellulite to develop. Genetic factors can influence your metabolism, how fat is distributed beneath the skin, your ethnicity, and your circulation — all of which can affect your likelihood of developing cellulite. ### The Role of Diet and Lifestyle Despite popular belief, cellulite is not caused by "toxins" — though a healthy lifestyle may help lower your risk. Diets high in fat, carbohydrates, and salt, and low in fiber, appear to be associated with greater amounts of cellulite. Cellulite may also be more common among smokers, those who don't exercise regularly, and people who sit or stand in one position for extended periods of time. Even something as simple as wearing underwear with tight elastic across the buttocks can restrict blood flow and may contribute to cellulite formation. While cellulite is more prevalent in people who carry excess body fat, slim and fit individuals can have it too. It becomes more likely after age 25, though it can affect younger people — including teenagers. ### Treatment and Removal Options Several therapies have been proposed for reducing or removing cellulite, but none have yet been definitively confirmed by scientific research. The American Academy of Dermatology (AAD) has reviewed a number of techniques that may help reduce the visible appearance of cellulite by breaking up the bands of connective tissue beneath the skin's surface. - **Acoustic wave therapy** uses a hand-held device to transmit sound waves. It may work, but it can take several sessions. - **Laser treatment** may improve the appearance of cellulite for a year or more. It involves inserting a very small laser probe under the skin. The laser is then fired, breaking up the tissue. This can also thicken the skin by increasing collagen production. The thickened skin may reduce the appearance of the cellulite below. - **Subcision** involves a dermatologist putting a needle under the skin to break up the connective tissue bands. Results can last 2 years or more, says the AAD. - **Vacuum-assisted precise tissue release** cuts the bands using a device containing small blades. As it cuts the connective bands, the tissue underneath moves up to fill the space under the skin, removing the appearance of cellulite. This may last for 3 years, but data on its success is limited. - **Carboxytherapy** involves inserting carbon dioxide gas under the skin. Side effects include bruising and discomfort after the procedure, but some cellulite might disappear. - **Endermologie** involves a deep massage with a vacuum-like device that lifts the skin. The U.S. Food and Drug Administration (FDA) has approved it as safe, but there is little evidence that it works, says the AAD. - **Ionithermie cellulite reduction treatment** involves covering the affected area with a special mud or clay, then wrapping it in plastic before applying an electric current. It is not proven to be effective. - **Radiotherapy** aims to reduce cellulite by heating it, but any results are short-term. - **Laser-assisted liposuction** removes small amounts of fat, but this may make dimpling worse. Research has not yet shown that it works to reduce cellulite. - **Ultrasonic liposculpting** targets and destroys fat, but again, research is lacking to show that it works. Techniques that the AAD does not recommend include cryolipolysis, which freezes fat, and mesotherapy, which involves injecting a mixture of substances under the skin. ### Topical Creams and Medications Some medications and creams have been proposed for cellulite because of the way they interact with fatty tissue. - **Caffeine** dehydrates cells, making them less visible. This needs to be applied daily. Various caffeine creams for cellulite are available to purchase online. - **Retinol** may reduce the appearance of cellulite by thickening the skin. At least 6 months' use is needed to see results. It is important to try a patch test first, because some people have experienced adverse effects, such as a racing heart. Retinol treatments are available to buy online. Some researchers have proposed using medications that can improve cell metabolism and circulation, but these have not been tested or proven effective. ### Complementary and Alternative Approaches Alternative or supplemental therapies include caffeine, grape seed extract, or gingko biloba. These agents have been applied topically, orally, and by injection, but none of them have proven effective. Some people wear compression garments to reduce the visible appearance of cellulite. These garments work by compressing arteries and promoting blood and lymph flow to minimize cellulite's appearance. Compression stockings and similar garments are available for purchase online. Liposuction and dieting do not remove cellulite because they don't address the underlying structure of the connective tissue. However, reducing fat intake means there is less fat available to push through those tissues. Eating a balanced, nutritious diet and staying active may therefore help reduce the appearance of cellulite. A [2015 review](https://www.medicalnewstoday.com/articles/149465#treatment-and-removal) of a variety of studies into the effectiveness of different techniques indicated that either the procedures did not work, or the research methodology was flawed. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/cellulite/symptoms-causes/syc-20354945> - <https://www.medicalnewstoday.com/articles/149465#treatment-and-removal> ---
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Care planCellulitisCellulitis is a bacterial skin infection that develops when bacteria enter your body through a break in the skin — a cut, scrape, or other wound. It can involve not just the surface of the skin, but also the deeper layers of tissue beneath it, and in serious cases, it can spread to your lymph nodes. While cellulitis most commonly affects the legs, it can also develop on the arms, face, and scalp. The good news is that antibiotics are usually effective at clearing the infection. However, complications can occur, and without prompt treatment, cellulitis can become life threatening. ## Understanding Cellulitis ### Signs & Symptoms - Pain and tenderness in the affected area - Swelling from fluid buildup (edema) - Redness of the skin - Skin that feels warm or hot to the touch - Fever - Chills ### What Causes Cellulitis? Cellulitis is caused by bacteria — most often streptococcus or staphylococcus aureus — that enter the body through a break in the skin, such as cuts, insect bites, burns, surgical incisions, IV catheters, or skin conditions like dermatitis. Methicillin-resistant staphylococcus aureus (MRSA) is a more dangerous, antibiotic-resistant form of staph infection that is becoming increasingly common. A related condition called erysipelas — a type of cellulitis that involves the lymph system — is often preceded by an upper respiratory infection and tends to affect infants, young children, and older adults. It is generally caused by streptococcal bacteria. ### Who Is Most at Risk? Certain factors can make you more vulnerable to developing cellulitis: - Older age — circulation tends to weaken with age, making it easier for cuts and scrapes to become infected - Diabetes - A history of chickenpox or shingles - Lymphedema (chronic swelling of the arms or legs), which can cause the skin to crack - Fungal infections of the feet, such as athlete's foot, which can also create cracks in the skin - Dirty or contaminated wounds - A weakened immune system - An existing infection elsewhere in the body ### What to Expect at Your Doctor's Visit If you think you may have cellulitis, don't wait — see your doctor right away. If you have a fever along with a rash, go to the emergency room. Your healthcare provider will perform a thorough physical examination to identify the cause of your symptoms. Blood tests and imaging studies may also be ordered to help make the diagnosis. ---
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Care planCentral Pain SyndromeCentral pain syndrome is a neurological condition that arises when the central nervous system (CNS) — your brain, brainstem, and spinal cord — is injured or stops functioning normally. It can develop as a result of stroke, multiple sclerosis, tumors, epilepsy, traumatic brain or spinal cord injury, or Parkinson's disease. Because central pain syndrome has so many possible causes, the nature of the pain it produces can look very different from one person to the next. It may sweep across large regions of the body or settle into specific areas like the hands or feet — and generally, the more extensive the CNS injury, the more widespread the pain. The pain is typically constant, ranging from moderate to severe, and tends to flare with touch, movement, strong emotions, or temperature changes — particularly exposure to cold. Most people experience more than one type of pain sensation, with burning being the most common. Layered on top of that burning, you might also notice "pins and needles," a pressing, tearing, or aching quality, and sudden, sharp bursts of intense pain — not unlike the jolt you feel when a dentist's probe hits an exposed nerve. Numbness often accompanies the pain in affected areas, and both the burning sensation and loss of normal touch perception tend to be most pronounced in the extremities, such as the feet and hands. Central pain syndrome usually appears shortly after the injury that triggers it, but it can be delayed by months or even years — this is especially true when the cause is a prior stroke. ### Are There Treatments Available? Pain medications can take the edge off, but rarely eliminate the pain of central pain syndrome entirely. Tricyclic antidepressants like nortriptyline, or anticonvulsants like neurontin (gabapentin), have shown benefit for many patients. Reducing stress also appears to help lower pain levels. ### What Can I Expect Long-Term? Central pain syndrome is not a life-threatening condition, but it is a deeply disabling one. For the majority of people living with it, chronic pain and diminished quality of life are ongoing realities. ---
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Care planCerebral PalsyCerebral palsy is an umbrella term for a group of disorders that affect movement, balance, and posture. These disorders typically become apparent within the first few years of life and, importantly, do not tend to worsen over time. Depending on severity, people with cerebral palsy may struggle with everyday physical tasks — from walking to writing to using a pair of scissors. Some individuals also live with related medical conditions, such as seizure disorders or cognitive impairment. Cerebral palsy arises when the areas of the brain responsible for controlling movement and posture fail to develop properly or sustain damage. Early signs almost always appear before age 3. Infants with cerebral palsy are often slower than their peers to reach developmental milestones like rolling over, sitting up, crawling, smiling, or walking. Some babies are born with the condition; others develop it in the months after birth. There is currently no cure for cerebral palsy, but effective treatment can meaningfully improve quality of life. A well-rounded treatment plan typically includes medications, orthotic braces, and physical, occupational, and speech therapy. **Reference:** *NIH: National Institute of Neurological Disorders and Stroke* ## Understanding Cerebral Palsy ### What Are the Different Types of Cerebral Palsy? There are three major types of cerebral palsy. It's worth noting that some individuals experience symptoms of more than one type. **Spastic cerebral palsy** is by far the most common form, affecting roughly 70 to 80 percent of people with cerebral palsy. In this type, the muscles are stiff and rigid, making movement difficult. Spastic diplegia primarily affects both legs — tight muscles in the hips and legs cause the legs to turn inward and cross at the knees, a pattern known as "scissoring," which makes walking challenging. Spastic hemiplegia affects only one side of the body, with the arm typically more severely impacted than the leg. The most severe form, spastic quadriplegia, involves all four limbs, the trunk, and the face. Children with spastic quadriplegia are usually unable to walk and often experience intellectual disability, difficulty speaking, and seizures. **Athetoid or dyskinetic cerebral palsy** affects approximately 10 to 20 percent of individuals. This form involves the entire body and is characterized by unpredictable fluctuations in muscle tone — muscles may swing between being too tight and too loose — and is often accompanied by involuntary movements that can range from slow and writhing to rapid and jerky. Children with this form of cerebral palsy frequently find it difficult to develop enough body control to sit upright or walk. Because the muscles of the face and tongue can also be involved, challenges with sucking, swallowing, and speech are common. **Ataxic cerebral palsy** is the least common type, affecting approximately 5 to 10 percent of individuals. It primarily disrupts balance and coordination. People with this form often walk with an unsteady, wide-based gait and have difficulty with tasks that demand precise coordination, such as writing. ### What Causes Cerebral Palsy? In most cases, cerebral palsy is caused by factors that interfere with the brain's normal development before birth. In some instances, genetic defects can lead to brain malformations or faulty wiring of nerve cell connections — both of which can result in cerebral palsy. Other cases stem from injuries to the developing brain, such as a stroke occurring in the fetus. Contrary to what many people believe, only a small minority of cerebral palsy cases are caused by a lack of oxygen reaching the baby during labor and delivery. A small number of children develop brain injuries during the first months or years of life that can lead to cerebral palsy. These injuries may result from brain infections such as meningitis or from head trauma. In many cases, however, no clear cause can be identified. Certain risk factors increase the likelihood that a baby will develop cerebral palsy — though it's important to know that most babies with one of these risk factors do not go on to develop the condition. Known risk factors include: **Premature birth:** Babies born before 37 weeks of pregnancy who weigh less than 3⅓ pounds are between 20 and 80 times more likely to develop cerebral palsy than babies born at full term. Many of these very small babies experience bleeding in the brain, which can injure delicate brain tissue, or develop a condition called periventricular leukomalacia — the destruction of nerve tissue surrounding the fluid-filled cavities (ventricles) of the brain. **Infections during pregnancy:** Certain maternal infections can damage the developing brain and lead to cerebral palsy. These include rubella, cytomegalovirus (typically a mild viral infection), herpes (viral infections that can cause genital sores), and toxoplasmosis (usually a mild parasitic infection). Infections involving the placental membranes (chorioamnionitis) may also contribute to cerebral palsy in both full-term and premature babies. A 2003 study at the University of California at San Francisco found that full-term babies were 4 times more likely to develop cerebral palsy if they were exposed to chorioamnionitis in the womb. **Inadequate oxygen supply to the fetus:** This can occur when the placenta is not functioning properly or when it separates from the wall of the uterus before delivery. **Oxygen deprivation during labor and delivery:** Until recently, it was widely believed that oxygen deprivation (asphyxia) during a difficult birth was the primary cause of most cerebral palsy cases. We now know that birth complications — including asphyxia — account for only 5 to 10 percent of cases. **Severe jaundice:** Jaundice is a yellowing of the skin and whites of the eyes caused by a buildup of a pigment called bilirubin in the blood. Mild jaundice typically resolves on its own without causing harm. However, in some cases jaundice becomes severe, with very high bilirubin levels in the blood. Without treatment, this can pose a serious risk of permanent brain damage, potentially resulting in athetoid cerebral palsy. **Certain blood disorders**, such as Rh disease, can cause severe jaundice and brain damage, resulting in cerebral palsy. Rh disease occurs when there is an incompatibility between the blood of the mother and her developing baby. It can usually be prevented by giving an Rh-negative mother an injection of a blood product called Rh immune globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby. **Blood clotting disorders (thrombophilias):** These disorders — in either the mother or the baby — may increase the risk of cerebral palsy. ### The Role of Nutrition in Treatment Regardless of how severe the neurological involvement or which symptoms are present, the nutritional approach to treatment remains fundamentally consistent. Nutritional therapy cannot restore brain or nerve cells that have already been damaged — but it can play a meaningful role in supporting the development of functional control through the brain's remarkable ability to adapt via surrounding healthy cells. It also goes a long way toward relieving the significant physical stress these patients experience day to day. Good nutrition can build strength, bolster resistance to infection and secondary illness, and — often quite powerfully — improve the mental outlook and emotional well-being of patients as they grow and mature. ### The Unique Nutritional Needs of Someone Living with Cerebral Palsy Children and adults with cerebral palsy face a heightened risk of poor nutrition due to a number of interconnected challenges: - Frequent infections and/or hospitalizations - Feeding, eating, drinking, and swallowing (FEDS) difficulties - The need for modified food textures (such as soft, minced and moist, or puréed) - Dependence on others for feeding assistance - Elevated nutritional requirements - Reduced appetite related to constipation or acid reflux Research indicates that up to one third of growing children with CP are poorly nourished due to feeding, eating, drinking, or swallowing difficulties (FEDS). This can result in mealtimes that are much longer or much more effortful than normal. FEDS difficulties range in severity. For a child or adult with CP it can sometimes be a struggle to achieve adequate nutrition or hydration to maintain health and weight. In severe cases, the inability to swallow effectively can cause a choking and safety hazard, or result in food entering the lungs (aspiration) leading to repeated chest infections and/or pneumonia. ---
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Care planCharcot-Marie-Tooth Disease / Hereditary Motor and Sensory NeuropathyCharcot-Marie-Tooth (shahr-KOH-Marie-Tooth) disease is a group of inherited conditions that cause progressive nerve damage — primarily affecting the nerves in your arms and legs (known as the peripheral nerves). You may also hear it called hereditary motor and sensory neuropathy. Over time, Charcot-Marie-Tooth disease leads to smaller, weaker muscles, along with reduced sensation, muscle cramps, and difficulty walking. Foot deformities — such as hammertoes and unusually high arches — are also common. Symptoms typically begin in the feet and legs, but can eventually extend to the hands and arms. Most people first notice symptoms during adolescence or early adulthood, though some don't develop them until midlife. ## Understanding Charcot-Marie-Tooth Disease ### What Does It Feel Like? Recognizing the Symptoms Charcot-Marie-Tooth disease can show up in a variety of ways. Common signs and symptoms include: - Weakness in your legs, ankles, and feet - Loss of muscle bulk in your legs and feet - Unusually high foot arches - Curled toes (hammertoes) - Difficulty running - Trouble lifting your foot at the ankle (footdrop) - An awkward or unusually high-stepping gait - Frequent tripping or falling - Reduced sensation or numbness in your legs and feet As Charcot-Marie-Tooth disease progresses, symptoms may spread from the feet and legs to the hands and arms. It's worth knowing that the severity of symptoms can vary enormously from person to person — even among members of the same family. ### What Causes It? Charcot-Marie-Tooth disease is inherited — meaning it's passed down through families via genetic mutations. These mutations affect the nerves that serve your feet, legs, hands, and arms. In some cases, the mutations directly damage the nerve fibers themselves. In others, they damage the protective coating that wraps around each nerve, called the **myelin sheath**. Either way, the result is the same: signals traveling between your brain and your limbs become weaker and less reliable. This communication breakdown has real consequences. For example, muscles in your feet may not receive your brain's signal to contract properly — making you more prone to tripping and falling. Likewise, your brain may not receive pain signals from your feet, so an injury like a blister rubbing on your toe could quietly become infected before you even realize anything is wrong. ### Who Is at Risk? Because Charcot-Marie-Tooth disease runs in families, your risk is higher if a close relative has been diagnosed with it. It's also important to know that other conditions that affect the nerves — such as diabetes — can produce similar symptoms or make existing Charcot-Marie-Tooth disease worse. Certain medications can also worsen symptoms — particularly some chemotherapy drugs, including vincristine (Marqibo), paclitaxel (Abraxane, Taxol), and others. Make sure your doctor has a complete, up-to-date list of every medication you're taking. ### Potential Complications How significantly Charcot-Marie-Tooth disease affects daily life varies from person to person. Foot abnormalities and difficulty walking tend to be the most common and impactful challenges. Muscles may continue to weaken over time, and areas of the body with reduced sensation are more vulnerable to injury that goes unnoticed. In some cases — when the muscles controlling breathing, swallowing, or speaking are involved — the disease can create more serious complications in those areas as well. **Source:** <https://www.mayoclinic.org/diseases-conditions/charcot-marie-tooth-disease/symptoms-causes/syc-20350517> ---
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Care planCholecystectomy (Gallbladder Removal)Your gallbladder is a small, pear-shaped organ tucked just beneath your liver. Its job is to store bile — a digestive fluid produced by your liver that helps your body break down and absorb fat. When you eat, your gallbladder releases this stored bile through the common bile duct, a small tube that connects your gallbladder and liver to your small intestine, where most digestion takes place. Under normal circumstances, your gallbladder carefully collects and concentrates bile, releasing a potent, well-timed burst of it whenever you eat a fatty meal. When the gallbladder is removed, that "reservoir" is gone — bile now trickles continuously and in a more diluted form directly from the liver into the intestine, which means it's far less effective at doing its job when you actually need it. > 📝 **NOTE:** In a 1999 study published in the *British Medical Journal*… "50% of patients who had gallbladder surgery did not see improvement in their digestive health complaints." > > **Reference:** *BMJ.* 1999 Jun 26; 318(7200): 1745–1748. doi: 10.1136/bmj.318.7200.1745. PMCID: PMC1116086. PMID: 10381713. Gallbladder disease. ---
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Care planCholesterol TestsMost people assume that if their cholesterol looks fine on paper, their heart is safe. But that assumption can be dangerously wrong. A landmark UCLA study found that nearly **75% of patients hospitalized for a heart attack** had LDL cholesterol levels that did **not** classify them as high-risk. Even more striking: **almost half** had LDL levels below **100 mg/dL**, a range often labeled "ideal." **Reference:** Waters DD et al. *Am Heart J.* 2009;157(1):111–117. [Study summary link](https://go.gale.com/ps/i.doid=GALE%7CA192736849&it=r&p=AONE&sid=sitemap) --- ## Understanding Cholesterol Particle Risk ### Why Your Cholesterol Number Doesn't Tell the Whole Story Cholesterol itself isn't *good* or *bad* — it's simply transported through the blood by different particles. The **type** and **number** of these particles matter far more for heart health than the total amount of cholesterol alone. Standard cholesterol tests measure **LDL-C** (the cholesterol *inside* LDL particles), but **not** how many LDL particles you actually have or what kinds they are. This distinction is crucial because: - LDL-C does **not** always match LDL particle number (**LDL-P**). - You can have *low* LDL-C yet remain *high-risk* if your LDL-P is elevated. - **Small, dense LDL particles** are much more damaging to arteries — but are invisible on routine lipid panels. ### ApoB and LDL-P: The Most Accurate Markers of Heart Risk **LDL-P** counts the actual number of LDL particles (in nmol/L), showing how many "cholesterol-carrying trucks" are on the highway. **ApoB** goes even further, counting *all* artery-damaging particles — LDL, VLDL, IDL, and Lp(a) — since each carries exactly **one ApoB molecule**. Why this matters: - More particles = more chances to penetrate artery walls and cause plaque buildup. - **30–40%** of people show a mismatch, where LDL-C looks normal but LDL-P or ApoB remains high. - Elevated ApoB correlates *more strongly* with heart-attack risk than LDL-C or non-HDL-C. Leading heart health organizations (AHA, ESC, NLA) now recognize **ApoB** as the *most accurate single marker* of artery-damaging risk. ### Small, Dense LDL: The Hidden Threat Inside Your Arteries Not all LDL particles are created equal. Small, dense LDL particles are about **three times more damaging** than large, buoyant LDL. They oxidize more easily, inflame artery walls, and slip through the delicate inner lining of blood vessels — yet they're **completely missed by standard tests**. ### What Standard Cholesterol Tests Are Missing The traditional cholesterol test measures only LDL-C — the cholesterol *inside* the particles — not how many particles are present or how dense they are. Two people with the exact same LDL-C reading can have very different particle numbers and very different levels of risk. More advanced tests such as **LDL-P** (via NMR LipoProfile) or **ApoB** provide a far clearer, more personalized picture of risk — especially for people with insulin resistance, metabolic syndrome, or high triglycerides, where LDL-C can appear falsely "normal." ---
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Care planChondrocalcinosis / Calcium Pyrophosphate Deposition Disease (CPDD) | Pseudogout | Pseudo-osteoarthritis | Pseudoneuropathic JointsChondrocalcinosis is a form of arthritis that causes painful flare-ups of joint inflammation. Though these flare-ups may come and go, the condition can quietly cause permanent joint damage over time. At its core, chondrocalcinosis involves the buildup of **calcium pyrophosphate crystals** within joint tissues — triggering inflammatory attacks and cartilage breakdown. The pain and inflammation in chondrocalcinosis stem from crystal deposits that accumulate in and around your joints. The knees are most commonly affected, but the condition can strike multiple joints at once — including the wrists, shoulders, ankles, elbows, and hands. Flare-ups can come on suddenly and may last anywhere from a few days to several weeks. The pain and swelling can be intense enough to interfere with everyday activities. In some cases, crystal deposits are present but cause no symptoms at all. ### What Does Chondrocalcinosis Feel Like? Common Symptoms: - Inflammation - Swelling - Pain - Irritation - Warmth - Tenderness - Discoloration - Fever - Chills - Weakness Between episodes, you may feel completely normal. However, over time, crystal deposits can drive chronic inflammation and joint damage — producing symptoms that closely resemble osteoarthritis or rheumatoid arthritis. ### Signs That Joint Damage May Be Developing: - Joint pain and stiffness - Low-grade inflammation - Swollen "knobby" joints - Limited range of motion - Morning joint stiffness and fatigue ### What Causes Chondrocalcinosis? In most cases, the exact cause of chondrocalcinosis remains unclear. Because the condition tends to run in families, genetics likely plays a role. Although chondrocalcinosis is more common in older adults, younger people are not immune. Most people diagnosed with pseudogout are 65 years of age or older. When a younger person develops the condition, it often points to an underlying metabolic disease worth investigating. According to 2020 case studies, metabolic diseases such as hyperparathyroidism, hemochromatosis, and hypomagnesemia may be contributing factors for people under the age of 45 years who develop chondrocalcinosis. Crystal deposits also frequently appear alongside joint infections, osteoarthritis, and other forms of arthritis such as gout. An acute flare can sometimes be triggered by a joint injury or surgical procedure. Other factors that may contribute to the development of chondrocalcinosis include: - Hemochromatosis (excess iron absorption) - Hypomagnesemia (low blood magnesium level) - Hyperparathyroidism (overactive parathyroid glands) - Severe hypothyroidism - Hypercalcemia - Hypophosphatemia (low blood phosphorus level) - Hemophilia ### How Is Chondrocalcinosis Diagnosed? Diagnosing chondrocalcinosis can be challenging because its symptoms closely overlap with those of gout, osteoarthritis, and rheumatoid arthritis. Your doctor will start by reviewing your symptoms and then order tests to get a clearer picture. One key test is **synovial fluid analysis** — a procedure in which a small sample of fluid is drawn from the affected joint and examined under a microscope. This allows the clinician to identify calcium pyrophosphate crystals or uric acid crystals (the hallmark of gout), and also helps rule out infection. Blood tests may also be ordered to eliminate other possible diagnoses. To pinpoint crystal deposits and other sources of pain, your doctor may order imaging tests such as: - Ultrasound - X-ray - CT scan - MRI ### What Does Chondrocalcinosis Look Like on Imaging? On an X-ray, chondrocalcinosis may appear as white, fluffy deposits within the soft tissue of a joint. Calcification in the soft tissues surrounding the joint may also be visible. ### Treatment Options There is currently no cure for chondrocalcinosis, but treating and managing your symptoms is essential. Left untreated, the condition can produce chronic, severe pain and inflammation — and over time, progressive joint degeneration can lead to disability. While the crystals themselves cannot be dissolved or removed, treatments can meaningfully reduce symptoms, improve joint function, slow disease progression, and address underlying causes. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin) and naproxen (Naprosyn) may reduce the frequency of acute attacks and relieve pain, swelling, and inflammation. Some people cannot take NSAIDs, including those who take blood thinners and have kidney concerns or stomach ulcers. Older adults (ages 65 years and older) may be more likely to experience side effects from anti-inflammatory medications. A rheumatologist can recommend an alternative medication for their condition. Medications used to manage chronic inflammation and severe flare-ups include: - Low doses of colchicine - Hydroxychloroquine (Plaquenil) - Methotrexate - Anakinra (Kineret) - Tocilizumab (Actemra) For severe pain and swelling, a clinician may use a needle to drain excess fluid from the joint, then inject a corticosteroid combined with a numbing agent to reduce inflammation and provide temporary relief. In the most severe cases, surgery may be needed to repair or replace damaged joints. Practical self-care strategies to help manage the condition at home include: - Resting the affected joints as much as possible - Using a compression wrap to reduce swelling - Applying ice therapy to ease pain and inflammation - Achieving or maintaining a healthy body weight to reduce inflammation - Staying active and following a balanced, nutritious diet ### Can Chondrocalcinosis Be Prevented? Because the exact causes of chondrocalcinosis remain incompletely understood, there is no definitive way to prevent it from developing in the first place. That said, managing underlying conditions, taking medications such as colchicine, and following a low-purine diet may help reduce the frequency of future attacks. Be sure to speak with your doctor before making significant dietary changes. ### What to Expect Going Forward Although no treatment currently exists to eliminate calcium pyrophosphate crystals from your joints, it is entirely possible to manage symptoms, reduce discomfort, and significantly lower the risk of future flare-ups. Getting an accurate diagnosis and committing to a treatment plan are the most important steps you can take to protect your joints and preserve your quality of life. A combination of medications, home remedies, and lifestyle modifications offers the best path forward. ### Chondrocalcinosis vs. Pseudogout: Is There a Difference? Chondrocalcinosis and pseudogout both refer to CPPD. People use the three terms interchangeably, though CPPD is the formal term. Chondrocalcinosis refers to the calcification of joint cartilage. Pseudogout is the former term for acute calcium pyrophosphate deposition arthritis, which involves sudden attacks of synovitis that are similar to gout. ### Key Takeaways Chondrocalcinosis is a form of arthritis caused by the accumulation of calcium pyrophosphate crystals in the joints. These deposits can trigger sudden, intense episodes of pain and inflammation lasting days or weeks — and, over time, can lead to chronic discomfort and structural joint damage. Early treatment makes a meaningful difference. Research into the causes, prevention, and treatment of chondrocalcinosis is ongoing. While no single cause has been identified, the condition is more common in older adults and may have a hereditary component. If you are experiencing joint pain and inflammation, don't wait — see a healthcare professional to get a proper diagnosis and a plan that works for you. **Sources:** - <https://www.medicalnewstoday.com/articles/chondrocalcinosis> - Calcium pyrophosphate deposition (CPPD). (2021). <https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Calcium-Pyrophosphate-Deposition-CPPD> - Calcium pyrophosphate deposition. (n.d.) <https://www.arthritis.org/diseases/calcium-pyrophosphate-deposition> - Duran, T. İ., *et al*. (2020). Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343227/> - Pseudogout. (2020). <https://www.assh.org/handcare/condition/pseudogout> - Sullivan, J., *et al*. (2021). Chondrocalcinosis: Advances in diagnostic imaging [Abstract]. <https://pubmed.ncbi.nlm.nih.gov/34623546/> - Zamora, E. A., *et al*. (2022). Calcium pyrophosphate deposition disease [Abstract]. <https://pubmed.ncbi.nlm.nih.gov/30986010/> ---
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Care planChronic Fatigue Syndrome (CFS)A chronic, persistent, or relapsing fatigue that is debilitating — or that leaves you feeling easily exhausted — that does not improve with bed rest and is severe enough to reduce your daily functioning to less than half of what it was before you became ill. ## Understanding Chronic Fatigue Syndrome ### How the International CFS Study Group Defines Chronic Fatigue Syndrome **I. A clinically evaluated, unexplained fatigue that is persistent or recurring and that:** - had a clear onset and was not present your entire life - is not caused by ongoing physical exertion - is not meaningfully relieved by rest - significantly limits your ability to work, study, socialize, or care for yourself compared to before you became ill **II. The simultaneous presence of four or more of the following symptoms, all of which must have persisted or recurred for at least six consecutive months and must not have appeared before the fatigue began:** - self-reported difficulty with short-term memory or concentration severe enough to meaningfully limit your ability to work, study, socialize, or care for yourself - sore throat - tender lymph nodes in the neck or armpits - muscle pain - pain in multiple joints without swelling or redness - headaches of a new type, pattern, or severity - sleep that leaves you feeling unrefreshed - a worsening of symptoms after physical or mental exertion that lasts more than 24 hours ### What May Cause Chronic Fatigue Syndrome - Viral infections and the fatigue that follows them - Fibromyalgia - A drop in blood pressure triggered by the nervous system (neurally-mediated hypotension) - Psychological factors that produce real biological changes in the body - A deficiency in natural killer cells — key immune system defenders ### Factors That May Worsen or Drive Chronic Fatigue Syndrome - Low oxygen levels in the blood, hormonal imbalances, and immune system dysfunction - Dysfunction related to chronic stress - Physical symptoms stemming from psychological distress - Borderline deficiencies in key nutrients - A "leaky gut," where the intestinal lining becomes abnormally permeable - An overgrowth of harmful bacteria in the gut (dysbiosis) - Sensitivities to certain foods or chemicals - Exposure to environmental chemicals - Heavy metal toxicity ### Symptoms Beyond the core symptoms listed above, **fatigue severity** can vary widely — some people are still able to work or manage at home but become exhausted easily, while others are forced to leave their jobs and drastically scale back their lives. Some patients may be bedridden, finding that even minor tasks like tidying the house or taking a short walk require a 2–3 day recovery period. More strenuous activity or formal exercise is often simply impossible. That said, many patients experience alternating stretches of profound fatigue and periods of near-normalcy. The condition typically begins gradually, with exhaustion slowly building until it becomes overwhelming. Other common symptoms include difficulty sleeping, and unintentional weight loss or gain. Additional symptoms that frequently accompany CFS: - Low-grade fever - Sore throat - Painful or swollen lymph nodes - Muscle weakness - Muscle-related headaches - Joint pain - Neurological and psychological complaints (such as brain fog, anxiety, or depression) - Disrupted sleep ### Lab Findings While laboratory testing for CFS was once cost-prohibitive and limited in scope, several labs now offer affordable, comprehensive panels that measure levels of various suspected causative agents — typically including Epstein-Barr virus, cytomegalovirus, toxoplasmosis, and candida. Antigen subtyping allows for a more precise picture of whether an infection is current, chronic, active, or resolved. It is worth noting, however, that symptom severity does not always mirror lab results: some patients with very high levels of a particular pathogen feel perfectly fine, while others with low levels may be severely ill. Common blood findings include a decreased white blood cell count, elevated lymphocytes, or atypical lymphocytes visible on a peripheral blood smear. ### Disease Course and What to Expect CFS remains underrecognized and underappreciated by many conventional physicians, despite a growing body of clinical evidence. Standard medical treatment typically focuses on suppressing or managing individual symptoms — for example, aspirin-like medications for fever, headaches, and muscle pain. Without thorough evaluation and a targeted treatment plan, patients often cycle through periods of improvement and relapse that may eventually consolidate into a persistent, unrelenting illness. However, with proper diagnosis and appropriate treatment, the majority of patients who engage fully with care can expect meaningful and even excellent recovery. ### What Research Says About Diet and Nutrition in CFS/ME > *"Nutrient deficiencies (vitamin C, vitamin B complex, sodium, magnesium, zinc, folic acid, l-carnitine, l-tryptophan, essential fatty acids, and coenzyme Q10) appear to be important in the severity and exacerbation of CFS symptoms."* > > **Reference:** *Biomedicine & Pharmacotherapy.* 2019 Jan;109:1000–1007. doi: 10.1016/j.biopha.2018.10.076. Epub 2018 Nov 5. Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach. ---
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Care planCoffee EnemaOne of the most powerful tools for supporting liver health is the coffee enema. Coffee enemas have appeared in folk medicine traditions for generations as a way to help the body eliminate toxins and built-up waste. They were even included in the *Merck Manual* — the gold standard reference guide for physicians — until 1977, when they were quietly dropped simply due to space constraints. As pharmaceuticals took center stage in medicine during the 1920s, coffee enemas fell out of favor. Over the past 10 to 15 years, however, there has been a meaningful revival of interest in their therapeutic value. ## Understanding the Coffee Enema A coffee enema is a low-volume enema that remains in the sigmoid colon — the final S-shaped segment of the large intestine. Between the sigmoid colon and the liver lies a dedicated circulatory pathway known as the enterohepatic circulation system. By the time stool reaches the sigmoid colon, it is laden with decomposed material and toxins. Through this specialized pathway, those toxins are sent directly to the liver for processing rather than being recirculated throughout the rest of the body. When administered rectally, a coffee enema helps detoxify the liver and break down fats. While coffee enemas support cleansing of the intestines, liver, and gallbladder alike, their primary purpose is liver and gallbladder detoxification. The idea of a coffee enema may feel unfamiliar — or even off-putting — to some people, but for those who try them, they can be remarkably beneficial. One particularly important application is helping to counteract the toxic burden produced by chemotherapy. Used regularly, coffee enemas can meaningfully support people who carry a high load of toxins. They can also be used on an as-needed basis to help clear acute allergic reactions, especially those triggered by chemical exposures. Dr. Sherry Rogers explores them in depth in her book, *Wellness Against All Odds*. > ⚠️ **IMPORTANT NOTE:** Caffeine is the active ingredient that makes a coffee enema work. **DO NOT USE DECAFFEINATED COFFEE.** ### What a Coffee Enema Does A coffee enema: - Increases the wave-like muscular contractions of the intestines, speeding up the emptying of the bowel - Triggers the release of toxins that have built up in the bile ducts, allowing other toxins in the body to flow into the liver for detoxification - Accelerates the emptying of liver ducts that hold detoxified materials, making the entire detoxification process more efficient - Promotes the passage of gallstones through the bile - Stimulates production of the enzyme glutathione-S-transferase, which is essential for the liver's detoxification pathways to function - Helps break down fat that has accumulated within liver cells - Assists in clearing chemical overloads and reactions to chemical exposures - Supports the body in tolerating chemotherapy and managing side effects caused by the toxic burden of cancer cell destruction - Does not wash out minerals and electrolytes — these important nutrients have already been absorbed higher up in the digestive tract, well before food residue ever reaches the sigmoid colon ---
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Care planCold / Flu (Influenza)The common cold is a mild infection of the nose and throat that can be triggered by more than 100 different viruses, including the human rhinovirus (HRV). In a single year, Americans suffer an estimated 1 billion colds. Most adults catch 2 to 4 colds per year, primarily during the Fall, Winter, and early Spring (September through May). In the United States, colds are the single most common reason people visit a healthcare provider, and the economic burden of non-influenza viral respiratory infections is projected to reach nearly $40 billion every year. Cold symptoms typically appear 2–3 days after you are first exposed to a virus and can last anywhere from a few days to several weeks. Colds tend to linger longer in children, older adults, and people who are not in optimal health. **For relief, try:** - Getting plenty of rest - Drinking plenty of fluids - Gargling with warm salt water - Using cough drops or throat sprays > 📝 **NOTE:** Honey was more effective than a placebo in controlling nighttime cough in children with upper respiratory infections (URI), according to results published online August 6, 2012 in *Pediatrics*. - Nutritional immune support There is no cure for the common cold. Most over-the-counter products aim to reduce the uncomfortable symptoms caused by your body's own inflammatory response to the infection — in other words, it's often your immune system fighting back that makes you feel so miserable. --- ## Understanding Influenza — The "Flu" Influenza, or the "flu," is a common viral infection of the respiratory tract — affecting your nose, throat, and airways. Its symptoms are typically more intense than a common cold and are more likely to involve your whole body, including your stomach and muscles. The flu spreads very easily from person to person. While most people recover within one to two weeks, serious — even life-threatening — complications like pneumonia are possible, particularly in older adults and people living with chronic illnesses. ### Signs and Symptoms - Sudden-onset fever (101–104°F) - Chills - Nausea, vomiting, or diarrhea, especially in children - Headache - Muscle aches - Fatigue - A dry cough that doesn't bring up mucus - Sore throat - Sneezing, runny nose, or nasal congestion - Loss of appetite ### What Causes the Flu? Influenza is caused by viruses that travel through the air on tiny droplets released when an infected person sneezes or coughs. Some strains cause only mild illness — or no symptoms at all — while others can trigger serious, widespread outbreaks. ### Who Is Most at Risk? People most vulnerable to catching the flu are those whose immune systems are not functioning at full strength — for example, organ transplant recipients or people living with HIV — as well as those whose daily routines bring them into frequent contact with sick individuals, such as healthcare workers. The following factors place you at the greatest risk of developing serious complications from the flu: - Being over age 50 - Having a serious underlying medical condition such as diabetes, heart disease, lung disease (including asthma or cystic fibrosis), or kidney disease - Having a weakened immune system ### Getting a Diagnosis In most cases, your healthcare provider can diagnose the flu based on a physical exam and a review of your symptoms — no elaborate testing required. ### Lifestyle Strategies That Can Help - Drink plenty of water to stay well hydrated - Rest — your body needs it to recover and to ward off complications like pneumonia - Fill your plate with fresh fruits and vegetables, which are packed with antioxidants — including vitamins A and C — that help keep your immune system strong - Exercise regularly, which may lower your chances of coming down with the flu - Actively manage your stress — consider yoga, tai chi, or other relaxation practices as part of your regular routine, since chronic stress can increase your susceptibility to viruses like influenza ### What the Research Says About Common Treatments > ⚠️ **IMPORTANT NOTE:** According to a [2015 study](http://bit.ly/1mknuzi) published in the journal *Respirology*, *"Acetaminophen may not have an effect on the flu virus or its symptoms — in theory, reducing fever, the adaptive response to infection, could actually worsen flu… Acetaminophen would reduce fevers, 'resulting in higher levels of influenza virus for longer periods, and therefore worse symptoms of the flu for longer,'"* according to coauthor Irene Braithwaite of the Medical Research Institute of New Zealand in Wellington. A 2014 Cochrane review concluded that *"Tamiflu has few if any beneficial effects, and can have adverse side effects like increased nausea and vomiting"* (see [Reuters story of April 10, 2014](http://reut.rs/1P2shRf)). **This is exactly why targeted nutritional support — particularly formulas with the right kind of immune-regulating activity — may be a smarter approach to relieving the symptoms driven by your body's inflammatory response to viral infections.** ---
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Care planColic in an InfantGastroesophageal reflux (GER) happens when the contents of your stomach flow backward, up into the esophagus — the muscular tube that connects your mouth to your stomach. GER is also known as acid reflux or acid regurgitation, because the digestive juices in your stomach contain acid. People with GER sometimes notice food or a sour, acidic liquid rising into the back of the throat. When that refluxed acid makes contact with the lining of the esophagus, it causes heartburn — also called acid indigestion. Heartburn is that familiar, uncomfortable burning sensation felt in the middle of the chest, behind the breastbone, or in the upper abdomen, the region between the chest and the hips. Gastroesophageal reflux disease (GERD) is a more serious, chronic — meaning long-lasting — form of GER. If reflux is happening more than twice a week over the course of several weeks, it may have crossed the line into GERD, which can lead to more serious health problems if left unaddressed. ## Understanding Reflux in Infants and Children ### What Causes Reflux? According to Chris Kresser, MD, author of the ebook [Heartburn & GERD](https://chriskresser.com/heartburn/): > *"Essentially, what you need to know is that heartburn is rarely caused by excess stomach acid production. Heartburn is caused by a dysfunction of the lower esophageal sphincter (LES), which is what separates the esophagus from the stomach. Normally, that sphincter is supposed to stay closed. It opens when food goes down, when we eat food and swallow it, so that the food goes into the stomach. Then it's supposed to shut, so that acid and bile don't reflux back up into the esophagus. But what happens with reflux and GERD is that the competence of the lower esophageal sphincter is impaired. So it starts to open at inappropriate times, and acid refluxes up into the esophagus. That's why acid-suppressing drugs can still work, even though the cause of heartburn is rarely excess stomach acid production. The PPIs suppress acid production almost to nothing, in some cases, if the dose is high enough. So if you don't have any acid at all in your stomach and your sphincter is still opening inappropriately, you're not going to experience heartburn and reflux, because there is no acid left to reflux into the esophagus."* The natural follow-up question is: what causes the **lower esophageal sphincter (LES)** to malfunction in the first place? There are many answers to this, but one of the primary culprits is SIBO — small intestinal bacterial overgrowth. SIBO leads to excess gas production in the small intestine and stomach, which creates pressure on the lower esophageal sphincter and can force it open at the wrong times. More broadly, any disruption in the balance of gut bacteria (dysbiosis) anywhere along the digestive tract can contribute to this problem. Another potential cause is food intolerances. In exclusively breastfed infants, this can mean sensitivity to something the mother is eating — gluten or dairy proteins, for example — that may be passing through breast milk. While the science of exactly what transfers into breast milk is still evolving, we do know that a mother's diet influences her baby in meaningful ways. Mothers of colicky babies often notice that spicy or highly allergenic foods in their own diet seem to worsen their baby's symptoms. For infants who have started eating solid foods, what's on their plate matters just as much. These are the core underlying causes of reflux in infants — and the foundation for understanding how to address it. ### Four Risk Factors for Reflux in Infants One of the most significant risk factors is **maternal antibiotic use during pregnancy** — whether to treat group B streptococcus (GBS), other infections, or even antibiotic use before conception. We now know that a mother's gut microbiome profoundly shapes her baby's. Researchers once believed that a baby's gut was completely sterile until birth, when the journey through the birth canal provided the infant's first exposure to bacteria — both vaginal microbiota and fecal bacteria — that would set the foundation of the baby's gut flora. But newer research suggests that colonization may actually begin in the womb. This means the health of a mother's gut, both before and during pregnancy, is actively shaping the microbial blueprint her baby inherits. For anyone planning to conceive, investing in gut health before pregnancy is one of the most impactful things you can do — though it's never too late to start, wherever you are in the journey. The second risk factor is **how the baby is born**. Study after study has shown that babies delivered by Caesarean section have a different — and less optimal — gut microbiome than those born vaginally. The reason is that C-section babies bypass the birth canal entirely. Instead of being colonized by the rich microbial community of the vaginal canal, they are first exposed to whatever bacteria happen to be present in the hospital environment — a very different microbial starting point. Research has linked C-section birth to higher rates of obesity, diabetes, and other health conditions later in life. This is not a criticism of emergency C-sections, which can be lifesaving for both mother and baby. But elective C-sections, which are increasingly common for scheduling convenience, carry real biological tradeoffs worth understanding. Optimizing nutrition and supporting a natural birth process, whenever safely possible, is worth the effort. The third risk factor is **how the baby is fed**. Breast milk is nature's perfectly engineered prebiotic and probiotic food for infants — the product of hundreds of thousands of generations of evolution. It contains galactooligosaccharides, special prebiotic molecules that selectively nourish bifidobacteria, one of the most beneficial and important species of bacteria in the infant gut. Some formula manufacturers have begun adding prebiotics to their products, but a synthetic approximation simply cannot replicate the full complexity of breast milk. That said, many mothers who want to breastfeed are unable to, for a wide range of valid reasons — and this is not a source of guilt. There is still much that can be done to support a baby's gut health. But when the choice is available, the research is clear: breastfeeding is strongly preferred. The World Health Organization (WHO) recommends six months of exclusive breastfeeding followed by complementary breastfeeding — meaning continuing to breastfeed alongside other foods — for up to 22 months. The fourth risk factor — **food intolerances** — is closely tied to all three of the others. Infants with poor maternal gut flora, who were born by C-section, and who were formula-fed are precisely the infants most likely to develop food intolerances in the first place. These risk factors are deeply interconnected, and understanding how they compound one another is key to understanding — and preventing — infant reflux. ---
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Care planColon CleanseYour colon — also known as the large intestine — is one of the hardest-working organs in your digestive system, and keeping it healthy is central to your overall well-being. You may have heard practitioners recommend an intestinal cleanse as part of a healthy digestive routine. The scientific evidence supporting these cleanses is still evolving, but certain approaches show real promise — particularly for relieving constipation, improving bowel regularity, and potentially even lowering colon cancer risk. Some proponents also suggest that cleansing can help clear the body of toxins and parasites. Much of the rationale behind colon cleansing traces back to an ancient concept called the theory of autointoxication. The idea is that undigested meat and other foods leave behind a mucus-like buildup in the colon — and that this buildup generates toxins that seep into the bloodstream, slowly poisoning the body from within. Believers in this theory suggest that those toxins can trigger a surprisingly wide range of symptoms, including: - Fatigue - Headache - Weight gain - Low energy At first glance, the notion that the colon can reabsorb harmful substances isn't far-fetched — after all, rectal suppositories are a well-established and rapid way to deliver medication directly into the bloodstream. That said, it's important to know that the theory of autointoxication as a whole has not been formally validated by scientific research. ---
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Care planColon PolypsA colon polyp is a small growth of cells that forms on the inner lining of the colon. Most colon polyps are harmless. But over time, some can develop into colon cancer — a disease that is often deadly when caught in its later stages. **Polyps fall into two broad categories: non-neoplastic and neoplastic.** Non-neoplastic polyps include hyperplastic polyps, inflammatory polyps, and hamartomatous polyps. These types generally do not turn into cancer. Neoplastic polyps include adenomas and serrated types. As a rule, the larger a polyp, the greater the cancer risk — particularly with neoplastic polyps. Anyone can develop colon polyps. Your risk is higher if you are 50 or older, overweight, or a smoker, or if you or a close family member has had colon polyps or colon cancer. Colon polyps often cause no symptoms at all. That is why regular screening — such as a colonoscopy — is so important. Polyps found early can almost always be removed safely and completely. Routine screening remains the single best strategy for preventing colon cancer. ### What to Watch For Many people with colon polyps have no symptoms whatsoever. You may not know a polyp is there until your doctor spots it during a routine bowel examination. That said, some people with colon polyps do notice: - **Rectal bleeding.** This can signal colon polyps or cancer, but it may also result from other causes such as hemorrhoids or small tears in the anus. - **Changes in stool color.** Blood in the stool can appear as red streaks or cause the stool to look black. Keep in mind that certain foods, medications, and supplements can also affect stool color. - **Changes in bowel habits.** Constipation or diarrhea lasting longer than a week may point to a large colon polyp — though many other conditions can cause similar changes. - **Abdominal pain.** A large polyp can partially block the bowel, causing cramping or discomfort in the belly. - **Iron deficiency anemia.** Polyps can bleed slowly over time without any visible blood in the stool. This steady, hidden blood loss gradually depletes your body's iron stores — the raw material needed to make hemoglobin, the protein in red blood cells that carries oxygen. The result is iron deficiency anemia, which can leave you feeling persistently tired and short of breath. ### When to Call Your Doctor Make an appointment with your doctor if you experience: - Abdominal pain - Blood in your stool - A change in your bowel habits that lasts longer than a week ### What Causes Colon Polyps? Under normal circumstances, cells grow and divide in a tightly regulated, orderly fashion. When certain genes mutate, however, cells can keep multiplying even when no new cells are needed. In the colon and rectum, this uncontrolled growth is what leads to polyp formation. Polyps can develop anywhere along the large intestine. As noted above, polyps fall into two main categories: non-neoplastic and neoplastic. Non-neoplastic polyps — including hyperplastic, inflammatory, and hamartomatous polyps — generally do not become cancerous. Inflammatory polyps can appear in the setting of ulcerative colitis or Crohn's disease of the colon. While these polyps themselves pose little direct threat, having either condition does raise your overall risk of colon cancer. Neoplastic polyps include adenomas and serrated types. Adenomas are the most common type of colon polyp. Serrated polyps carry a risk of becoming cancerous that depends on their size and location. In general, larger polyps carry greater cancer risk — especially among neoplastic types. ### Who Is at Risk? Several factors can increase your likelihood of developing colon polyps or colon cancer: - **Age.** Most people with colon polyps are 50 or older. - **Chronic intestinal inflammation**, such as ulcerative colitis and Crohn's disease. - **Family history.** Having a parent, sibling, or child who has had colon polyps or colon cancer raises your risk. The more family members affected, the higher your risk. In some families, however, this pattern is not driven by a known inherited gene. - **Tobacco** and **alcohol** use. - **Obesity** and **a sedentary lifestyle.** - **Race.** African-Americans are at higher risk of developing colon cancer. - **Poorly controlled type 2 diabetes.** > 📝 **NOTE: Antibiotic Use and Increased Colon Cancer Risk** — Even a single course of antibiotics was found to be associated with an increase in the risk of developing colon cancer nearly a decade later, results from a matched, case-control study suggest. This risk was particularly apparent for cancers in the proximal colon and with the use of anti-anaerobic antibiotics. > > Nearly 60% of participants in the cohort study had been prescribed more than one class of antibiotics. However, antibiotics with anti-anaerobic properties were associated with a significantly greater risk of colon cancer, especially colon cancer in the proximal colon (P < .001). > > **Reference:** *Gut.* Published online August 20, 2019. ### Inherited Polyp Conditions In rare cases, people inherit gene mutations that cause colon polyps to form. These inherited conditions carry a dramatically elevated risk of colorectal cancer. The good news is that regular screening and early detection can catch — and in many cases prevent — these cancers before they become life-threatening. Hereditary disorders associated with colon polyps include: - **Lynch syndrome**, also called hereditary nonpolyposis colorectal cancer. People with Lynch syndrome tend to develop relatively few colon polyps, but those polyps can quickly become malignant. Lynch syndrome is the most common form of inherited colon cancer and is also associated with tumors in the breast, stomach, small intestine, urinary tract, and ovaries. - **Familial adenomatous polyposis (FAP)**, a rare disorder that causes hundreds or even thousands of polyps to develop in the lining of your colon beginning during your teenage years. If the polyps aren't treated, your risk of developing colon cancer is nearly 100 percent, usually before age 40. Genetic testing can help determine your risk of FAP. - **Gardner's syndrome**, a variant of FAP that causes polyps to develop throughout your colon and small intestine. You may also develop noncancerous tumors in other parts of your body, including your skin, bones, and abdomen. - **MYH-associated polyposis (MAP)**, a condition similar to FAP that is caused by mutations in the MYH gene. People with MAP often develop multiple adenomatous polyps and colon cancer at a young age. Genetic testing can help determine your risk of MAP. - **Peutz-Jeghers syndrome**, a condition that usually begins with freckles developing all over the body, including the lips, gums, and feet. Then noncancerous polyps develop throughout the intestines. These polyps may become malignant, so people with this condition have an increased risk of colon cancer. - **Serrated polyposis syndrome**, a condition that leads to multiple serrated adenomatous polyps in the upper part of the colon. These polyps may become malignant. ### Possible Complications Some colon polyps can develop into cancer. The earlier polyps are found and removed, the less likely they are to turn malignant. ### How to Lower Your Risk Regular screening is the most powerful tool you have for reducing your risk of colon polyps and colorectal cancer. Certain lifestyle choices can also make a meaningful difference: - **Build healthy daily habits.** Fill your plate with fruits, vegetables, and whole grains, and cut back on fatty foods. Limit alcohol, quit tobacco, stay physically active, and aim for a healthy body weight. - **Calcium and vitamin D.** Studies have shown that increasing your consumption of calcium may help prevent recurrence of colon adenomas. But it isn't clear whether calcium has any protective benefits against colon cancer. Other studies have shown that vitamin D may have a protective effect against colorectal cancer. - **Know your options if your risk is elevated.** If colon polyps run in your family, consider meeting with a genetic counselor. If you have been diagnosed with an inherited condition that causes polyps, you will likely need regular colonoscopies beginning in early adulthood. ### How Polyps Are Detected Screening tests are the cornerstone of polyp detection before cancer has a chance to develop. They can also identify colorectal cancer in its earliest, most treatable stages. Common screening options include: - **Colonoscopy**, the most sensitive test for colorectal polyps and cancer. If polyps are found, your doctor may remove them immediately or take tissue samples (biopsies) for analysis. - **Virtual colonoscopy (CT colonography)**, a minimally invasive test that uses a CT scan to view your colon. Virtual colonoscopy requires the same bowel preparation as a colonoscopy. If a polyp is found, you'll need a colonoscopy to have it removed. - **Flexible sigmoidoscopy**, in which a slender, lighted tube is inserted in your rectum to examine it and the last third of your colon (sigmoid) and rectum. If a polyp is found, you'll need a colonoscopy to have it removed. - **Stool-based tests.** This type of test works by checking for the presence of blood in the stool or assessing your stool DNA. If your stool test is positive, you will need a colonoscopy. ### How Polyps Are Treated When polyps are found during a bowel examination, your doctor will typically remove all of them. Removal options include: - **Removal with forceps or a wire loop (polypectomy).** If a polyp is larger than 0.4 inches (about 1 centimeter), a liquid may be injected under it to lift and isolate the polyp from surrounding tissue so that it can be removed. - **Minimally invasive surgery.** Polyps that are too large or that can't be removed safely during screening are usually removed laparoscopically, which is performed by inserting an instrument called a laparoscope into the bowel. - **Colon and rectum removal.** If you have a rare inherited syndrome, such as FAP, you may need surgery to remove your colon and rectum (total proctocolectomy). Some polyp types are far more likely than others to become cancerous. A pathologist — a physician who specializes in examining tissue under a microscope — will typically analyze the removed polyp to determine whether it carries cancer risk. If you have had an adenomatous polyp or a serrated polyp removed, your risk of colon cancer is elevated. Exactly how much depends on the size, number, and characteristics of the polyps that were found. **Source:** <https://www.mayoclinic.org/diseases-conditions/colon-polyps/symptoms-causes/syc-20352875> ---
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Care planCompartment SyndromeCompartment syndrome is a dangerous medical condition in which pressure builds up dangerously inside a muscle compartment. If left untreated, it can cause lasting damage to muscles and nerves, and seriously disrupt blood flow to the affected area. ### What Causes It? Your arms and legs are organized into distinct groups of muscles, each wrapped in a tough, fibrous layer of tissue called fascia — think of it like the plastic insulation around an electrical wire. The space inside each fascial wrapping is called a compartment, and it houses not just muscle, but also nerves and blood vessels. Here's the critical problem: fascia cannot stretch. So when swelling occurs inside a compartment, the pressure has nowhere to go — it simply builds. That rising pressure begins to squeeze the muscles, nerves, and blood vessels within. If the pressure climbs high enough, it can completely cut off blood flow to the compartment. The result can be permanent damage to nerves and muscles. If the pressure is sustained long enough, the muscles can actually die — and in the most severe cases, amputation of the affected limb may become necessary. The swelling that triggers compartment syndrome typically follows a significant trauma — such as a car accident, crush injury, or surgery. It can also develop from complex bone fractures or serious soft tissue injuries. A chronic (long-term) form of compartment syndrome also exists, most often seen in runners and other athletes who perform repetitive movements. In these cases, pressure only spikes during the activity itself, then returns to normal with rest. Compartment syndrome most frequently affects the lower leg and forearm, though it can also develop in the hand, foot, thigh, and upper arm. ### What Does It Feel Like? The hallmark of compartment syndrome is severe pain — pain that stubbornly refuses to improve with pain medication or with elevating the affected limb. In more advanced cases, you may also experience: - Reduced sensation in the affected area - Numbness and tingling - Skin that looks pale or washed out - Pain that keeps intensifying over time - Weakness in the affected limb ### How Is It Diagnosed? During a physical exam, your doctor will typically find: - Pain when the affected area is pressed or squeezed - Intense pain when you move the area (for example, a person with compartment syndrome in the foot or lower leg will have severe pain when moving the toes up and down) - Visible swelling in the affected region To confirm the diagnosis, your doctor may need to directly measure the pressure inside the compartment. This is done by inserting a small needle connected to a pressure-measuring device directly into the affected area. The test is performed both during and after the activity that provokes your symptoms. ### What Is the Outlook? When compartment syndrome is caught and treated promptly, the outlook for full recovery of the affected muscles and nerves is excellent. That said, your overall prognosis will depend heavily on the nature and severity of the underlying injury that caused the syndrome in the first place. If diagnosis is delayed, permanent nerve damage and loss of muscle function can occur. This risk is especially high in patients who are unconscious or heavily sedated, since they cannot communicate their pain. Permanent nerve injury can set in after just **12–24 hours** of sustained compression. ### Possible Complications If compartment syndrome is not treated in time, the consequences can be severe and irreversible — including permanent nerve and muscle damage that can dramatically limit the function of the affected limb. ### Can It Be Prevented? Unfortunately, there is likely no reliable way to prevent compartment syndrome from occurring. However, recognizing it early and acting quickly can prevent many of its most serious complications. If you or a loved one is wearing a cast, it is important to understand the risk of swelling inside the cast. If pain beneath the cast worsens despite taking pain medication and keeping the limb elevated, seek care from your healthcare provider or go to the emergency room right away — do not wait. **References:** - Twaddle BC, Amendola A. "Compartment syndrome." (Chapter 13). In: Browner BD, Jupiter JB, Levine AM, Trafton PG, Krettek C (Eds.). *Skeletal Trauma* (4th ed.). Philadelphia, Pa: Saunders Elsevier; 2008. - Geiderman JM, Katz D. "General principles of orthopedic injuries." (Chapter 46). In: Marx J (Ed.). *Rosen's Emergency Medicine: Concepts and Clinical Practice* (7th ed.). Philadelphia, Pa: Mosby Elsevier; 2009. - Marshall ST, Browner BD. "Emergency care of musculoskeletal injuries." (Chapter 20). In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL (Eds.). *Sabiston Textbook of Surgery* (19th ed.). Philadelphia, Pa: Saunders Elsevier; 2012. ---
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Care planComplex Regional Pain Syndrome (CRPS)**Complex Regional Pain Syndrome (CRPS)**, also called **Reflex Sympathetic Dystrophy Syndrome**, is a chronic pain condition in which an affected area of the body receives an abnormally high volume of nerve signals. Experts believe CRPS stems from a malfunction in either the central or peripheral nervous system — essentially, a miscommunication within the body's own wiring. CRPS most commonly affects people between the ages of 20 and 35, though it can occur in children as well. Women are diagnosed more often than men. ### What Causes CRPS? CRPS likely doesn't have a single, simple cause. Instead, it probably arises from a combination of factors that converge to produce similar symptoms. One leading theory suggests that pain receptors in the affected area become sensitized to catecholamines — chemical messengers of the nervous system. When CRPS follows an injury, the immune system's response to that injury may be the trigger, producing the classic inflammatory signs of redness, warmth, and swelling. This is why many researchers believe CRPS may represent a kind of derailment of the body's normal healing process. ### What Does CRPS Feel Like? Recognizing the Symptoms The symptoms of CRPS can vary widely in intensity and duration, and they may evolve over time. A hallmark feature is continuous, intense pain that worsens rather than improves — and that often seems far out of proportion to the original injury. For example, a minor injury to a finger or toe can give rise to pain that spreads throughout the entire arm or leg, and in some cases, pain can even migrate to the opposite limb. **Additional symptoms of CRPS include:** - A persistent "burning" pain sensation - Swelling and stiffness in the affected joints - Difficulty moving the affected body part (motor disability) - Changes in nail and hair growth — either unusually rapid growth or a complete halt in growth - Skin changes — including temperature shifts (the affected limb may feel warmer or cooler than the other side), color changes (blotchy, pale, purple, or red), texture changes (skin may become shiny and thin), and episodes of excessive sweating > ⚠️ **IMPORTANT NOTE:** Emotional stress can intensify CRPS symptoms, so stress management is an important part of care. ### How Is CRPS Diagnosed? There is no single definitive test for CRPS, but several tools can help rule out other conditions. Triple-phase bone scans can detect changes in bone structure and blood circulation. Some clinicians will apply a stimulus — such as heat, touch, or cold — to check for abnormal pain responses in a specific area. Early in the course of the disorder, when symptoms may still be subtle, making a confident diagnosis of CRPS can be challenging. In practice, diagnosis rests primarily on careful observation of the following: - A documented initial injury - Pain that is disproportionately greater than what the injury would normally be expected to cause - A visible change in the appearance of the affected area - No other identifiable explanation for the pain or the changes in appearance ### How Is CRPS Treated? Because there is currently no cure for CRPS, the primary goal of treatment is to reduce and manage the painful symptoms associated with the condition. A variety of approaches are used, including psychotherapy, physical therapy, and medications such as topical pain relievers, narcotics, corticosteroids, osteoporosis medications, antidepressants, and antiseizure drugs. **Additional treatment options include:** - **Sympathetic nerve blocks:** These procedures, which can be performed in several ways, can offer meaningful pain relief for some individuals. One common approach involves placing a local anesthetic alongside the spine to directly block sympathetic nerve activity. - **Surgical sympathectomy:** This more controversial procedure works by destroying the nerves involved in generating CRPS symptoms. Some specialists report favorable results, while others believe it can worsen the condition. It is generally reserved for individuals whose pain responds dramatically — but only temporarily — to targeted sympathetic nerve blocks. - **Intrathecal drug pumps:** Small implanted pumps and catheters deliver pain-relieving medication directly into the fluid surrounding the spinal cord, allowing for precise, continuous dosing. - **Spinal cord stimulation:** In this approach, small electrodes are placed alongside the spinal cord and used to deliver gentle electrical impulses that can interrupt pain signals — providing significant relief for many people living with CRPS. **Source:** <https://www.webmd.com/pain-management/guide/complex-regional-pain-syndrome> ---
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Care planConcussion / Traumatic Brain InjuryFootball players with concussions grab a lot of headlines, but the science tells a different story: female athletes appear to be at significantly higher risk for concussion than their male counterparts. Researchers at Columbia University found that among college athletes competing in sports like soccer, football, and basketball, women were **50% more likely** to sustain sports-related concussions — and when a woman does sustain one, the damage tends to be more severe and the road to recovery tends to be longer. *"It is unclear why women appear to be at higher risk for sports-related concussion than men,"* said study investigator James Noble, MD, MS, a neurologist at The Neurological Institute of New York Taubs Institute — reported at the American Academy of Neurology 2017 Annual Meeting in Boston. A concussion is a traumatic brain injury that disrupts the way your brain works. The effects are usually temporary, but they can include headaches and trouble with concentration, memory, balance, and coordination. Concussions are most often caused by a blow to the head, but they can also happen when the head and upper body are violently shaken. They can cause a brief loss of consciousness — though most concussions don't. Because of this, many people have concussions and don't even know it. Concussions are common, especially in contact sports like football. But every concussion injures the brain to some degree — and that injury needs time and rest to heal properly. The good news: most concussive traumatic brain injuries are mild, and the vast majority of people recover fully. Your brain is the most nutrient-hungry, energy-demanding organ in your body. It weighs about three pounds and has the consistency of Jell-O. When it's injured, the effects can quickly ripple throughout your entire body. Every year, more than **3.8 million concussions** are reported; many more go unreported and undiagnosed. More than **500,000 children** are treated in emergency rooms each year for sports-related concussions alone. --- ## Understanding Concussion ### Why Early Treatment Matters The sooner a concussion is treated, the better the outcome. Treatment during the first week — and ideally within the first few days or even the first few hours — is critical. When care begins promptly, recovery can take around **20 days**. When treatment is delayed by 8 to 21 days after the injury, recovery can stretch to **30 days or longer** — and delayed care is also linked to a higher risk of post-concussion syndrome. ### Recognizing a Concussion: Signs and Symptoms Concussion symptoms can be subtle and may not appear right away. They can last for days, weeks, or even longer. The most common symptoms following a concussive traumatic brain injury are headache, memory loss (amnesia), and confusion. The amnesia — which may or may not follow a loss of consciousness — typically involves losing memory of the event that caused the concussion itself. Signs and symptoms of a concussion may include: - Headache or a feeling of pressure in the head - Temporary loss of consciousness - Confusion or feeling as if in a fog - Amnesia surrounding the traumatic event - Dizziness or "seeing stars" - Ringing in the ears - Nausea - Vomiting - Slurred speech - Delayed response to questions - Appearing dazed - Fatigue Some symptoms may appear immediately, while others can be delayed by hours or even days after the injury: - Concentration and memory complaints - Irritability and other personality changes - Sensitivity to light and noise - Sleep disturbances - Psychological adjustment problems and depression - Disorders of taste and smell ### Concussion Symptoms in Children Head injuries are very common in young children. But concussions can be especially hard to recognize in infants and toddlers, who may not yet be able to describe how they feel. Non-verbal signs that may point to a concussion include: - Appearing dazed - Listlessness and tiring easily - Irritability and crankiness - Loss of balance and unsteady walking - Crying excessively - Change in eating or sleeping patterns - Lack of interest in favorite toys ### When to See a Doctor See a doctor within 1 to 2 days if you or your child experiences a head injury, even if emergency care isn't required. The American Academy of Pediatrics recommends that you call your child's doctor for advice if your child receives anything more than a light bump on the head. If your child shows no signs of a serious head injury, remains alert, moves normally, and responds to you, the injury is likely mild and usually doesn't require further testing. In this case, if your child wants to nap, it's fine to let them sleep. If any worrisome signs develop later, seek emergency care right away. > ⚠️ **IMPORTANT NOTE:** Seek emergency care immediately for any adult or child who sustains a head injury and experiences any of the following symptoms: > > - Repeated vomiting > - A loss of consciousness lasting longer than 30 seconds > - A headache that gets worse over time > - Changes in behavior, such as irritability > - Changes in physical coordination, such as stumbling or clumsiness > - Confusion or disorientation, such as difficulty recognizing people or places > - Slurred speech or other changes in speech > - Seizures > - Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes > - Lasting or recurrent dizziness > - Obvious difficulty with mental function or physical coordination > - Symptoms that worsen over time > - Large head bumps or bruises on areas other than the forehead in children, especially in infants under 12 months of age When a concussion is left untreated, treated too late, or treated incorrectly or incompletely, **post-concussive syndrome** can become a chronic condition — with symptoms that persist for more than three months after the initial injury. Over time, chronic post-concussive syndrome can lead to lasting problems such as migraines, dizziness, memory difficulties, brain fog, fatigue, and sleep disturbances that interfere with everyday life. ### A Note for Athletes No one should return to play or vigorous activity while signs or symptoms of a concussion are still present. Experts recommend that any athlete suspected of having a concussion be medically evaluated by a healthcare professional trained in concussion assessment and management before returning to play. Children and adolescents should be evaluated by a provider with specific training in pediatric concussions. Experts also agree that adult, child, and adolescent athletes with a concussion should not return to play on the same day as the injury. **References:** Centers for Disease Control and Prevention and Mayo Clinic website ---
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Care planConjunctivitis (Pink Eye)Pink eye — known medically as conjunctivitis — is an acute inflammation of the clear membrane that lines the inner surface of your eyelids and covers the white part of the eye. It can be caused by a virus, a bacterium, or an allergic reaction. In fact, bacteria are responsible for only about 25% of cases. The majority of cases are caused by viruses (especially adenoviruses) or allergies, though everyday irritants like smoke, dust, wind, sunlamps, snow glare, the common cold, certain rashes, and contact lenses can also be to blame. In newborns, the most common culprits are a chemical reaction to silver nitrate eye drops, chlamydia, gonorrhea, other bacteria (strep pneumonia, staph aureus, Hemophilus influenza), and viruses (especially Herpes Simplex I and II). It is also possible for a bacterial infection to develop on top of a viral or allergic case of pink eye. Allergic pink eye tends to linger until the triggering season ends (for example, spring hay fever), until the specific allergen is identified and avoided, or until symptoms are managed with homeopathic desensitizing drops and nutritional support. Viral pink eye usually clears up on its own within 1–2 weeks, but it is highly contagious — so it is important to avoid spreading the infection from one eye to the other or to someone else. Simple precautions, like using separate towels, go a long way. Bacterial pink eye, on the other hand, requires prompt treatment to prevent damage to the eye. If you wear contact lenses, remove them for a few days, support your recovery with good nutrition, and reintroduce lens wear gradually once your eyes have healed. If the underlying cause is not addressed, pink eye can become a chronic condition. While the symptoms are generally milder than the acute form, they can still be quite bothersome — persistent redness, itching, a stinging sensation, and the feeling that something is stuck in your eye. ### How to Tell What Type of Pink Eye You Have - **Viral:** Clear discharge; minimal or absent lid swelling; no itching; often, lymphadenopathy of periauricular node is present. - **Allergic:** Clear, mucoid discharge; high eosinophils; mild to marked lid swelling; severe itching with increased lacrimation; no nodal involvement. - **Bacterial:** Purulent, green discharge; high polymorphonuclear leukocytes; moderate lid swelling; no itching; no nodal involvement; possible fever. - **Contact Lens Wearers:** Mild to marked lid swelling; mild to moderate itching; usually no discharge. Regardless of the cause, you may wake up in the morning to find your eyelids crusted or stuck together. For children experiencing this for the first time, it can be quite frightening — so a gentle heads-up from a parent or caregiver goes a long way. ### Pink Eye in Newborns - **Gonorrhea:** Usually occurs within 3–5 days of birth. - **Chlamydia:** Usually occurs within 5–14 days of birth. - **Chemical irritation from silver nitrate** (now rare, as most hospitals have switched to erythromycin): Occurs 6–8 hours after instillation into the eyes. ---
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Care planConstipationConstipation is the single most common digestive complaint in the United States — and it's far more than just an inconvenience. It drives more than 2.5 million doctor visits every year and tops the list of reasons people reach for something off the pharmacy shelf to treat themselves. Consider the scale of this: more than 35% of Americans struggle with constipation, and over $1 billion is spent on over-the-counter laxatives each year. This is a genuine public health concern — not a minor annoyance. > 📝 **NOTE:** A [2020 study](https://www.nature.com/articles/s41467-019-14177-z) published in *Nature Communications*, which analyzed the impact of common medications on the composition and metabolic function of gut bacteria, showed that of 41 classes of medications, 19 were associated with changes in the microbiome — most notably antibiotics, proton pump inhibitors, laxatives, and metformin. The good news? There are alternative approaches that are both safer and more effective than conventional laxatives — and they work for more people than fiber supplements alone. ### What Does Constipation Actually Feel Like? When constipation goes unmanaged, it rarely stays silent. Most people develop a range of uncomfortable symptoms that extend well beyond the bathroom — affecting how they feel throughout the day. In serious or long-standing cases, constipation can progress to fecal impaction, which may paradoxically cause severe diarrhea, colon ulceration, or even intestinal obstruction. The full spectrum of symptoms includes: - Large bowel pain - Rectal discomfort - Abdominal fullness - Nausea - Loss of appetite - A general sense of feeling unwell ### What's Causing Your Constipation? Diet, Lifestyle, and Beyond Constipation rarely has a single cause. A wide range of factors — many of them modifiable — can contribute, including: - Not eating enough fiber - Not drinking enough fluids - Digestive enzyme issues - Food sensitivities or allergies - Insufficient physical activity - Misuse of laxatives - Thyroid disorders - High blood calcium (hypercalcemia) - Inflammatory bowel conditions - Neuromuscular disorders - Acute diverticulitis - Certain medications — including antacids containing aluminum or calcium, opioid pain relievers, antibiotics, antidepressants, anti-Parkinson's drugs, and diuretics — can all slow things down. Even pregnancy is a well-known trigger. Age is another factor worth understanding. As we get older, the wall of the colon tends to thicken. When that natural change is combined with a lifetime of eating too little fiber, constipation becomes increasingly likely. What you eat matters enormously. Cutting back on high-fiber vegetables, fruits, and whole grains — while eating more high-fat meats, dairy products, and refined sugar — creates the perfect conditions for constipation to develop. Hydration is equally important and frequently overlooked. Water and other healthy fluids add bulk and softness to stool, making bowel movements easier and more regular. Most people simply aren't drinking enough. Despite all of these known causes, many people experience chronic constipation because their bowel is simply sluggish — it doesn't contract with enough force or regularity (a process called peristalsis) — and they need more targeted, active strategies to keep things moving consistently. ### The Constipation–Headache Connection: More Than a Coincidence Constipation and headaches occur together more often than most people realize — and the connection isn't random. Several well-studied mechanisms help explain why these two seemingly unrelated problems so frequently go hand in hand: **1. Dehydration as a Common Link** - **How it works:** Constipation is often triggered by not drinking enough water, and that same dehydration can cause headaches. When the body is low on fluids, there's less water available to soften stool — contributing to constipation. At the same time, dehydration reduces blood volume, which limits the delivery of oxygen and nutrients to the brain, setting the stage for tension headaches and migraines. **Reference:** Blau, J. N., & Kell, C. A. (2004). "Water-deprivation headache: a new headache with two variants." *Headache: The Journal of Head and Face Pain*, 44(1), 79–83. <https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2004.04011.x> **2. The Gut-Brain Axis and Inflammation** - **How it works:** The gut and brain are in constant, two-way communication through what scientists call the gut-brain axis. When constipation disrupts this system, it can fuel systemic inflammation — a known contributor to both migraines and tension headaches. **Reference:** Rhee, S. H., Pothoulakis, C., & Mayer, E. A. (2009). "Principles and clinical implications of the brain–gut–enteric microbiota axis." *Nature Reviews Gastroenterology & Hepatology*, 6(5), 306–314. <https://www.researchgate.net/publication/24379066_Principles_and_clinical_implications_of_the_brain-gut-enteric_microbiota_axis> **3. Toxin Buildup** - **How it works:** When waste moves too slowly through the colon, byproducts like ammonia can accumulate in the bloodstream. For people who are sensitive to shifts in body chemistry, this buildup can be enough to trigger a headache. **Reference:** Mertz, H. (2003). "Irritable bowel syndrome." *New England Journal of Medicine*, 349(22), 2136–2146. <https://www.nejm.org/doi/full/10.1056/NEJMra035579> **4. Stress and Serotonin** - **How it works:** Stress affects both gut function and headache frequency — and serotonin is the common thread. This key neurotransmitter regulates both bowel motility and pain signaling in the brain. When serotonin levels drop, the result can be both sluggish bowel function and an increased susceptibility to migraines. **Reference:** Gershon, M. D. (1999). "The enteric nervous system: a second brain." *Hospital Practice*, 34(7), 31–42. <https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2004.04011.x> **5. IBS, Migraines, and Shared Biology** - **How it works:** People with Irritable Bowel Syndrome (IBS) frequently experience both constipation and migraines. These conditions appear to share an underlying biology — involving altered gut motility and the way the central nervous system processes pain signals. **Reference:** Tornblom, H., Van Oudenhove, L., Holvoet, L., & Tack, J. (2012). "Gastrointestinal symptoms in migraine: a cross-sectional study in the general population." *Cephalalgia*, 32(5), 345–353. Taken together, these findings reveal that constipation and headaches are not coincidental companions — they are often linked through shared physiological and neurological pathways that deserve to be addressed together. ---
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Care planCOPD (Chronic Obstructive Pulmonary Disease)Chronic Obstructive Pulmonary Disease (COPD) is a condition that makes breathing a daily struggle. For many people, the first sign is a persistent cough that brings up mucus. The two most common forms of COPD are chronic bronchitis and emphysema — and often, both are present at the same time. Picture your airways as an upside-down tree, with branches reaching deep into your lungs. At the tip of each branch sit tiny, balloon-like air sacs. In healthy lungs, both the airways and air sacs are springy and flexible — they expand when you breathe in and snap back when you breathe out. In COPD, that springiness is lost. Your airways and air sacs become floppy and misshapen, much like a rubber band that's been stretched out too many times. Cigarette smoking is the leading cause of COPD. Breathing in other irritants — pollution, dust, or chemicals — can also trigger or worsen the disease. The single most powerful step you can take to protect yourself? Quit smoking. *NIH: National Heart, Lung, and Blood Institute* --- ## Understanding Lung Disease ### Chronic Obstructive Pulmonary Disease (COPD) **COPD can cause a variety of symptoms, including:** - Chronic breathlessness - Persistent cough - Increased mucus production - Shortness of breath (especially during physical activity) - Wheezing - Tightness in the chest ### Interstitial Lung Diseases: When the Lungs Scar From Within Interstitial lung disease is an umbrella term for a large group of conditions that cause inflammation or scarring deep within the lung tissue. That inflammation and scarring make it increasingly difficult to take in enough oxygen. The scarring itself is called pulmonary fibrosis. Breathing in dust or other particles suspended in the air is responsible for some types of interstitial lung disease. Specific types include: - Black lung disease among coal miners, from inhaling coal dust - Farmer's lung, from inhaling farm dust - Asbestosis, from inhaling asbestos fibers - Siderosis, from inhaling iron from mines or welding fumes - Silicosis, from inhaling silica dust Other causes include autoimmune diseases or long-term exposure to molds, gases, or fumes in the workplace. In some cases, no cause is ever identified. Treatment depends on the type of exposure and how far the disease has progressed. Options may include medications, supplemental oxygen therapy, or — in the most severe cases — a lung transplant. ### Pulmonary Fibrosis: When Scar Tissue Takes Over Pulmonary fibrosis occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it increasingly difficult for your lungs to do their job. As pulmonary fibrosis progresses, breathlessness worsens — often gradually, but relentlessly. The scarring associated with pulmonary fibrosis can be triggered by many different factors. But in most cases, doctors are never able to pinpoint the exact cause. When no cause can be identified, the condition is called idiopathic pulmonary fibrosis. The lung damage caused by pulmonary fibrosis cannot be reversed, but medications and other therapies can sometimes help ease symptoms and improve quality of life. For some people, a lung transplant may be the right path forward. Signs and symptoms of pulmonary fibrosis include: - Shortness of breath (dyspnea) - A dry cough - Fatigue - Unexplained weight loss - Aching muscles and joints The course of pulmonary fibrosis — and the severity of symptoms — can vary considerably from person to person. Some people become seriously ill very quickly. Others experience more moderate symptoms that worsen slowly over months or years. **Causes** Pulmonary fibrosis scars and thickens the delicate tissue surrounding the tiny air sacs (alveoli) in your lungs — the very places where oxygen crosses into your bloodstream. When that tissue stiffens, oxygen transfer becomes difficult. The damage can be triggered by many different things, including airborne toxins in the workplace, certain lung diseases, and even some types of medical treatments. **Occupational and Environmental Factors** Prolonged exposure to certain toxins and pollutants can cause lasting damage to your lungs. These may include: - Silica dust - Asbestos fibers - Grain dust - Bird and animal droppings **Radiation Treatments** Some people who receive radiation therapy for lung or breast cancer develop signs of lung damage months — or sometimes years — after their initial treatment. The severity of the damage depends on: - How much of the lung was exposed to radiation - The total amount of radiation administered - Whether chemotherapy also was used - The presence of underlying lung disease **Medications** A surprising number of medications can damage the lungs, especially: - **Chemotherapy drugs.** Drugs designed to kill cancer cells, such as methotrexate (Trexall) and cyclophosphamide (Cytoxan), can also damage lung tissue. - **Heart medications.** Some drugs used to treat irregular heartbeats, such as amiodarone (Cordarone, Nexterone, Pacerone) or propranolol (Inderol, Inderide, Innopran) may harm lung tissue. - **Some antibiotics.** Nitrofurantoin (Macrobid, Macrodantin, others) and sulfasalazine (Azulfidine) can cause lung damage. **Medical Conditions** Lung damage can also result from: - Tuberculosis - Pneumonia - Systemic lupus erythematosus - Rheumatoid arthritis - Sarcoidosis - Scleroderma ### Idiopathic Pulmonary Fibrosis: When the Cause Remains a Mystery The list of substances and conditions that can lead to pulmonary fibrosis is long. Even so, in most cases, the cause is never found. Pulmonary fibrosis with no identifiable cause is called idiopathic pulmonary fibrosis. Researchers have put forward several theories about what might trigger idiopathic pulmonary fibrosis, including viral infections and exposure to tobacco smoke. And because one form of idiopathic pulmonary fibrosis tends to run in families, genetics is also thought to play a role. **Risk Factors** Factors that may make you more susceptible to pulmonary fibrosis include: - **Age.** Although pulmonary fibrosis has been diagnosed in children and infants, the disorder is much more likely to affect middle-aged and older adults. - **Smoking.** Far more smokers and former smokers develop pulmonary fibrosis than do people who have never smoked. - **Your occupation.** You have an increased risk of developing pulmonary fibrosis if you work in mining, farming, or construction, or if you're exposed to pollutants known to damage your lungs. - **Cancer treatments.** Having radiation treatments to your chest or using certain chemotherapy drugs makes you more susceptible to pulmonary fibrosis. - **Genetic factors.** Some types of pulmonary fibrosis appear to run in families, so a genetic component is suspected. **Potential Complications of Pulmonary Fibrosis:** - **High blood pressure in your lungs (pulmonary hypertension).** Unlike systemic high blood pressure, this condition affects only the arteries in your lungs. It begins when the smallest arteries and capillaries are compressed by scar tissue, causing increased resistance to blood flow in your lungs. This in turn raises pressure within the pulmonary arteries. Pulmonary hypertension is a serious illness that becomes progressively worse and may eventually prove fatal. - **Right-sided heart failure (cor pulmonale).** This serious condition occurs when your heart's lower right chamber (ventricle) has to pump harder than usual to move blood through partially blocked pulmonary arteries. - **Respiratory failure.** This is often the last stage of chronic lung disease. It occurs when blood-oxygen levels fall dangerously low. - **Lung cancer.** Long-standing pulmonary fibrosis also increases your risk of developing lung cancer. ### Emphysema: When the Air Sacs Break Down Emphysema is a key driver in the progression of chronic obstructive pulmonary disease (COPD) — a condition that restricts airflow when you breathe out. It develops when the tiny air sacs at the tips of your smallest airways (bronchioles) are slowly destroyed. Cigarette smoking is the leading cause. As emphysema advances, those delicate, grape-cluster-like air sacs are transformed into large, irregular pockets riddled with holes in their walls. The result: fewer functional air sacs and less oxygen reaching your bloodstream. On top of that, the elastic fibers that normally hold small airways open are progressively destroyed — so when you breathe out, those airways collapse and trap stale air inside your lungs. Airway obstruction, another hallmark of COPD, compounds this problem. Together, emphysema and obstructed airways make breathing increasingly laborious. Treatment can often slow the progression, but it cannot reverse the damage that has already occurred. **Symptoms** Emphysema symptoms tend to be subtle at first but worsen steadily as the disease advances. The main emphysema symptoms are: - Shortness of breath - Wheezing - Chest tightness - Reduced capacity for physical activity - Chronic coughing, which could also indicate chronic bronchitis, loss of appetite and weight - Fatigue These signs and symptoms don't necessarily mean you have emphysema, but they do signal that your lungs aren't working as they should — and that's reason enough to see your doctor as soon as possible. **Causes** The causes of emphysema include: - **Smoking.** Cigarette smoke is by far the most common cause of emphysema. There are more than 4,000 chemicals in tobacco smoke, including secondhand smoke. These chemical irritants slowly destroy the small peripheral airways, the elastic air sacs, and their supporting elastic fibers. - **Protein deficiency.** Approximately 1 to 2 percent of people with emphysema have an inherited deficiency of a protein called AAt, which protects the elastic structures in the lungs. Without this protein, enzymes can cause progressive lung damage, eventually resulting in emphysema. If you're a smoker with a lack of AAt, emphysema can begin in your 30s and 40s. The progression and severity of the disease are greatly accelerated by smoking. **Risk Factors** Risk factors for emphysema include: - **Smoking.** Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked. - **Age.** Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60. - **Exposure to secondhand smoke.** Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe, or cigar. Being around secondhand smoke increases your risk of emphysema. - **Occupational exposure to fumes or dust.** If you breathe fumes from certain chemicals or dust from grain, cotton, wood, or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke. - **Exposure to indoor and outdoor pollution.** Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema. - **HIV infection.** Smokers living with HIV are at greater risk of emphysema than are smokers who don't have HIV infection. - **Connective tissue disorders.** Some conditions that affect connective tissue — the fibers that provide the framework and support for your body — are associated with emphysema. These conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton, and lungs. **Complications** Emphysema can worsen other chronic conditions, such as diabetes and heart failure. If you have emphysema, exposure to air pollution or a respiratory infection can trigger a sudden COPD flare-up (exacerbation), bringing on extreme shortness of breath and dangerously low oxygen levels. In severe cases, this may require admission to an intensive care unit and temporary support from a mechanical ventilator until the infection resolves. ### Chronic Bronchitis: A Cough That Won't Quit Bronchitis is an inflammation of the lining of your airways, or bronchial tubes. When those airways are inflamed or infected, less air can move in and out of your lungs — and coughing up heavy mucus or phlegm becomes a daily reality. There are two types of bronchitis: acute and chronic. - **Acute bronchitis** can accompany a cold and clears up after a week or two. - A person with **chronic bronchitis** has a mucus-producing cough most days of the month, three months of a year for two years in a row without other underlying disease to explain the cough. After a long period of irritation: - Excess mucus is produced constantly - The lining of the airways becomes thickened, and an irritating cough develops - Air flow may be hampered - The lungs become scarred - The airways then create an ideal environment for recurrent infections Chronic bronchitis doesn't strike suddenly. After a winter cold seems to have cleared, you may find yourself still coughing and producing large amounts of mucus for several weeks. Because people who develop chronic bronchitis are often smokers, that lingering cough is frequently dismissed as nothing more than a "smoker's cough." Over time, colds become more damaging. Coughing and bringing up phlegm last longer after each illness. Without realizing it, you may begin to accept this constant coughing and mucus production as simply part of life — year-round. The cough tends to be worse in the morning and in cold, damp weather. You may bring up an ounce or more of yellow mucus each day. In 2009, it was estimated that 9.9 million Americans had received a physician diagnosis of chronic bronchitis. It's also worth noting that a person with chronic bronchitis may also develop emphysema — and when both conditions exist together, they are collectively referred to as Chronic Obstructive Pulmonary Disease (COPD). **How Serious Is Chronic Bronchitis?** Many people ignore the warning signs of chronic bronchitis until the disease is well advanced, mistakenly believing it isn't life-threatening. But waiting to seek treatment can mean your lungs have already sustained serious injury — putting you at real risk for severe respiratory problems or even heart failure. The good news: chronic bronchitis can be caught early, and there is much that can be done to treat and manage the disease effectively. **What Causes Chronic Bronchitis?** Cigarette smoking is by far the most common cause of chronic bronchitis. In some cases, the airways may have first been irritated by bacterial or viral infections. People with long-term occupational exposure to industrial dusts and fumes — such as coal miners, grain handlers, and metal molders — are also at high risk. Air pollution can further aggravate chronic bronchitis symptoms. ### Feather Duvet Lung: When Your Bedding Becomes a Breathing Hazard "Feather duvet lung" is an inflammatory reaction to goose or duck feathers in linens. It's a form of the lung condition hypersensitivity pneumonitis, which itself is one of many disorders that fall under the umbrella of interstitial lung disease (ILD). Feather duvet lung is a type of "hypersensitive pneumonitis" — a condition in which your immune system mounts an inflammatory response to a specific environmental trigger, causing the air sacs and airways of the lungs to become inflamed. There are many variations of this condition: farmer's lung (triggered by dust from hay, corn, or other crops) and wood-worker's lung (triggered by sawdust) are two well-known examples. These are all forms of hypersensitivity pneumonitis, which is one of many disorders that fall under the umbrella of interstitial lung disease. Feather duvet lung is your body's reaction to long-term exposure to environmental irritants — such as feathers — found in your bedding. That exposure triggers an inflammatory response, causing the tiny air sacs in your lungs to become swollen and irritated. If you're experiencing symptoms like shortness of breath, cough, or chest pain — and you sleep under a down comforter — it's important to work with your doctors to explore all possible causes. Your bedding may well be the culprit. It may seem hard to believe that your bedding could be behind your breathing troubles, but lung specialist Daniel Culver, DO, says otherwise. *"We never cease to be amazed by some of the things that cause hypersensitivity pneumonitis in some people's environments,"* he says. Feather duvet lung is one type of a larger condition called bird fancier's lung, one of the most common forms of hypersensitivity pneumonitis. Pet bird owners take heed: feathers and droppings can also cause inflammation in the lungs. Even arts and craft materials, such as feathers, can cause irritation. **Source:** <https://health.clevelandclinic.org/is-your-bedding-disrupting-your-breathing/> ---
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Care planCopper ToxicityCopper toxicity is a medical condition that occurs when too much copper builds up in your body — though severe cases are uncommon. Copper is a mineral your body genuinely needs, but like many things in life, too much of a good thing can cause problems. Copper and zinc work in a careful balancing act within the body, so anything that disrupts your zinc levels can throw off that balance and push your copper levels too high.[³] ## Understanding Copper Toxicity **Acute copper poisoning has been noted in instances where beverages were stored in copper-containing containers or from contaminated water supplies.** The U.S. Environmental Protection Agency and the World Health Organization have set guideline values for copper in drinking water at 1.3 mg/liter and 2 mg/liter, respectively.[³] **Chronic copper toxicity, arising from long-term exposure to lower doses of copper, can potentially cause liver damage.** That said, in otherwise healthy people, daily copper intake of up to 10 mg has not been shown to damage the liver. For this reason, the U.S. Food and Nutrition Board has established 10 mg/day — from food and supplements combined — as the safe upper limit. People with inherited conditions that affect how the body handles copper may experience harm at much lower intake levels.[³] **In some instances, overconsumption has been reported, with copper intake levels as high as 7.8 mg/day over a period of 147 days.** At these levels, there is reason to be concerned about negative effects on immune function and the body's antioxidant defenses.[³] **Copper exists in two forms in the blood: approximately 85% to 95% is bound to ceruloplasmin, and the remaining is "free," loosely bound to albumin and other small molecules.** Copper poisoning is relatively uncommon in Western countries, though it is seen more frequently in parts of South Asia, particularly in rural communities. Newborns and infants are especially vulnerable because their systems for clearing excess copper are not yet fully developed.[²] ---
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Care planCrepitus (Joint Popping)In orthopedic and sports medicine, "crepitus" is the technical term for the popping, clicking, or crackling sounds a joint makes. These sounds often simply mean that air is moving within the joint — which is usually nothing to worry about. Crepitus most commonly occurs in the knees, but it can show up in other joints as well, including the shoulder, elbow, and neck. When crepitus is accompanied by pain, however, it may be a signal of wear and tear or an underlying injury worth investigating. ### What Does Joint Popping or Cracking Feel Like? Joint sounds can be a completely normal part of everyday movement, and many people notice them more as they age. Here's what you might experience: - Popping or cracking when you bend your knee or elbow - A crunching sensation in your knee when climbing stairs or kneeling - Crackling, grinding, or crunching when you move your shoulder - Occasional or persistent swelling around the affected joint ### What Causes Crepitus and Joint Popping? In most cases, crepitus is harmless. It typically occurs when air works its way into the soft tissues surrounding a joint — like the kneecap — and the bubbles burst when you bend that joint, producing an audible crack. That said, not all joint sounds are benign. When popping or crunching comes with pain, it's worth seeing a doctor to find out what's going on. **Common causes of painful joint popping include:** - **Osteoarthritis:** Arthritis occurs when the protective cartilage in a joint gradually wears away, leaving bones exposed and inflamed. As the bones rub against each other, they cause pain and stiffness that typically worsens with activity. - **Patellofemoral pain syndrome (PFS):** Commonly called "runner's knee," PFS produces crepitus along with pain behind the kneecap (patella). It often develops when you ramp up your activity level too quickly and is frequently triggered by running, squatting, or jumping. PFS tends to be more common in women than in men. - **Torn cartilage:** A cartilage tear can result from a sports injury, a fall, or an accident — and is another recognized cause of painful crepitus. ### How Is Crepitus Treated — in the Knee, Shoulder, or Other Joints? The good news is that many causes of joint popping and cracking respond well to simple home remedies, such as over-the-counter anti-inflammatory medications or the "RICE method" (rest, ice, compression, and elevation). More persistent or severe cases may benefit from a doctor's guidance. > *"Our joints are mobile, so there are a lot of things that slide over or run past each other. When they move, there is the potential for anatomy to intersect."* Pockets of nitrogen gas can also form within the fluid that lubricates joints and nourishes cartilage — and when those pockets shift or burst, they can produce popping sounds as well. > *"It's not known if it is the creation or the popping of the bubbles that makes the sounds though."* Robert Gallo, M.D., an orthopedic sports medicine specialist at Hershey Medical Center, noted that the only time people need to get concerned about noisy joints is if the sounds are accompanied by swelling and/or pain. Contrary to what many people believe, both doctors agree there is no established link between joint sounds and arthritis. Gallo noted that some patients turn to chondroitin and glucosamine supplements — or joint injections — to help keep their joints lubricated. While the scientific evidence supporting these approaches is limited, *"there is little downside other than cost. They are relatively safe as far as we know."* Regularly stretching the tendons and ligaments around a joint, and strengthening the surrounding muscles, can help keep joints properly aligned — particularly the kneecap, which sits in a relatively shallow groove and depends heavily on that muscular support to stay centered. **Sources:** - <https://chicagohealthonline.com/joint-cracks-pops-usually-not-cause-concern/> - <https://www.aurorahealthcare.org/services/orthopedics/conditions/crepitus> ---
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Care planCushing SyndromeCushing syndrome is a condition that develops when your body is exposed to elevated levels of the stress hormone cortisol over an extended period of time. Sometimes called **hypercortisolism**, Cushing syndrome can arise from taking oral corticosteroid medications — or from your body simply producing too much cortisol on its own. Chronically high cortisol levels can produce some of the most recognizable hallmarks of Cushing syndrome: a fatty hump between the shoulders, a rounded "moon" face, and pink or purple stretch marks across the skin. Beyond these visible changes, Cushing syndrome can also drive high blood pressure, weaken your bones, and — in some cases — trigger type 2 diabetes. The good news is that effective treatments exist to bring cortisol levels back to normal and meaningfully improve how you feel. As with most conditions, the sooner treatment begins, the better your chances for a full recovery. ## Understanding Cushing Syndrome ### What Does Cushing Syndrome Look and Feel Like? The signs and symptoms of Cushing syndrome can vary widely depending on just how elevated your cortisol levels are. **The most common signs involve gradual weight gain and changes to the skin, including:** - Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump) - Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms - Thinning, fragile skin that bruises easily - Slow healing of cuts, insect bites and infections - Acne **Women with Cushing syndrome may also notice:** - Thicker or more visible body and facial hair (hirsutism) - Irregular or absent menstrual periods **Men with Cushing syndrome may experience:** - Decreased libido - Decreased fertility - Erectile dysfunction **Additional signs and symptoms that can affect anyone include:** - Severe fatigue - Muscle weakness - Depression, anxiety and irritability - Loss of emotional control - Cognitive difficulties - New or worsened high blood pressure - Headache - Bone loss, leading to fractures over time - In children, impaired growth **When should you see a doctor?** Reach out to your doctor if you notice symptoms that point to Cushing syndrome — particularly if you are currently taking a corticosteroid medication to manage a condition like asthma, arthritis, or inflammatory bowel disease. --- ### What Causes Cushing Syndrome? **The role of your adrenal glands** The root cause of Cushing syndrome is too much cortisol circulating in the body. Cortisol is produced by your adrenal glands and serves many vital functions — it helps regulate blood pressure, keeps your cardiovascular system running smoothly, helps your body handle stress, and governs how you convert proteins, carbohydrates, and fats from food into usable energy. When cortisol levels climb too high and stay there, Cushing syndrome can develop. **When medications are the culprit** Cushing syndrome can originate from a source outside your body — this is called exogenous Cushing syndrome. The most common external trigger is taking oral corticosteroid medications, such as prednisone, at high doses over a prolonged period. These drugs mimic the effects of cortisol in the body, and when taken in doses higher than what your body naturally produces, the excess can lead to Cushing syndrome. Oral corticosteroids are often necessary to manage inflammatory diseases like rheumatoid arthritis, lupus, and asthma, or to prevent organ rejection after a transplant. Because the therapeutic doses required are frequently higher than your body's normal daily cortisol need, unwanted side effects from cortisol excess can occur. It is also possible — though less common — to develop Cushing syndrome from injectable corticosteroids, such as repeated joint injections for pain, bursitis, or back problems. Inhaled steroids used for asthma and topical steroid creams used for skin conditions like eczema carry a lower risk, but in certain individuals — especially at high doses — they too can trigger Cushing syndrome. **When your own body produces too much cortisol** Cushing syndrome can also arise entirely from within — a form known as endogenous Cushing syndrome. This happens when one or both adrenal glands overproduce cortisol, or when there is excess production of adrenocorticotropic hormone (ACTH), the hormone that normally signals the adrenal glands to release cortisol. In these cases, the underlying cause may be one of the following: - **A pituitary gland tumor (pituitary adenoma).** A noncancerous (benign) tumor of the pituitary gland, located at the base of the brain, secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this form of the syndrome develops, it's called Cushing disease. It occurs much more often in women and is the most common form of endogenous Cushing syndrome. - **An ectopic ACTH-secreting tumor.** Rarely, when a tumor develops in an organ that normally does not produce ACTH, the tumor will begin to secrete this hormone in excess, resulting in Cushing syndrome. These tumors, which can be noncancerous (benign) or cancerous (malignant), are usually found in the lungs, pancreas, thyroid or thymus gland. - **A primary adrenal gland disease.** In some people, the cause of Cushing syndrome is excess cortisol secretion that doesn't depend on stimulation from ACTH and is associated with disorders of the adrenal glands. The most common of these disorders is a noncancerous tumor of the adrenal cortex, called an adrenal adenoma. - **Cancerous tumors of the adrenal cortex (adrenocortical carcinomas)** are rare, but they can cause Cushing syndrome as well. Occasionally, benign, nodular enlargement of both adrenal glands can result in Cushing syndrome. - **Familial Cushing syndrome.** Rarely, people inherit a tendency to develop tumors on one or more of their endocrine glands, affecting cortisol levels and causing Cushing syndrome. ### What Can Happen If Cushing Syndrome Goes Untreated? Left untreated, Cushing syndrome can lead to serious, compounding health problems, including: - Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet - High blood pressure (hypertension) - Type 2 diabetes - Frequent or unusual infections - Loss of muscle mass and strength ### How Is Cushing Syndrome Treated? All treatments for Cushing syndrome share the same fundamental goal: bringing the excess cortisol in your body back down to a healthy level. The right treatment path for you will depend on the underlying cause of your condition. Here is an overview of the available options: **Cutting Back on Corticosteroid Medications** If long-term corticosteroid use is driving your Cushing syndrome, your doctor may be able to bring your symptoms under control by carefully tapering the dose downward over time — while still keeping your underlying condition, such as asthma or arthritis, adequately managed. For many conditions, your doctor may be able to switch you to non-corticosteroid alternatives, which could allow for a further reduction — or even elimination — of corticosteroid use. It is essential, however, that you never reduce your dose or stop taking these medications on your own. Any changes must be made under your doctor's direct supervision. Stopping corticosteroids abruptly can cause dangerously low cortisol levels. A slow, supervised taper gives your body the time it needs to gradually resume producing cortisol on its own. **Surgery** When a tumor is responsible for your Cushing syndrome, surgical removal is often the recommended approach. Pituitary tumors are typically removed by a neurosurgeon using a technique performed through the nose. Tumors located in the adrenal glands, lungs, or pancreas can be removed through traditional open surgery or, in many cases, through minimally invasive procedures that require only small incisions. Following surgery, you will need to take cortisol replacement medications to ensure your body has the right amount of this essential hormone. In most cases, normal adrenal hormone production will gradually return, and your doctor will slowly taper the replacement therapy. This recovery process, however, can take up to a year or longer. In some individuals, normal adrenal function never fully returns, making lifelong hormone replacement therapy necessary. **Radiation Therapy** When a pituitary tumor cannot be completely removed during surgery, radiation therapy is typically prescribed alongside the operation. Radiation is also an option for individuals who are not good surgical candidates. Radiation can be delivered in small, carefully calibrated doses spread over a six-week period, or through a more targeted technique called stereotactic radiosurgery — in which a single, high-precision dose of radiation is aimed directly at the tumor, minimizing exposure to the surrounding healthy tissue. **Medications** When surgery and radiation are not sufficient — or while preparing a patient for surgery — medications can be used to rein in cortisol production. It is important to note, however, that drug therapy alone may not fully resolve all symptoms of cortisol excess. Medications to control excessive production of cortisol at the adrenal gland include ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone). Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effect of cortisol on your tissues. Side effects from these medications may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling. Some have more-serious side effects, such as neurological side effects and liver toxicity. The newest medication for Cushing syndrome is pasireotide (Signifor), and it works by decreasing ACTH production from a pituitary tumor. This medication is given as an injection twice daily. It's recommended if pituitary surgery is unsuccessful or cannot be done. Side effects are fairly common and may include diarrhea, nausea, high blood sugar or diabetes, headache, abdominal pain, and fatigue. In some cases, the tumor or its treatment will cause other hormones produced by the pituitary or adrenal gland to become deficient, and your doctor will recommend hormone replacement medications to address this. If none of these treatment options is appropriate or effective, your doctor may recommend surgical removal of your adrenal glands (bilateral adrenalectomy). This procedure will cure excess production of cortisol, but will require lifelong replacement medications. **Source:** <https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310> ---
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Care planCystic Fibrosis (CF)**Cystic Fibrosis** is a serious, inherited disease that can damage the lungs, digestive system, and other vital organs throughout the body. At its core, cystic fibrosis disrupts the cells responsible for making mucus, sweat, and digestive juices. Normally, these fluids are thin and slippery — working quietly behind the scenes to keep your body running smoothly. In people with cystic fibrosis, however, a faulty gene causes these secretions to become abnormally thick and sticky. Rather than lubricating the body's passageways, they clog tubes, ducts, and airways — particularly in the lungs and pancreas. Living with cystic fibrosis does require daily attention and care, but many people with the condition lead active, fulfilling lives — attending school, holding jobs, and enjoying a quality of life that is meaningfully better than it was for previous generations. Thanks to advances in early screening and treatment, people with cystic fibrosis are now living into their mid- to late 30s on average, and a growing number are reaching their 40s and 50s. --- ## Understanding Cystic Fibrosis ### Signs & Symptoms: What to Look For In the United States, newborn screening for cystic fibrosis is now routine in every state. This means many children are diagnosed within the first month of life — often before any symptoms appear. For those born before universal newborn screening was in place, recognizing the signs of cystic fibrosis early is especially important. Cystic fibrosis looks different from person to person. Symptoms can range from mild to severe, and they may fluctuate over time — sometimes improving, sometimes worsening. Some individuals don't notice symptoms until adolescence or even adulthood. One telling sign: people with cystic fibrosis have unusually salty sweat — so much so that parents often notice a salty taste when kissing their child. Most other symptoms involve the respiratory and digestive systems. Adults who receive a later-in-life diagnosis tend to present with less typical symptoms, such as recurring pancreatitis (inflammation of the pancreas), infertility, or repeated bouts of pneumonia. ### Respiratory Symptoms The thick, sticky mucus that defines cystic fibrosis clogs the airways that carry air in and out of the lungs. This can lead to: - A persistent cough that produces thick mucus (sputum) - Wheezing - Breathlessness - Exercise intolerance - Repeated lung infections - Inflamed nasal passages or a stuffy nose ### Digestive Symptoms The same thick mucus can block the channels that carry digestive enzymes from the pancreas to the small intestine. Without these enzymes working properly, the intestines can't fully absorb the nutrients from food — which often results in: - Foul-smelling, greasy stools - Poor weight gain and growth - Intestinal blockage, particularly in newborns (meconium ileus) - Severe constipation Straining frequently during bowel movements can sometimes cause a portion of the rectum — the end of the large intestine — to protrude outside the anus, a condition called rectal prolapse. In children, this can be an early signal of cystic fibrosis, and a physician with expertise in the condition should be consulted. While rectal prolapse may occasionally require surgery, it's becoming less common thanks to earlier diagnosis and treatment of cystic fibrosis. ### When to See a Doctor If you or your child is experiencing symptoms that could suggest cystic fibrosis — or if cystic fibrosis runs in your family — speak with your doctor about getting tested. If you or your child has difficulty breathing, seek medical attention right away. ### What Causes Cystic Fibrosis? Cystic fibrosis is caused by a mutation — a flaw — in a gene that controls how salt moves in and out of cells. When this gene doesn't work properly, mucus becomes thick and sticky throughout the respiratory, digestive, and reproductive systems, and sweat becomes saltier than normal. There are many possible mutations in this gene, and the specific type of mutation a person carries influences how severe their disease will be. For a child to develop cystic fibrosis, they must inherit one defective copy of the gene from each parent. Inheriting only one copy means the child will be a carrier — they won't develop the disease themselves, but they could pass the gene on to their own children one day. ### Who Is at Risk? - **Family history.** Because cystic fibrosis is inherited, it tends to run in families. - **Race.** Although cystic fibrosis can affect people of any race, it is most commonly seen in white people of Northern European ancestry. ### Potential Complications **Respiratory Complications:** - **Damaged airways (bronchiectasis).** Cystic fibrosis is one of the leading causes of bronchiectasis — a condition in which the airways are permanently damaged, making it harder to breathe and to clear mucus from the lungs. - **Chronic infections.** The thick mucus coating the lungs and sinuses creates a perfect environment for bacteria and fungi to grow. As a result, people with cystic fibrosis are prone to frequent sinus infections, bronchitis, and pneumonia. - **Growths in the nose (nasal polyps).** Chronic inflammation of the nasal lining can lead to the development of soft, fleshy growths called polyps. - **Coughing up blood (hemoptysis).** Over time, the airway walls can thin, causing teenagers and adults with cystic fibrosis to cough up blood. - **Pneumothorax.** This occurs when air leaks into the space between the lungs and the chest wall — a condition that becomes more common with age in people with cystic fibrosis. It can cause chest pain and sudden breathlessness. - **Respiratory failure.** Over time, cystic fibrosis can damage lung tissue so severely that it can no longer function adequately. Lung function tends to decline gradually, and in advanced cases, this can become life-threatening. - **Acute exacerbations.** People with cystic fibrosis may experience sudden worsening of respiratory symptoms — such as increased coughing and shortness of breath — lasting days to weeks. Known as an acute exacerbation, this typically requires hospitalization and intensive treatment. **Digestive Complications:** - **Nutritional deficiencies.** Mucus blockages in the channels connecting the pancreas to the intestines can prevent the body from absorbing proteins, fats, and fat-soluble vitamins — nutrients that are essential for health and growth. - **Diabetes.** The pancreas also produces insulin, which the body needs to process sugar. Cystic fibrosis increases diabetes risk significantly — around 30 percent of people with cystic fibrosis develop diabetes by age 30. - **Blocked bile duct.** The tube that carries bile from the liver and gallbladder to the small intestine can become blocked and inflamed, potentially causing liver damage and, in some cases, gallstones. - **Intestinal obstruction.** Intestinal blockages can affect people with cystic fibrosis at any age. Older children and adults are particularly susceptible to intussusception — a condition in which a portion of the intestine folds in on itself, like an accordion. - **Distal intestinal obstruction syndrome (DIOS).** DIOS is a partial or complete blockage at the junction where the small intestine meets the large intestine. **Reproductive Complications** Nearly all men with cystic fibrosis are infertile because the vas deferens — the tube connecting the testes to the prostate gland — is either blocked with mucus or absent entirely. Certain fertility treatments and surgical options can sometimes make biological fatherhood possible for men with cystic fibrosis. Women with cystic fibrosis may have reduced fertility compared to women without the condition, but many are able to conceive and carry successful pregnancies. That said, pregnancy can intensify cystic fibrosis symptoms, so it's important to talk openly with your doctor about the potential risks before trying to conceive. **Other Complications** - **Thinning of the bones (osteoporosis).** People with cystic fibrosis face a heightened risk of developing dangerously thin, fragile bones. - **Electrolyte imbalances and dehydration.** Because sweat in cystic fibrosis is saltier than normal, the mineral balance in the blood can be disrupted. This may cause a fast heart rate, fatigue, muscle weakness, and low blood pressure. ### Can Cystic Fibrosis Be Prevented? If you or your partner has a family history of cystic fibrosis, genetic testing before having children is worth considering. A simple blood test performed in a lab can help you understand your risk of passing the gene to a child. If you're already pregnant and genetic testing suggests your baby may be at risk, your doctor can recommend additional testing to get a clearer picture during the pregnancy. Genetic testing isn't the right choice for everyone. Before deciding, it's a good idea to speak with a genetic counselor, who can help you think through what the results might mean — emotionally as well as medically. ### What to Expect: Living with Cystic Fibrosis Cystic fibrosis is not a one-size-fits-all disease. Symptoms and severity vary enormously from person to person. Some individuals face serious challenges from birth, including significant lung and digestive problems. Others experience a much milder form of the disease that may not even surface until the teen years or early adulthood. While there is currently no cure for cystic fibrosis, treatment has advanced dramatically over the past few decades. Until the 1980s, most deaths from cystic fibrosis occurred in children and teenagers. Today, thanks to steadily improving therapies, people with cystic fibrosis are living, on average, beyond age 35. **Sources:** - *NIH: National Heart, Lung, and Blood Institute* - <https://www.mayoclinic.org/diseases-conditions/cystic-fibrosis/symptoms-causes/syc-20353700> ---
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Care planCystic Lung DiseaseIf you've been told you have cystic lung disease, it means your lungs have developed cysts — small, abnormal pockets filled with air or fluid. While there is no one-size-fits-all cure, effective treatments exist, and the right approach depends on which type of cystic lung disease you have. Because the different types share many of the same symptoms, your doctor will likely order a specialized imaging study called high-resolution computed tomography (CT) to help pinpoint your diagnosis. If the CT scan isn't conclusive, a lung biopsy may be needed — a procedure in which a tiny sample of lung tissue is removed and examined in a laboratory. Other lung conditions, such as emphysema and honeycomb lung, can mimic cystic lung disease on imaging. To confirm your diagnosis, your doctor will carefully evaluate lung capacity, as well as the size, wall thickness, shape, and location of any cysts found on your scans. Cystic lung disease is uncommon. Most adults who are diagnosed will have one of these four types. --- ## Understanding Cystic Lung Disease ### Lymphangioleiomyomatosis (LAM) LAM occurs when abnormal muscle cells in the lung begin growing uncontrollably, forming cysts that progressively damage surrounding lung tissue. It predominantly affects women between the ages of 20 and 40. **LAM comes in two forms: TSC-LAM and sporadic LAM.** - **TSC-LAM** refers to LAM that occurs alongside a rare genetic condition called tuberous sclerosis complex (TSC). - **Sporadic LAM** refers to LAM that develops on its own, without TSC. Both forms are believed to stem from mutations in the tuberous sclerosis gene. Research suggests that estrogen plays a meaningful role in LAM's development and progression. The disease may worsen during menstruation and pregnancy, as well as with the use of estrogen-containing birth control pills. The most common symptoms of LAM include: - Chest pain - Fatigue - Persistent cough (which may occasionally produce blood) - Shortness of breath - Wheezing You may also develop a buildup of fluid in the space between your lungs and chest wall — a condition known as **pleural effusion** — which can make breathing feel labored. Fluid can also accumulate in the abdomen, legs, and feet. If a cyst ruptures through the lining of your lung, it can cause a collapsed lung (**pneumothorax**) — a medical emergency in which air escapes into the chest cavity and deflates part of the lung, requiring immediate treatment. There is currently no cure for LAM, but the medication sirolimus (Rapamune) has been shown to slow disease progression and may even lead to improvements in lung function. Bronchodilators — medications that help relax and open the airways — may also be prescribed to ease breathing. If LAM progresses significantly, supplemental oxygen therapy (delivered via a tank or machine) may become necessary. --- ### Pulmonary Langerhans Cell Histiocytosis (PLCH) PLCH is a lung disease that predominantly affects young adults with a history of smoking. In its early stages, it may cause no symptoms at all, or only mild shortness of breath and a cough. As the disease advances, additional symptoms may develop, including: - Chest pain - Fever - Night sweats - Fatigue - Unintentional weight loss PLCH begins when chemicals in cigarette smoke trigger abnormal cell growth in the lungs. Over time, scar tissue forms, causing the lung tissue to become stiff and thickened. This progressively makes it harder to breathe in deeply, leading to shortness of breath even with routine daily activities. PLCH can lead to lung collapse, sometimes recurrently. In such cases, your doctor may recommend a procedure called **pleurodesis**, which seals off the space between the lung and chest wall to prevent air or fluid from re-accumulating there. **Whether PLCH is best classified as a cancer or an immune disorder remains an open question in medicine.** Regardless, quitting smoking is the single most important treatment step — doing so can halt the disease's progression and may even lead to partial recovery. Anti-inflammatory steroid medications may also be prescribed. For patients who don't respond to steroids, chemotherapy agents are sometimes used. Supplemental oxygen may be needed for those experiencing significant breathing difficulty. --- ### Birt-Hogg-Dubé Syndrome (BHD) BHD is a hereditary condition caused by a faulty gene passed down from an affected parent. It can also arise from a spontaneous new mutation in one of your genes. Genetic testing can confirm whether you carry this mutation. Symptoms typically first appear in a person's 20s or 30s. The most recognizable early sign of BHD is the development of small, noncancerous skin bumps — benign tumors of the hair follicles — most commonly on the face, but also on the neck, ears, or upper torso. Approximately **80%** of people with BHD develop lung cysts. In most cases, these cysts don't cause symptoms, and lung function remains normal. However, up to one-third of people with BHD may experience recurrent lung collapses, and between **15% and 30%** may develop kidney tumors. These tumors tend to grow slowly and are typically diagnosed between the ages of 48 and 50. Regular CT scans of the abdomen are recommended to catch any kidney tumors early, when treatment is most effective. Treatment for BHD is tailored to each patient's specific symptoms. Skin growths can be removed with laser treatment; pleurodesis may be recommended for recurrent lung collapses; and kidney tumors can be addressed surgically. --- ### Lymphoid Interstitial Pneumonia (LIP) LIP is an exceptionally rare condition. Researchers believe it may function both as a disease in its own right and as a reaction — either to something in the environment or to another underlying illness. LIP is frequently associated with autoimmune diseases, particularly **Sjögren's syndrome** — a condition in which the immune system mistakenly attacks the glands responsible for producing tears and saliva. LIP affects approximately twice as many women as men and is most often diagnosed between the ages of 52 and 56. The hallmark symptoms are a progressively worsening cough and shortness of breath. Treatment typically involves corticosteroids to reduce inflammation. If steroids prove ineffective, medications that modulate the immune system's activity may be considered. > 📝 **NOTE:** Cysts related to pneumocystis pneumonia are usually multiple, occur most often in the upper parts of the lungs, and tend to decrease in size or resolve after the acute stage of the infection. **Sources:** - <https://www.webmd.com/lung/what-is-cystic-lung-disease> - Korean Journal of Internal Medicine: "Diagnosis and treatment of cystic lung disease." - Cleveland Clinic Journal of Medicine: "Cystic lung disease: Systematic, stepwise diagnosis." - Cleveland Clinic: "Lymphangioleiomyomatosis (LAM)," "Corticosteroids." - National Heart, Lung, and Blood Institute: "LAM." - Mayo Clinic: "Pneumothorax," "Autosomal dominant inheritance pattern." - Chest Foundation: "What is Pulmonary Langerhans Cell Histiocytosis?" - UW Health: "What is a pleurodesis?" - Histiocytosis Association: "Is Langerhans Cell Histiocytosis a Cancer?" - BHD Foundation: "What is BHD." - National Organization of Rare Diseases: "Birt-Hogg-Dubé Syndrome." - Chest Journal: "Lymphoid Interstitial Pneumonia." - Genetics Home Reference: "Sjögren syndrome." - Merck Manuals: "Lymphocytic Interstitial Pneumonia (Lymphoid Interstitial Pneumonitis)." ---
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Care planDehydrationTrue hydration goes far beyond simply drinking water. Electrolytes — the minerals that power nearly every function in your body — are just as important as the fluid itself. When your electrolyte balance is off, dehydration sets in, and the consequences can range from fatigue and muscle cramps to far more serious complications. > *"Electrolytes are minerals contained in your blood and other bodily fluids that affect the amount of water your body retains. Some of the more common electrolytes are calcium, magnesium, potassium and sodium. When there is an imbalance of these minerals, dehydration sets in and all sorts of complications can occur: blackouts, stroke, kidney failure and muscle malfunctions. It can even lead to death."* > > **Source:** Mayo Clinic ## Understanding Electrolytes and Hydration Electrolytes are minerals that carry an electrical charge when dissolved in water. They circulate throughout your body's fluids and use that electrical energy to power a remarkable range of vital functions. Electrolytes are essential for: - Keeping your fluid levels in balance - Regulating your blood pressure - Enabling your muscles to contract — including your heart - Maintaining the proper acidity of your blood (pH) Your body's fluids are loaded with electrolytes sourced from everything you eat and drink. Think of electrolytes as the body's all-purpose workhorses — they play a critical role in keeping your brain, nerves, and muscles firing properly, and they're essential for building new tissue. When electrolytes dissolve in your body's fluids, they generate electrical signals that travel throughout your body, quietly keeping you alive and functioning at your best. Among their many jobs, electrolytes help keep your heartbeat steady and make it possible for your muscles to move. Because they're so fundamental to good health, keeping your electrolyte levels in a healthy range truly matters — an imbalance can trigger a range of unpleasant and sometimes serious symptoms. You can lose electrolytes through sweating, physical activity, urination, or simply from not eating a well-rounded diet. ### Key Electrolytes and What They Do Electrolytes include sodium, potassium, calcium, chloride, and other key minerals — each with a distinct and important job in your body. - **Calcium –** Supports muscle contractions and movement, cell division, nerve signaling, blood clotting, and the formation and maintenance of strong bones and teeth. - **Potassium –** Helps keep your blood pressure steady, supports muscle function and bone health, transmits nerve impulses, and plays a key role in regulating your heartbeat. - **Magnesium –** A true multitasker — it supports muscle contractions, nerve function, bone building and strength, healthy digestion, heart rhythm regulation, stable blood sugar levels, a robust immune system, reduced anxiety, and a healthy protein-fluid balance. - **Sodium –** Helps maintain fluid balance, nerve signaling, blood pressure, and muscle contractions. - **Chloride –** Works to maintain fluid balance, a healthy pH, and supports proper digestion. - **Phosphate –** Strengthens your bones and teeth and fuels the energy your body needs for tissue growth and repair. ### Electrolytes, Exercise, and Heat **When you're physically active, your body needs extra fluids to make up for what's lost through sweat.** In fact, losing as little as 1–2% of your body weight in fluid can noticeably reduce your strength, speed, and mental focus. **Sweat carries electrolytes with it,** including a significant amount of sodium along with smaller amounts of potassium, calcium, and magnesium. On average, you lose around 1 gram of sodium with every liter of sweat. **Electrolyte-rich hydration drinks are a smarter choice than plain water** for replenishing both fluid and electrolytes — especially if you tend to sweat heavily, exercise for longer than one hour, or work out in hot conditions. > *"During exercise, **consuming beverages containing electrolytes and carbohydrates can provide benefits over water alone** under certain circumstances. After exercise, the goal is to replace any fluid electrolyte deficit. The speed with which rehydration is needed and the magnitude of fluid electrolyte deficits will determine if an aggressive replacement program is merited."* **Hot environments also raise your risk for a range of heat-related illnesses,** spanning from mild heat rash all the way to life-threatening heatstroke. Under normal circumstances, your body manages heat by releasing it through your skin and through sweat. But in extreme heat, this natural cooling system can start to fail — allowing your body temperature to climb to dangerously high levels. While limiting your time in the heat is the most important preventive step, staying well-stocked with fluids and electrolytes is equally critical for helping your body keep its cool. **During physical activity and/or in hot environments, hydration drinks such as [Hydrate](https://nutridyn.com/dynamic-hydrate) are the recommended choice over other beverages.** ### Electrolytes and Keto If you're following a ketogenic diet, it's especially important to keep a close eye on your electrolyte levels — even if you're drinking plenty of water. Keto diets often cause your body to shed a significant amount of water weight, and along with that water goes a meaningful amount of essential electrolytes. If you're going keto, make it a priority to stay well-hydrated and actively replenish your electrolytes, including with an advanced electrolyte formula like **[Hydrate](https://nutridyn.com/dynamic-hydrate-2041).** **Sources:** - <https://medlineplus.gov/fluidandelectrolytebalance.html> - <https://medlineplus.gov/ency/article/002350.htm> - <https://pubmed.ncbi.nlm.nih.gov/26920240/> - <https://pubmed.ncbi.nlm.nih.gov/17277604/> - <https://pubmed.ncbi.nlm.nih.gov/28332116/> - <https://pubmed.ncbi.nlm.nih.gov/15952443/> - <https://www.cdc.gov/disasters/extremeheat/faq.html> - <https://drjockers.com/electrolyte-imbalance/> ---
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Care planDepressionDepression is a serious medical illness rooted in the brain — and it's far more than just feeling "down in the dumps" or "blue" for a few days. If you are among the more than 20 million people in the United States living with depression, those feelings don't simply fade. They linger, deepen, and begin to interfere with everyday life. **Symptoms can include:** - Sadness - Loss of interest or pleasure in activities you once enjoyed - Changes in weight - Difficulty sleeping or sleeping too much - Loss of energy - Feelings of worthlessness - Thoughts of death or suicide Depression is a brain disorder shaped by a complex mix of genetic, environmental, psychological, and biochemical factors. It most often begins between the ages of 15 and 30, and is significantly more common in women. Women may also experience postpartum depression following the birth of a baby. Some people develop seasonal affective disorder (SAD) during winter months. Depression is also one component of bipolar disorder. > *"Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use."* > > **Reference:** Association of Hormonal Contraception With Depression. *JAMA Psychiatry.* Published online September 28, 2016. doi:10.1001/jamapsychiatry.2016.2387 > *"The vast majority of antidepressants are ineffective, and some may even be unsafe, for use in children and teens with major depressive disorder (MDD)."* > > **Reference:** *Lancet.* Published online June 8, 2016. As we know, diet and the nutrient density of the foods we eat are inseparably linked to conditions like heart disease, obesity, and diabetes. *"However current research also documents that what we consume, and the nutrient / phytonutrient density of what we consume, (or lack of), has significant implications for the brain, thus the need to address 'base nutrition / phyto-nutrition, and essential fatty acids.'"* Most of the health problems Americans face trace back to lifestyle and dietary choices — and depression is no different. At the root of many cases of depression lies an addiction to nicotine, caffeine, and other stimulants. According to Joseph Beasley, M.D., the primary investigator behind the landmark Kellog Report, "The Impact of Nutrition, Environment, and Lifestyle on Illness in America," the United States is a nation of addicts. Many people claim they smoke, drink alcohol, or use drugs because it calms them. In reality, these substances only make things worse. The relaxation or chemical "high" they produce is short-lived — and ultimately heaps even more stress onto an already taxed system. People struggling with depression or other psychological conditions must absolutely stop smoking, drinking alcohol, and consuming coffee and other sources of caffeine. --- ## Understanding Depression: The Research Foundation ### Nutrition and Mental Health: A Powerful Connection In uncertain times, building and maintaining robust mental health can be a real challenge. Traumatic events and difficult circumstances affecting entire communities have historically been followed by rises in a range of mental and behavioral illnesses, including depression and post-traumatic stress disorder (PTSD).[1] Clinical strategies that incorporate nutrition interventions hold potentially powerful promise — not only for chronic mental health disorders, but for a patient's overall mental wellness. ### What You Eat Affects How You Feel: Diet Quality and Mental Health Depression is a leading cause of disability worldwide,[2] and in the United States, anxiety disorders are among the most common psychiatric illnesses, affecting approximately 40 million adults every year.[3] Psychotherapy and medications remain the standard first-line treatments for clinical depression and generalized anxiety disorders.[4,5] But an emerging field called nutritional psychiatry is revealing a compelling relationship between diet quality and mental health — and exploring the use of dietary and nutraceutical interventions to address mental disorders and potentially improve patient outcomes.[6,7] Recent research suggests that nutritional habits, dietary patterns, and diet quality may all impact overall mental wellness, and may also be modifiable risk factors for mental disorders.[6,8–10] For example, studies suggest that routinely eating a highly processed, Western-style diet increases the risk of developing symptoms associated with depression and anxiety.[8] In contrast, those same studies found that following an anti-inflammatory, Mediterranean-style diet was associated with lower risk.[8] ### Bipolar Disorder: The Role of Mitochondrial Support and Omega-3s The exact biological underpinnings of bipolar disorder remain unclear; however, supporting mitochondrial function and improving diet quality may offer therapeutic benefits and help ease some depressive symptoms.[7,13] A double-blind randomized controlled trial (RCT) with 181 participants with bipolar depression found no difference between groups treated with 2,000 mg/day of N-acetylcysteine (NAC) — a potential agent for mitochondrial regeneration — NAC plus a combination of nutrient agents, or placebo.[7] Yet a sub-study of this RCT assessed diet quality and found that participants with better diets reported reduced general depression and bipolar symptoms, and showed greater clinician-rated improvements — regardless of the treatment they received.[14] Researchers also suggested that the combination treatment including additional mitochondria-supporting nutrients may have helped buffer the harmful effects of pro-inflammatory diets on participants' self-reported cognitive function.[14] The American Psychiatric Association recommends omega-3 supplementation as an add-on therapy for mood disorders, including bipolar depression, noting potentially greater efficacy with treatments using eicosapentaenoic acid (EPA) alone, or EPA and docosahexaenoic acid (DHA) together when EPA levels are higher in the combination.[15] To test the effectiveness of DHA alone, a recent RCT explored DHA as a standalone therapy for bipolar disorder. Though the trial was small — 31 participants with bipolar disorder and 15 healthy controls — researchers found that after 12 weeks of DHA supplementation (1,250 mg daily) versus a corn oil placebo, no significant differences between groups were found in cognitive function, except in testing of emotional inhibition.[16] ### Depression and Overall Diet Quality: What the Research Shows Following a Mediterranean-style diet has been linked to a reduced risk of developing depression. Improving diet quality has also been studied as a potential treatment for depression — with promising results. Two smaller RCTs from 2017 found that improving overall diet quality by adopting a Mediterranean-style diet reduced depression symptoms in study participants.[9,19] In fact, one of these studies enrolled only participants with both major depressive disorder and a history of "poor quality" diet — and found that 32% of participants in the dietary intervention group achieved a remission of depressive episodes within the three-month study period.[19] While research into improved dietary quality has shown positive outcomes for people with depression, results from a 2019 RCT indicated that taking a multi-nutrient supplement alone did not significantly reduce depressive or anxiety symptoms.[20] ### It Goes Both Ways: A Bidirectional Relationship The relationship between nutrition and mental health is also bidirectional — dietary choices may influence mental wellness, but mental health states can equally shape dietary habits and food choices.[21,22] Specific to depression and anxiety, the role of the gut-brain axis and the status of the gut microbiota has recently emerged as a potentially important consideration in future diet-depression research and clinical nutrition interventions.[23] ### Putting It Into Practice: Clinical Applications In functional medicine, personalized nutrition interventions are foundational components of therapeutic strategies that address chronic mental health issues and support a patient's overall mental wellness. **Source:** <https://www.ifm.org/news-insights/nut-role-nutrition-mental-health/> **References:** 1. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. *JAMA Intern Med.* Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562 2. World Health Organization. Depression fact sheet. Published January 30, 2020. <https://www.who.int/en/news-room/fact-sheets/detail/depression> 3. Anxiety and Depression Association of America. Facts & statistics. <https://adaa.org/about-adaa/press-room/facts-statistics> 4. Anxiety and Depression Association of America. Clinical practice overview for GAD. Revised July 2, 2015. <https://adaa.org/resources-professionals/practice-guidelines-gad> 5. National Institute of Mental Health. Depression. Revised February 2018. <https://www.nimh.nih.gov/health/topics/depression/index.shtml> 6. Marx W, Moseley, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. *Proc Nutr Soc.* 2017;76(4):427-436. doi:10.1017/S0029665117002026 7. Berk M, Turner A, Malhi GS, et al. A randomised controlled trial of a mitochondrial therapeutic target for bipolar depression: mitochondrial agents, N-acetylcysteine, and placebo. *BMC Med.* 2019;17(1):18. doi:10.1186/s12916-019-1257-1 8. Owen L, Corfe B. The role of diet and nutrition on mental health and wellbeing. *Proc Nutr Soc.* 2017;76(4):425-426. doi:10.1017/S0029665117001057 9. Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED). *Nutr Neurosci.* 2019;22(7):474-487. doi:10.1080/1028415X.2017.1411320 10. Wilson JE, Blizzard L, Gall SL, et al. An eating pattern characterised by skipped or delayed breakfast is associated with mood disorders among an Australian adult cohort. *Psychol Med.* Published online October 16, 2019. doi:10.1017/S0033291719002800 11. Sawchuk CN. Coping with anxiety: can diet make a difference? Mayo Clinic. Published May 24, 2017. <https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/expert-answers/coping-with-anxiety/faq-20057987> 12. Harvard Health Publishing. A guide to getting through grief. *Harvard Mental Health Letter.* Published December 2011. <https://www.health.harvard.edu/newsletter_article/a-guide-to-getting-through-grief> 13. Pereira C, Chavarria V, Vian J, et al. Mitochondrial agents for bipolar disorder. *Int J Neuropsychopharmacol.* 2018;21(6):550-569. doi:10.1093/ijnp/pyy018 14. Ashton MM, Dean OM, Marx W, et al. Diet quality, dietary inflammatory index and body mass index as predictors of response to adjunctive N-acetylcysteine and mitochondrial agents in adults with bipolar disorder: a sub-study of a randomised placebo-controlled trial. *Aust N Z J Psychiatry.* 2020;54(2):159-172. doi:10.1177/0004867419882497 15. Task Force on Complementary and Alternative Medicine. Complementary and alternative medicine in major depressive disorder: the American Psychiatric Association Task Force assessment of the evidence, challenges, and recommendations. *American Psychiatric Association.* Published June 2009. <https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/rd2009_CAM.pdf> 16. Ciappolino V, DelVecchio G, Prunas C, et al. The effect of DHA supplementation on cognition in patients with bipolar disorder: an exploratory randomized control trial. *Nutrients.* 2020;12(3):E708. doi:10.3390/nu12030708 17. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. *Ann Neurol.* 2013;74(4):580-591. doi:10.1002/ana.23944 18. Khalid S, Williams CM, Reynolds SA. Is there an association between diet and depression in children and adolescents? A systematic review. *Br J Nutr.* 2016;116(12):2097-2108. doi:10.1017/S0007114516004359 19. Jacka FN, O'Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). *BMC Med.* 2017;15(1):23. doi:10.1186/s12916-017-0791-y 20. Bot M, Brouwer IA, Roca M, et al. Effect of multinutrient supplementation and food-related behavioral activation therapy on prevention of major depressive disorder among overweight or obese adults with subsyndromal depressive symptoms: the MooDFOOD randomized clinical trial. *JAMA.* 2019;321(9):858-868. doi:10.1001/jama.2019.0556 21. van der Pols JC. Nutrition and mental health: bidirectional associations and multidimensional measures. *Public Health Nutr.* 2018;21(5):829-830. doi:10.1017/S1368980017003974 22. Hibbeln JR, Northstone K, Evans J, Golding J. Vegetarian diets and depressive symptoms among men. *J Affect Disord.* 2018;225:13-17. doi:10.1016/j.jad.2017.07.051 23. Bear TLK, Dalziel JE, Coad J, Roy NC, Butts CA, Gopal PK. The role of the gut microbiota in dietary interventions for depression and anxiety. *Adv Nutr.* Published online March 9, 2020. doi:10.1093/advances/nmaa016 ---
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Care planDetoxificationEvery year, more than **4 billion pounds** of chemical compounds are released into our environment. A growing body of research suggests a link between exposure to these toxicants and the development of a number of chronic conditions, including chronic fatigue syndrome (CFS), multiple chemical sensitivities (MCS), fibromyalgia (FM), and atherosclerosis. Shared symptoms across these conditions — such as relentless, debilitating fatigue, muscle and joint pain, and mental fog — are all too common. Connections between environmental toxicant exposure and many other chronic, degenerative diseases have also been reported. The good news? Your body is naturally equipped to process and eliminate many of these substances. The challenge is that today's overwhelming load of environmental agents, compounded by poor diet and nutrition, can push that system past its limits. Metabolic detoxification works by providing targeted, advanced nutritional support to help your body do what it was designed to do: clear out unwanted chemicals efficiently and effectively. ## Understanding Metabolic Detoxification ### The Most Common Types of Toxins — and Where They Come From The word "toxin" doesn't refer to one specific type of compound — it's a broad term for anything capable of causing harm to the body. More precisely, a toxin or toxic substance is a chemical or mixture that may injure, or pose an unreasonable risk of injury to, the health of an exposed organism. The National Cancer Institute draws a useful distinction: a *toxin* is a poisonous compound produced by bacteria, plants, or animals, while a *toxicant* is a poison made by humans or introduced into the environment through human activity. Regardless of the source, every toxic substance has a defined dose or concentration at which it begins to cause harm. We can be exposed to environmental toxicants through the air we breathe, the food we eat, and the water we drink — as well as through direct skin contact. **Industrial chemicals and combustion pollutants.** This is one of the largest categories of toxicants in existence. In fact, virtually everyone is exposed to halogenated hydrocarbons — such as polychlorinated biphenyls (PCBs) — at some level on any given day. **Pesticides.** Many industrial chemicals are deliberately engineered for their toxic effects on specific organisms, and then brought to market as pesticides, insecticides, and herbicides. Most pesticides carry some degree of toxicity to humans as well. **Endocrine disruptors.** Common endocrine disruptors include phthalates found in plastics, PCBs, bisphenol A (BPA), certain pesticides, synthetic steroids in meat, and dichlorodiphenyltrichloroethane (DDT). Scientists have long documented problems with infertility and malformation of reproductive organs in animal species, linking these issues to the presence of these contaminants in the environment. **Toxic metals.** Lead, mercury, cadmium, arsenic, and other heavy metals are widespread in the environment and are especially insidious because they accumulate in the body over time, often producing delayed effects. Lead, for example, can be stored in bone — where it displaces calcium and has a half-life of 62 years. The health consequences of lead toxicity are wide-ranging, including DNA damage, suppressed immune function, anemia, high blood pressure, kidney disease, and accelerated tooth decay. **Food additives, preservatives, and drugs.** By far the greatest source of toxin exposure is through the mouth — from foods, medications, and water containing toxic substances that can be absorbed directly through the gastrointestinal (GI) tract. --- ### What Actually Happens Inside Your Body During Detox? Nobody welcomes uninvited guests — and your body is no different. Heavy metals, pesticides, and pollutants from the air, water, and soil are constantly bombarding your system. Over time, these unwelcome visitors can accumulate and begin to contribute to symptoms like brain fog, persistent fatigue, body aches, and skin issues. Understanding the three phases of your body's natural detoxification process is the first step toward supporting it effectively. **Here's how it works, step by step:** **Phase I: Reaction** In this first phase, your body responds to incoming toxins by deploying a family of enzymes (known as P450 enzymes) that chemically transform those toxins into free radicals. While "free radicals" may sound alarming, this is actually a natural and necessary step — when kept in balance, free radicals are not inherently harmful. It's only when they become imbalanced that problems arise. Through this conversion process, toxins are transformed into water-soluble molecules that your kidneys can more easily filter out — ultimately leaving your body through urine. **Phase II: Neutralization** Think of this as the activation phase of detox. After Phase I, some toxins actually become more chemically reactive than they were to begin with — which is why Phase II is so critical. In this phase, those reactive products are paired with other water-soluble substances to increase their solubility and prepare them for elimination through urine or bile. This pairing process is called a conjugation reaction, and it depends on specific helper molecules — called cofactors (metal ions or coenzymes) — to work properly. **Phase III: Transportation** Think of Phase III as the ferry system of detoxification. Just as a ferry moves cars and passengers from one shore to another, the specialized transporters of Phase III carry the water-soluble compounds produced in Phases I and II out of your cells. Before they depart, these compounds are neutralized and bound to dietary fiber — and from there, they are literally flushed from the body through excretion. **References:** 1. Goldman RH et al. The occupational and environmental health history. 1981 Dec 18;246(24):2831-6. Nelson et al. 2011. 2. Liska D. The Detoxification Enzyme Systems. *Altern Med Rev*. 1998 Jun;3(3):187-98. 3. Infographic: The 3 Phases of Detoxification. Metagenics Institute. Available at: <https://www.metagenicsinstitute.com/ce-education/clinical-tools/3-phases-detoxification>. Accessed August 30, 2018. 4. Why Metabolic Detox Is Not Just a Fad by Deanna Minich, PhD. 5. The Savvy Health-Seeker's Introduction to Detox. Thomas Sult, M.D. and Pamela DeLoatch. --- ### Is Metabolic Detoxification Right for You? To help determine whether a Metabolic Detoxification Program is appropriate for you — and which program length makes the most sense — please complete the linked questionnaire below: - **[Metabolic Detoxification Questionnaire](https://www.dropbox.com/s/2mk9o9vc59i403m/HAQ%20-%20Detoxification%20Questionnaire.pdf?dl=0)** ---
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Care planDetoxifying Endocrine-Disrupting Chemicals (EDCs)Endocrine-disrupting chemicals (EDCs) are substances that can quietly sabotage your hormonal system. They work by mimicking or blocking your body's natural hormones — throwing off the delicate chemical messaging that governs nearly every aspect of your health. Here's what you need to know about the ways EDCs can affect your body:
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Care planDiabetic NeuropathyDiabetic neuropathy is nerve damage caused by diabetes. When blood sugar (glucose) runs too high for too long, it can injure nerves throughout your body. Most often, the nerves in your legs and feet take the hardest hit. **Diabetic polyneuropathy (DPN)** is a form of nerve damage that affects multiple peripheral nerves — the sensory and motor nerves that branch out from your spinal cord into your arms, hands, legs, and feet. As a general rule, the longest nerves — those stretching all the way from your spine to your feet — tend to be the most severely affected. Depending on which nerves are involved, diabetic neuropathy can cause pain and numbness in the legs, feet, and hands. It can also disrupt the digestive system, urinary tract, blood vessels, and heart. For some people, symptoms are mild. For others, diabetic neuropathy can be deeply painful and interfere with daily life. Diabetic neuropathy is a serious complication of diabetes that may affect as many as **50%** of people living with the disease. The good news: you can often prevent it — or slow its progression — by keeping your blood sugar well-controlled and embracing a healthy lifestyle. There are four main types of diabetic neuropathy, and you may have one or more of them at the same time. Your symptoms depend on which type you have and which nerves are affected. Symptoms usually develop gradually — and in many cases, significant nerve damage may already have occurred before you notice anything is wrong. ## Understanding Diabetic Neuropathy ### Peripheral Neuropathy: Numbness, Pain, and Tingling in Your Extremities Also known as distal symmetric peripheral neuropathy, this is the most common form of diabetic neuropathy. It typically strikes the feet and legs first, then progresses to the hands and arms. Symptoms are often worse at night and may include: - Numbness or a reduced ability to feel pain or temperature changes - Tingling or a burning sensation - Sharp pains or cramping - Muscle weakness - Extreme sensitivity to touch — for some people, even the weight of a bedsheet can be painful - Serious foot complications, such as ulcers, infections, and damage to bones and joints ### Autonomic Neuropathy: When Diabetes Disrupts Your Body's Autopilot Your autonomic nervous system quietly manages the functions you don't consciously control — blood pressure, heart rate, sweating, vision, bladder, digestion, and sexual function. When diabetes damages these nerves, it can trigger a range of symptoms, including: - Failure to recognize when blood sugar drops dangerously low (hypoglycemia unawareness) - A sudden drop in blood pressure upon standing, which can cause dizziness or fainting (orthostatic hypotension) - Bladder or bowel problems - Slow stomach emptying (gastroparesis), leading to nausea, vomiting, a feeling of fullness, and loss of appetite - Difficulty swallowing - Changes in how your eyes adjust between light and dark, or between near and far distances - Increased or decreased sweating - Sexual dysfunction, such as vaginal dryness in women and erectile dysfunction in men ### Proximal Neuropathy: Hip, Thigh, and Trunk Pain (Diabetic Polyradiculopathy) This type of neuropathy tends to affect the nerves in the thighs, hips, buttocks, or legs — and can also involve the abdomen and chest. Symptoms usually appear on one side of the body but may eventually spread to the other side. Proximal neuropathy may cause: - Severe pain in the buttock, hip, or thigh - Weakness and shrinkage of the thigh muscles - Difficulty rising from a seated position - Pain in the chest or abdominal wall ### Mononeuropathy: When a Single Nerve Is Targeted (Focal Neuropathy) Mononeuropathy refers to damage affecting one specific nerve — which may be located in the face, torso, arm, or leg. Depending on which nerve is involved, mononeuropathy may lead to: - Difficulty focusing or double vision - Paralysis on one side of the face - Numbness or tingling in the hand or fingers - Hand weakness that causes you to drop things - Pain in the shin or foot - Weakness that makes it hard to lift the front part of your foot (foot drop) - Pain in the front of the thigh ### What Causes Diabetic Neuropathy? The exact cause of each type of neuropathy isn't fully understood. The leading theory is that sustained high blood sugar gradually damages nerve fibers and interferes with their ability to transmit signals — a process that ultimately gives rise to diabetic neuropathy. Chronically elevated blood sugar also weakens the walls of the tiny blood vessels (capillaries) that deliver oxygen and nutrients to those nerves. ### Who Is Most at Risk? Anyone with diabetes can develop neuropathy. However, certain factors make nerve damage significantly more likely: - **Poor blood sugar control.** Uncontrolled blood sugar raises the risk of every diabetes complication, including nerve damage. - **Longer duration of diabetes.** The risk of diabetic neuropathy climbs the longer you've had diabetes — particularly when blood sugar hasn't been well managed. - **Kidney disease.** Diabetes can damage the kidneys, and when they're not working properly, toxins accumulate in the blood — which can in turn damage nerves. - **Being overweight.** A body mass index (BMI) of 25 or higher may increase your risk of developing diabetic neuropathy. - **Smoking.** Smoking narrows and stiffens the arteries, reducing blood flow to the legs and feet. This impairs wound healing and causes direct damage to the peripheral nerves. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580> - <https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetic-neuropathy-nerve-problems> ---
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Care planDiabetic RetinopathyDiabetic retinopathy is a serious but common complication of diabetes that directly affects your eyes. It develops when high blood sugar damages the delicate blood vessels supplying the retina — the light-sensitive tissue lining the back of your eye that makes vision possible. In its earliest stages, diabetic retinopathy may produce no noticeable symptoms, or only subtle changes in your vision. Left unaddressed, however, it can progress to blindness. This condition can affect anyone living with type 1 or type 2 diabetes. The longer you've had diabetes — and the less controlled your blood sugar — the greater your risk of developing this complication. In the early stages, the walls of the tiny blood vessels in your retina begin to weaken. Small bulges form along these vessel walls and may leak fluid or blood into the surrounding retinal tissue. This can cause the retina to swell and produce white patches. As the disease progresses, abnormal new blood vessels can grow in the retina, threatening your vision in more serious ways. ## Understanding Diabetic Retinopathy ### Recognizing the Symptoms In the early stages of diabetic retinopathy, you may notice nothing at all. As the condition advances, watch for any of the following warning signs: - Spots or dark strings drifting across your field of vision (floaters) - Blurred vision - Vision that fluctuates from day to day - Dark or blank patches in your visual field - Progressive vision loss ### When to See an Eye Doctor The single most powerful thing you can do to protect your vision is to manage your diabetes carefully. If you have diabetes, schedule a comprehensive dilated eye exam with your eye doctor every year — even when your vision feels perfectly normal. If you developed diabetes during pregnancy (gestational diabetes), or had diabetes before becoming pregnant, your risk of diabetic retinopathy is elevated. Your eye doctor may recommend more frequent eye exams throughout your pregnancy to stay ahead of any changes. Don't wait for your next appointment if your vision suddenly shifts or becomes blurry, spotty, or hazy — contact your eye doctor right away. ### What Causes Diabetic Retinopathy? Over time, chronically elevated blood sugar can block the tiny blood vessels that deliver oxygen and nutrients to your retina, effectively cutting off its lifeline. In response, the eye attempts to compensate by growing new blood vessels — but these replacements are structurally fragile and prone to leaking. Diabetic retinopathy falls into two distinct stages: - **Early diabetic retinopathy.** In this more common form — called nonproliferative diabetic retinopathy (NPDR) — new blood vessels aren't growing (proliferating). When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels become blocked. In some cases, leaking blood vessels cause fluid to accumulate in the central portion of the retina, called the macula — a condition known as macular edema. When macular edema reduces vision, treatment is necessary to prevent permanent damage. - **Advanced diabetic retinopathy.** Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye (vitreous). Over time, scar tissue formed by these abnormal vessels can tug the retina away from the back of the eye — a retinal detachment. Additionally, if new blood vessel growth obstructs the normal drainage of fluid from the eye, pressure builds inside the eyeball. This elevated pressure can damage the optic nerve — the critical connection that sends visual information from your eye to your brain — leading to glaucoma. ### Who Is at Risk? Anyone living with diabetes is at risk for diabetic retinopathy. Certain factors can raise that risk even further: - A longer duration of diabetes - Poorly controlled blood sugar levels - High blood pressure - High cholesterol - Pregnancy - Tobacco use - Being Black, Hispanic, or Native American ### Possible Complications When abnormal blood vessels develop in the retina, a cascade of serious vision-threatening complications can follow: - **Vitreous hemorrhage.** The new blood vessels may bleed into the clear, jellylike substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more severe cases, blood can fill the vitreous cavity and completely block your vision. A vitreous hemorrhage on its own does not usually cause permanent vision loss. In most cases, the blood clears from the eye within a few weeks to months. As long as the retina itself is undamaged, your vision is likely to recover to its previous clarity. - **Retinal detachment.** The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light, or severe vision loss. - **Glaucoma.** New blood vessels can grow in the front part of your eye (iris) and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure can damage the nerve that carries images from your eye to your brain (optic nerve). - **Blindness.** Diabetic retinopathy, macular edema, glaucoma, or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed. ### Prevention: What You Can Do Starting Today While diabetic retinopathy cannot always be prevented entirely, a great deal of damage can be avoided. Consistent eye exams, well-controlled blood sugar and blood pressure, and timely treatment of early problems are your best defenses against serious vision loss. If you have diabetes, the following steps can meaningfully reduce your risk: - **Manage your diabetes.** Make healthy eating and physical activity part of your daily routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take oral diabetes medications or insulin as directed. - **Monitor your blood sugar level.** You might need to check and record your blood sugar level several times a day — or more frequently if you're ill or under stress. Ask your doctor how often you need to test your blood sugar. - **Ask your doctor about a glycosylated hemoglobin test.** The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the 2- to 3-month period before the test. For most people with diabetes, the A1C goal is to be under 7%. - **Keep your blood pressure and cholesterol under control.** Eating healthy foods, exercising regularly, and losing excess weight can help. Sometimes medication is needed, too. - **If you smoke or use other types of tobacco, ask your doctor to help you quit.** Smoking increases your risk of various diabetes complications, including diabetic retinopathy. - **Pay attention to vision changes.** Contact your eye doctor right away if your vision suddenly changes or becomes blurry, spotty, or hazy. Keep in mind: diabetes does not have to mean vision loss. Taking an active, informed role in managing your diabetes can make an enormous difference in preventing complications. **Source:** <https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611> ---
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Care planDiarrhea*E. coli* is a common bacterium that lives naturally in the intestines of humans and animals. The vast majority of strains are completely harmless — many actually help keep your gut healthy. But certain strains, most notably **E. coli O157:H7**, produce a dangerous substance called a **Shiga toxin** that can infect and inflame the intestines. The result: **diarrhea (sometimes bloody), abdominal cramps, nausea, and a low-grade fever**. Symptoms typically appear **3–4 days after exposure** — most often from contaminated food or water — and usually resolve within about a week. For most people, recovery comes down to **rest, staying well-hydrated, and keeping meals simple**. In more serious cases, the kidneys can be affected, particularly in young children, older adults, or anyone with a compromised immune system. It's important to know that **antibiotics and anti-diarrheal medications are not recommended** for this infection — they can actually make things worse. The best protection remains **thorough handwashing and careful food-handling practices**. --- ## Understanding Clostridium difficile (C. difficile) *C. difficile* is a bacterium that seizes the opportunity to overgrow in the gut when **antibiotic use** disrupts the normal, healthy balance of intestinal bacteria. It is the **leading cause of antibiotic-associated diarrhea** in healthcare settings and can cause **abdominal pain, cramping, fatigue, and watery diarrhea** — sometimes severe enough to become a medical emergency. Milder cases may improve simply by discontinuing the antibiotic that triggered the imbalance, while more serious infections typically require treatment with **targeted antibiotics such as vancomycin or metronidazole**. For those dealing with chronic or recurrent infections, **fecal microbiota transplantation (FMT)** — transplanting healthy gut bacteria from a donor — has shown remarkably high success rates in restoring a healthy gut ecosystem. Research also shows that **specific probiotics, including *Saccharomyces boulardii* and *Lactobacillus GG***, can meaningfully reduce the risk of developing *C. difficile* infection during antibiotic therapy. Prevention centers on protecting your **microbiome's natural balance** and reserving antibiotics for situations where they are truly necessary. --- ## Understanding Chronic Loose Stools When loose stools persist beyond an acute illness, the causes are often layered: lingering gut inflammation, incomplete recovery from an infection like *E. coli* or *C. difficile*, the aftermath of antibiotic overuse, food sensitivities, or an ongoing imbalance in the intestinal microbiome. Left unaddressed, chronic loose stools can lead to **dehydration, loss of key nutrients, and a weakened gut barrier** — making the intestines more vulnerable to further irritation or infection. Getting to the bottom of chronic loose stools means **identifying and addressing the underlying cause**, replenishing lost fluids and electrolytes, and actively rebuilding intestinal balance. This includes using **gut-repair nutrients (such as glutamine, zinc-carnosine, and DGL licorice)** alongside **probiotics or immunoglobulin support**. When the microbiome is restored to a healthy, balanced state, bowel function normalizes, nutrient absorption improves, and the likelihood of recurrence drops significantly. ---
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Care planDientamoeba Fragilis Infection**Dientamoeba fragilis** is a microscopic, single-celled organism that can take up residence in the digestive tracts of humans, pigs, and gorillas. While some people who carry it never feel a thing, others experience significant gastrointestinal distress. It is a recognized cause of traveler's diarrhea, persistent chronic diarrhea, fatigue, and — particularly in children — poor growth and development. ### What Does a Dientamoeba Fragilis Infection Feel Like? Many people infected with *Dientamoeba fragilis* have no symptoms whatsoever. When symptoms do appear, the most common ones are diarrhea, abdominal pain, and cramping. Loss of appetite, unintentional weight loss, nausea, and fatigue are also frequently reported. Importantly, this infection stays confined to the intestines and does not travel to other organs or parts of the body. ### How Is This Infection Diagnosed? To confirm a *Dientamoeba fragilis* infection, your doctor will request one or more stool samples for laboratory analysis. Because the parasite isn't always detectable in a single sample, you may be asked to collect samples on multiple days. Your doctor may also test for pinworm eggs, which are frequently — though not always — found alongside *D. fragilis* infections. ### How Is a Dientamoeba Fragilis Infection Treated? Multiple studies have demonstrated that this parasite can be successfully cleared from the body, with complete resolution of symptoms, using a variety of antiparasitic medications. Treatments reported to be effective against *Dientamoeba fragilis* infection include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines, and the 5-nitroimidazole class of drugs — including metronidazole, secnidazole, tinidazole, and ornidazole. It is worth noting that most of what we currently know about treatment comes from a relatively small number of individual case reports. Large-scale, double-blind, randomized, placebo-controlled trials evaluating the effectiveness of these antimicrobial agents against *D. fragilis* have not yet been conducted, underscoring the need for further research in this area. ### How Do You Become Infected With Dientamoeba Fragilis? The exact route of transmission for *D. fragilis* is not yet fully understood. The parasite is quite delicate and likely cannot survive long outside a host. Current evidence suggests infection may be spread by: - Accidentally swallowing pinworm eggs — which may serve as a protective vehicle for this fragile parasite — or the eggs of other parasites. - Swallowing contaminated water or food, or touching a contaminated surface and then bringing your fingers to your mouth, when that surface or food has been exposed to stool from an infected person. - Threadworms (also called pinworms) may also play a role. *D. fragilis* may be sheltered inside threadworm eggs, hitchhiking into the body when those eggs are swallowed. Threadworm eggs hatch inside the intestine, where the worms mature, then migrate to the area around the anus at night to lay new eggs on the surrounding skin. Those eggs can be transferred to the mouth if a person scratches the area or doesn't wash their hands after using the toilet. Threadworm eggs can also shed into bedding or clothing, or become airborne, settling on surfaces throughout the home or school environment. ### Who Is Most Vulnerable to Infection? Anyone can contract this parasite. That said, your risk may be higher if you live in or travel to areas with limited sanitation infrastructure, or if your immune system is compromised in any way. **Sources:** - <https://www.webmd.com/a-to-z-guides/dientamoeba-fragilis-infection> - <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862407/> - <https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/dientamoeba+fragilis+infection/dientamoeba+fragilis+infection+-+including+symptoms+treatment+and+prevention> ---
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Care planDiffuse Idiopathic Skeletal Hyperostosis (DISH)Diffuse idiopathic skeletal hyperostosis (DISH) is a condition in which the ligaments and tendons gradually harden — a form of arthritis that can lead to pain, stiffness, and limited movement. The good news: DISH can be effectively managed with physical therapy, medications, heat therapy, and in some cases, surgery. ## Understanding DISH ### What Exactly Is DISH? DISH is a skeletal condition in which the ligaments and tendons throughout the body slowly calcify — meaning they harden as calcium salts accumulate within them. Over time, these calcified areas can also develop into bone spurs (patches of abnormal new bone growth), which are responsible for the pain, stiffness, and reduced range of motion that many people with DISH experience. Although DISH most commonly affects the spine, it can develop in other parts of the body as well. It is a form of arthritis, and you may also hear it referred to by its older name: Forestier's disease. ### How Common Is DISH? DISH is relatively rare in people under 40, and becomes more common after age 50. It is also more frequently diagnosed in men than in women. ### What Causes DISH? DISH arises from the calcification of ligaments and tendons — a process in which these soft tissues harden due to a buildup of calcium salts — along with the abnormal formation of new bone. While doctors can identify what is happening in the body, the precise trigger that sets this process in motion remains unknown. ### What Does DISH Feel Like? Recognizing the Symptoms It is worth knowing that some people with DISH experience no symptoms at all — the condition is discovered incidentally when X-rays are taken for an entirely different reason. When symptoms do appear, they may include: - Numbness or tingling in the legs - Pain - Reduced mobility - Stiffness - Difficulty swallowing or hoarseness (changes in your voice) if DISH develops in the neck ### How Is DISH Diagnosed? Your doctor will use imaging studies — typically X-rays and CT scans — to diagnose DISH by directly visualizing the bony growths. These tests also help rule out other conditions that can look similar, including other forms of arthritis. ### How Is DISH Managed and Treated? It is important to understand upfront that no treatment can reverse the calcification or stop new bone from forming. Instead, the focus of care is on relieving your symptoms and slowing the condition's progression. Your doctor may recommend one or more of the following approaches: - **Heat therapy:** Warm compresses applied to affected areas can meaningfully ease stiffness and pain. - **Medication:** Several options are available to help control pain, including: - Over-the-counter pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs) - Corticosteroid injections - Muscle relaxants - **Physical therapy:** A targeted exercise program can help restore and preserve your mobility. - **Surgery:** In cases where bone overgrowth is pressing on nerves or interfering with breathing, surgery may be the most appropriate option. ### What Complications Can DISH Cause? When DISH develops along the ligament running beside the spine, the resulting bone growth can compress the spinal cord — potentially causing paralysis. Beyond this serious risk, other complications associated with DISH include: - Chronic (long-lasting) pain - A higher risk of bone fractures - Loss of mobility in the affected area - Sleep apnea (a condition that disrupts normal breathing during sleep) - Difficulty breathing or swallowing ### Who Is Most at Risk for DISH? Certain factors appear to increase the likelihood of developing DISH. You may be at higher risk if you: - Are age 50 or older - Are male - Have diabetes or are obese - Have had prolonged exposure to high levels of vitamin A ### Can DISH Be Prevented? While you cannot guarantee prevention, you can meaningfully lower your risk by maintaining a healthy weight and keeping your blood sugar levels in a healthy range. Limiting your use of medications or supplements that contain high amounts of vitamin A may also offer some protection against developing DISH. ### What Is the Long-Term Outlook for People with DISH? The encouraging news is that DISH does not shorten your life. Many people with this condition successfully manage their symptoms and go on to live healthy, active lives. That said, if DISH goes untreated, symptoms can gradually worsen. Seeking timely care is key — not only to find relief, but to keep the condition from progressing further. **Source:** <https://my.clevelandclinic.org/health/diseases/17948-diffuse-idiopathic-skeletal-hyperostosis> **References:** - Arthritis Foundation. Diffuse idiopathic skeletal hyperostosis. <https://www.arthritis.org/about-arthritis/types/diffuse-idiopathic-skeletal-hyperostosis/> Accessed 10/2/2018. - Arthritis Research UK. Diffuse idiopathic skeletal hyperostosis (DISH). <https://www.versusarthritis.org/about-arthritis/conditions/diffuse-idiopathic-skeletal-hyperostosis-dish/> Accessed 10/2/2018. - Genetic and Rare Diseases Information Center. Diffuse idiopathic skeletal hyperostosis. <https://rarediseases.info.nih.gov/diseases/6460/diffuse-idiopathic-skeletal-hyperostosis> Accessed 10/2/2018. ---
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Care planDistal Radial Epiphysitis / Medial Epicondyle ApophysitisSports are a beloved part of growing up in America. According to a 2008 report compiled by the Women's Sports Foundation, approximately 69% of girls and 75% of boys participate in organized team sports. But with greater competition comes greater demand — and for young athletes still growing into their bodies, that demand carries a real risk of injury. Approximately two million children each year seek medical intervention due to repetitive stress injuries pertaining to sports-related activities. An even higher incidence is likely present, as sport injuries in which the player continues to "play through pain" are not represented in the aforementioned number. The most common sports-related pediatric overuse injuries include inflammatory conditions, fractures, sprains, strains, and contusions. Children's bodies are not simply smaller versions of adult bodies — they are actively growing, and that makes them uniquely vulnerable. Key intrinsic factors impacting injury to the growing child include open growth plates, muscle imbalance, and incoordination due to growth. The pressure to specialize in a single sport early, train harder, and compete year-round doesn't give young bones, muscles, and tendons the recovery time they need. Adolescents are particularly at risk for injury due to the imbalance of ossifying bone. The porous ossifying bone is highly susceptible to fracture as it lengthens during a growth spurt. A wide variety of sports-related trauma, both acute and chronic, can develop in the upper extremity including fractures, tendonitis/tendonopathies, apophysitis, epiphysitis, growth plate damage, and tendon rupture. **Common overuse sports injuries affecting the child's upper extremity include little league elbow, osteochondritis dissecans (OCD), and gymnast's wrist.** --- ## Understanding Gymnast's Wrist (Distal Radial Epiphysitis) Gymnast's Wrist is irritation and inflammation of the growth plate (epiphysis) at the end of the radius (forearm bone) where it connects to the hand to form the wrist. In a child, the bones grow from areas called growth plates. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone. ### How Does Gymnast's Wrist Happen? Gymnast's wrist is an overuse injury that occurs in up to 40% of young gymnasts. It usually appears during a period of increased intensity of gymnastic activity, such as when a gymnast moves to a higher competitive level. High-impact skills like tumbling and vaulting place enormous compressive force on the wrist's growth plate, and over time, that repetitive stress triggers inflammation and irritation. If not treated properly, gymnast's wrist can lead to premature closure of the radial growth plate, causing the radius to be shorter than the ulna. This imbalance between the two forearm bones disrupts how forces are distributed across the wrist during impact activities, setting the stage for chronic pain, stiffness, and difficulty competing in gymnastics. ### What Does Gymnast's Wrist Feel Like? The most common symptom is wrist pain with impact activities. There may also be swelling and reduced range of motion. ### How Is Gymnast's Wrist Diagnosed? Your doctor will review your symptoms and examine your wrist. X-rays may show signs of gymnast's wrist such as irregular bone edges, scarring, or widening at the radial growth plate. ### How Is Gymnast's Wrist Treated? A short period of rest from impact activities is required to remove the stress at the growth plate and allow it to heal. Pushing through pain will only make the injury worse. Ice will help to reduce the inflammation. Apply ice for 15–20 minutes, every 2–3 hours. ### When Can My Child Return to Gymnastics After Gymnast's Wrist? When the inflammation and pain have resolved, you may return to impact activities slowly and gradually. If your pain comes back, stop the irritating activities and see your doctor for further evaluation. ### Can Gymnast's Wrist Be Prevented? Your doctor may recommend a wrist brace or taping to control wrist extension when you return to gymnastics. This may reduce the stress on your growth plate when you tumble and vault. Exercises to strengthen your forearm and upper body muscles can improve the body's ability to absorb the impact forces during tumbling and may reduce the risk of re-injury. Above all, do not train through pain. Pain is your body's signal that something is wrong — that tissues are stressed, irritated, or injured. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport. --- ## Understanding Little League Elbow (Medial Epicondyle Apophysitis) Little league elbow is a common overuse injury seen in young throwing athletes, also known as **medial epicondyle apophysitis**. It occurs when the repeated stress of overhead throwing pulls and shears at the bony growth center on the inner side of the elbow. Radiographs may reveal a widening of the physis at the medial epicondyle apophysis or a frank medial epicondyle fracture. This overuse injury is most commonly diagnosed between the ages of 9 and 12 years, before closure of the medial epicondyle apophysis. Athletes at risk for medial elbow pain include pitchers, catchers who throw the ball back to the pitcher following every pitch, quarterbacks, and tennis players. Reportedly, 70% of baseball players from ages 7 to 19 years have elbow pain at some point during sport participation, including 28% of young pitchers. ### Making the Diagnosis The diagnosis of medial epicondyle apophysitis is largely based on the clinical examination given the variability of radiographic findings. However, obtaining radiographs of the contralateral side can assist in observing if there is apophysis widening or a fracture present. A widening of the medial epicondyle physis is indicative of early injury, and if play is continued, progression to a UCL tear or medial epicondyle avulsion fracture is possible. The older athlete may also have ulnar nerve irritation or even instability of the nerve during throwing. A study by Wei et al. showed that magnetic resonance imaging (MRI) does not commonly provide findings beyond the information obtained from a thorough history, physical examination, and plain radiographs and is therefore not necessary for true cases of medial epicondyle apophysitis. ### Preventing Little League Elbow Rest is of utmost importance in the prevention of medial epicondyle apophysitis. Pitchers are not the only athletes at risk; catchers, volleyball players, tennis players, and football quarterbacks are also vulnerable to the valgus stresses of the overhead thrower. Such athletes should play a maximum of 8 months out of the year to allow their bodies time to rest and prevent long-term damage. Avoidance of participation in more than one game per day, playing on multiple teams, pitching and catching in the same game, and pitching for more than three consecutive days are also measures that should be taken to prevent injury. Young athletes should not play through pain. Both the Major League Baseball Association and the Little League Association support the need for young players to rest their throwing arm between games. As a preventative measure, the USA Baseball organization with collaboration from the American Sports Medicine Institute has set forth pitching guidelines and recommendations via the Pitch Smart Program. However, the amount and types of pitches thrown during practices are not defined or taken into account in these counts. On a positive note, the minimum age for the types of pitches has begun to be considered in their recommendations. ### Non-Surgical Treatment In the absence of a medial epicondyle fracture, conservative treatment of medial epicondyle apophysitis consists of 4–6 weeks of complete rest from all sports-related activities, supplemented with icing and anti-inflammatory medication. Practitioners may also recommend a long-arm orthosis if compliance is in question or the patient is in substantial pain. If the radiographs demonstrate a widening of the apophysis and/or an avulsion fracture with less than 5 mm of displacement, the patient should be placed in a long arm cast or orthosis at 90 degrees of flexion with the forearm in neutral rotation for 4 weeks. A course of occupational or physical therapy is subsequently recommended to gradually rehabilitate and strengthen the affected extremity. A progressive therapy program that starts with joint mobility and range of motion (ROM), followed by the initiation of biomechanical patterns needed for throwing and ending with increasing stress to facilitate tissue adaption for throwing is recommended to fully rehabilitate the upper extremity. Return to throwing within a structured sport is not recommended for at least 3 months. The patient's throwing mechanics and technique must be evaluated and modified as necessary during this time period. **Sources:** - <https://www.luriechildrens.org/en/specialties-conditions/gymnast-wrist-distal-radial-epiphysitis/> - <https://obgynkey.com/pediatric-sports-injuries-little-league-elbow-osteochondritis-dissecans-of-the-elbow-gymnast-wrist/> ---
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Care planDiverticulosis and Non-Acute DiverticulitisDiverticula are small, finger-like pouches that form and push outward through the wall of the colon (your large intestine). When these pouches are present, the condition is called **Diverticulosis**. It becomes increasingly common with age — in fact, about half of all people over 60 have it. Most experts believe the primary driver is a diet low in fiber. The good news: most people with diverticulosis never notice a thing. When symptoms do occur, they tend to be mild — think occasional cramping, bloating, or constipation. In most cases, adding more fiber to your diet and taking a gentle pain reliever is enough to bring relief. When those pouches become inflamed or infected, the condition is called **Diverticulitis**. The most telling symptom is abdominal pain — typically on the lower left side. If infection is involved, you may also experience fever, nausea, vomiting, chills, cramping, and constipation. In more serious cases, diverticulitis can lead to bleeding, tears in the colon wall, or blockages. Treatment is centered on clearing the infection with antibiotics, giving the colon a chance to rest, and taking steps to prevent future flare-ups. Severe cases may require a hospital stay. ### What Causes Diverticulosis and Diverticulitis? Diverticula typically form when areas of natural weakness in the colon wall give way under the pressure of normal digestive activity. The result is small, marble-sized pouches that bulge outward through the colon wall. How exactly those pouches become inflamed or infected is not fully understood. One leading theory suggests that poor nutritional status leads to increased pressure inside the colon, gradually weakening the walls of the diverticula and making them vulnerable to infection. Another theory proposes that the narrow openings of these pouches can trap fecal matter, creating a breeding ground for bacteria. A third possibility is that a blockage at the opening of a diverticulum reduces local blood flow, triggering inflammation. For years, doctors cautioned patients to avoid nuts, seeds, popcorn, and corn, believing these foods could lodge in diverticula and cause problems. **However, research has since shown that these foods are not actually associated with an increased risk of diverticulitis.** ### What Puts You at Risk for Diverticulosis and Diverticulitis? Several factors can increase your likelihood of developing diverticulitis: - **Getting older.** The risk of diverticulitis rises after age 40, though the exact reason isn't fully understood. It's thought that age-related changes — including a gradual loss of strength and flexibility in the bowel wall — may play a contributing role. - **A low-fiber diet and insufficient gut support through probiotics.** Diverticulitis is rare in parts of the world where high-fiber diets are the norm, keeping stools soft and bowel movements regular. It's far more common in industrialized countries like the United States, where refined carbohydrates dominate and fiber intake is low. Notably, the rise of diverticular disease closely followed the introduction of steel-rolling mills, which stripped much of the fiber from flour and other grains. From the moment we enter the world, we begin building our relationship with probiotics. During a normal vaginal birth, a newborn passes through the birth canal and receives its first dose of beneficial bacteria from the mother — the very beginning of a healthy microbial community in the infant's gut. As we grow, that community faces constant threats: chlorinated tap water, heavily processed foods, prescription antibiotics, and even the antibiotic residues found in the meat we eat. The beneficial bacteria living in your digestive tract can only do their best work when the right balance of microbial species is maintained. Probiotics can have a far-reaching impact — not just on gut health, but on your overall well-being. Consider this: **80% of your immune system resides in your gut.** - **Too little physical activity.** A sedentary lifestyle has been linked to a greater risk of developing diverticula in the first place — and by extension, diverticulitis. Exactly why this connection exists isn't yet clear, but the association is well established. - **Obesity.** Carrying excess body weight significantly raises your risk of both diverticulitis and diverticular bleeding. - **Smoking.** Cigarette smokers are more likely to develop diverticulitis than non-smokers. **Source:** NIH: National Institute of Diabetes and Digestive and Kidney Diseases ---
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Care planDry Eyes (Keratoconjunctivitis sicca)Dry eye is one of the most common eye conditions around — and it happens when your tears can no longer do their job of keeping your eyes comfortably lubricated. Tears can fall short in different ways: sometimes your eyes simply don't make enough of them, and other times the tears you do make aren't the right quality to keep your eyes healthy and comfortable. Whatever the cause, dry eyes are genuinely uncomfortable. Your eyes may sting, burn, or feel gritty. You might notice symptoms flaring up in specific situations — on an airplane, in an air-conditioned room, while riding a bike, or after spending a few hours staring at a screen. ## Understanding Dry Eye Your eye has two sets of structures dedicated to producing tears. Smaller tear glands work quietly in the background to maintain a steady baseline of moisture on the eye's surface. That moisture isn't just about comfort — it's essential for clear vision. Tears nourish and lubricate the eye and wash away debris. A smooth, well-balanced tear film — made up of water, oil, and mucus — also allows light to enter the eye in just the right way. When that delicate balance is disrupted, you may experience tearing, burning, irritation, and — most importantly — blurred vision. Unfortunately, **inflammatory conditions like rheumatoid arthritis and Sjögren's disease, as well as the natural processes of aging and menopause, can all lead to decreased tear production.** As tear production declines, the surface of the eye gradually dries out. For some people, the root cause of dry eye is simply not making enough tears. For others, tears evaporate too quickly, or the tear film itself is out of balance. ### Not Making Enough Tears When your eyes can't produce sufficient tears, doctors call this keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VY-tis SIK-uh). Common reasons tear production can fall short include: - **Aging** - **Certain medical conditions,** including diabetes, rheumatoid arthritis, lupus, scleroderma, Sjögren's syndrome, thyroid disorders, and vitamin A deficiency - **Certain medications,** including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control, and Parkinson's disease - **Laser eye surgery,** though dry eye symptoms related to this procedure are usually temporary - **Tear gland damage** from inflammation or radiation ### Tears Evaporating Too Quickly Common reasons your tears may evaporate faster than they should include: - **Wind, smoke, or dry air** - **Blinking less often,** which tends to happen when you're focused on something — reading, driving, or working at a computer - **Eyelid problems,** such as lids that turn outward (ectropion) or inward (entropion) - **Inflammation of the oil glands along the edge of the eyelid** — common in people with rosacea — causes the tear film to break down and evaporate too soon. When this happens, your brain senses that the eye is dry and irritated and signals the main tear gland to flood the eye with tears. Paradoxically, this means dry eyes can actually cause excessive tearing and wateriness. People with dry eyes often notice this intermittent tearing during activities like reading, driving, watching TV, using a computer, or going outside on a windy day — all situations where blinking slows down, allowing the eye to dry out. ### How Dry Eyes Are Treated 1. Replacing tears with artificial lubricants, which are available over the counter 2. Using medications or natural nutritional supplements that reduce inflammation in the tear glands and help restore natural tear production ### Who Is Most at Risk? Certain factors make dry eyes more likely. These include: - **Being older than 50.** Tear production tends to decline with age, making dry eyes more common in this group. - **Being a woman.** Insufficient tear production is more common in women, particularly those experiencing hormonal shifts related to pregnancy, birth control pills, or menopause. - **Eating a diet low in vitamin A,** found in liver, carrots, and broccoli, or low in omega-3 fatty acids, found in fish, walnuts, and vegetable oils - **Wearing contact lenses** ### Potential Complications When dry eyes go unaddressed, they can lead to more serious problems: - **Eye infections.** Your tears serve as a protective barrier against infection. Without enough of them, your risk of eye infection increases. - **Damage to the eye's surface.** Left untreated, severe dry eyes can lead to eye inflammation, scratching of the corneal surface, corneal ulcers, and vision problems. - **Reduced quality of life.** Dry eyes can make everyday tasks — like reading — genuinely difficult. ### How to Protect Your Eyes — Prevention Tips If you have dry eyes, start paying attention to the situations that seem to trigger your symptoms — then take steps to minimize your exposure to those triggers. Here are some practical strategies: - **Keep air from blowing directly into your eyes.** Avoid pointing hair dryers, car heaters, air conditioners, or fans at your face. - **Add moisture to indoor air.** In winter, a humidifier can help combat the dryness that comes with heated indoor air. - **Consider wraparound sunglasses or protective eyewear.** Side and top shields on your eyeglasses can block wind and dry air. Ask about these options where you purchase your glasses. - **Give your eyes regular breaks during prolonged tasks.** If you're reading or doing work that demands intense visual focus, pause periodically. Close your eyes for a few minutes, or blink rapidly for a few seconds to help spread your tears evenly across the eye's surface. - **Stay mindful of your environment.** Air at high altitudes, in desert climates, and in airplane cabins can be extremely dry. In these settings, closing your eyes for brief intervals can help minimize tear evaporation. - **Position your computer screen below eye level.** When your screen is above eye level, your eyes open wider — allowing more tear evaporation. Lowering your screen naturally reduces how wide your eyes stay open and may help your tears last longer between blinks. - **Quit smoking and steer clear of secondhand smoke.** If you smoke, talk to your doctor about a quit strategy that works for you. If you don't smoke, avoid environments where others do — smoke can significantly worsen dry eye symptoms. - **Use artificial tears consistently.** If you have chronic dry eyes, use lubricating eye drops even on days when your eyes feel fine — staying ahead of dryness is easier than catching up to it. > 📝 **NOTE:** It may seem counterintuitive, but patients who experience **increased tearing** may actually have a problem with tear production or tear drainage. Other causes of excessive tear production — such as allergies, infections, or an eyelash irritating the eye — are also possible and can often be identified during a clinical examination. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863> - Tear System — American Society of Ophthalmic Plastic and Reconstructive Surgery ---
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Care planDry Mouth (Xerostomia)**Dry Mouth (Xerostomia)** is the persistent sensation that your mouth just doesn't have enough saliva. Nearly everyone experiences a dry mouth from time to time — perhaps when nervous, upset, or going through a stressful moment. But when dryness becomes your daily reality, it's more than just uncomfortable. Left unaddressed, it can lead to real and serious health consequences. It's important to know that dry mouth is not a normal or inevitable part of getting older. **Common causes include certain medications, radiation therapy, chemotherapy, and nerve damage. Diseases of the salivary glands, Sjogren's syndrome, HIV/AIDS, and diabetes can also be responsible.** ## Understanding Dry Mouth ### Symptoms Common signs and symptoms of dry mouth include: - A sticky, dry feeling in the mouth - Trouble chewing, swallowing, tasting, or speaking - A burning feeling in the mouth - A dry feeling in the throat - Cracked lips - A dry, rough tongue - Mouth sores - An infection in the mouth ### What Causes Dry Mouth? Dry mouth can stem from a surprising range of sources. Some of the most common include: - **Medications** — Hundreds of commonly used drugs list dry mouth as a side effect. These range from pain relievers to medications for depression, cold symptoms, muscle spasms, and allergies. In fact, medications are the single most frequent cause of dry mouth. Older adults, who often take multiple medications simultaneously, are particularly susceptible. - **Underlying diseases and infections** — A number of medical conditions are closely linked to dry mouth, including diabetes, anemia, cystic fibrosis, rheumatoid arthritis, Sjogren's syndrome, high blood pressure, and HIV infection. In Sjogren's syndrome, the body's own immune system mistakenly attacks the salivary and tear glands. Certain viral infections, like mumps, can also directly disrupt saliva production. - **Dehydration** — Anything that depletes your body's fluid levels — fever, excessive sweating, vomiting, diarrhea, blood loss, or fluid loss through burned skin — can trigger dry mouth. - **Radiation therapy** — Dry mouth is a well-known and common side effect of radiation treatment for cancers of the head and neck. - **Surgical removal of a salivary gland** — When a mass develops within a salivary gland, surgical removal of that gland may sometimes be the recommended course of action. **The right treatment starts with finding the right cause.** ### Simple Self-Care Steps Simple steps you can take on your own include: - Sipping water frequently, and steering clear of caffeinated beverages, tobacco, and alcohol - Chewing sugarless gum or slowly dissolving sugarless hard candies to naturally stimulate saliva **Source:** NIH: National Institute of Dental and Craniofacial Disorders ---
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Care planDupuytren ContractureDupuytren contracture is a hereditary condition that causes the connective tissue beneath the skin of your palm and fingers to gradually thicken and tighten. While there is no cure, symptoms typically develop slowly over months or years — and a range of treatments, including non-surgical options, can meaningfully improve your quality of life. ## Understanding Dupuytren Contracture Dupuytren contracture (also known as Dupuytren disease) is a hereditary condition in which the connective tissue beneath the skin of your palm and fingers slowly thickens and tightens. It begins with small firm bumps, called nodules, that form in the fascia — the tough, fibrous layer of tissue just under your skin that gives your hand its structure and support. Over time, these nodules can develop into thick, rope-like cords beneath the skin that pull your fingers inward toward your palm, eventually making it difficult or impossible to straighten them. Importantly, these growths are always benign — they are never a sign of cancer, nor do they increase your risk of developing cancer. Many cases can be managed effectively without surgery, though surgical options are available when needed. ### Who Gets Dupuytren Contracture? Dupuytren contracture can develop in anyone, but certain groups are at higher risk, including: - People assigned male at birth (AMAB). - People of European descent. - People with a close family member who has had the condition. ### Dupuytren Contracture and Other Health Conditions Certain underlying health conditions appear to increase your likelihood of developing Dupuytren contracture, including: - Diabetes. - Epilepsy and other seizure disorders. - Alcohol use disorder (formerly known as alcoholism). - HIV and AIDS. - Vascular disease. ### How Common Is It? Dupuytren contracture is relatively uncommon, affecting around 5% of the population. It is significantly more prevalent among people of European descent than in other ethnic groups. ### How Does Dupuytren Contracture Affect Your Body? In many cases, Dupuytren contracture progresses so slowly that you may not notice any changes at first — or ever. Mild cases sometimes cause no functional problems whatsoever. When symptoms do develop, they typically unfold gradually over months or years. In more advanced stages, you may find it difficult or impossible to fully straighten the affected fingers. Dupuytren contracture can affect any finger, including the thumb. Fingers tend to be affected in the following order, from most to least common: - Ring (fourth finger). - Pinkie (fifth finger). - Middle (third finger). - Index (second finger). - Thumb (first finger). ### Can It Affect Other Parts of the Body? Dupuytren contracture is limited strictly to the hands. Even though it belongs to a family of connective tissue disorders that can occur elsewhere in the body, Dupuytren contracture itself will never develop outside of your hands. > 📝 **NOTE:** People with Dupuytren contracture may be more prone to developing similar connective tissue conditions elsewhere, such as Ledderhose disease (affecting the feet) and Peyronie's disease (affecting the penis). ### What Are the Symptoms? Because Dupuytren contracture can take months or even years to develop, you may not notice any symptoms early on. When they do appear, symptoms typically unfold in the following sequence: - **Nodules:** The earliest sign of Dupuytren contracture is the appearance of small, firm bumps just beneath the skin at the base of your fingers, where they meet the palm. You may be able to feel or see them. In some people, the condition never progresses beyond this stage — and in others, nodules may even resolve on their own. The surrounding skin may appear dimpled or puckered. - **Cords:** Over time, nodules may thicken and extend into long, rope-like cords running along the fascia beneath your skin. These cords can pull on your fingers, creating a persistent sensation of being drawn inward toward your palm. - **Contracture:** The most advanced stage — and the one that gives this condition its name — occurs when the cords become so tight and dense that you can no longer fully extend or straighten your affected fingers away from your palm. Unlike many other musculoskeletal conditions, Dupuytren contracture typically does not have identifiable triggers that cause sudden flare-ups. Instead, symptoms tend to evolve slowly and steadily over time. Not everyone progresses through all three stages. **Additional symptoms** beyond the changes to your fingers may include the following in the affected hand: - Inflammation or swelling. - Tenderness. - Pain or a burning sensation. - Itching. These symptoms are uncommon, occurring in only about one-quarter of people with Dupuytren contracture. If you experience any of them, let your provider know — they can occasionally signal other conditions affecting the skin or underlying fascia. ### What Causes Dupuytren Contracture? The precise cause of Dupuytren contracture is not yet fully understood. What is well established, however, is that it has a strong hereditary component — your risk is significantly higher if a family member has had the condition. In fact, Dupuytren contracture is the most common inherited disorder affecting connective tissue. ### How Is It Diagnosed? Your healthcare provider will diagnose Dupuytren contracture through a straightforward physical examination of your hand. They will visually inspect your hand and fingers, gently feel for nodules and cords beneath the skin, and assess the degree of any contracture present. **Are any tests needed?** No specialized tests are required to diagnose Dupuytren contracture. Your provider may order blood tests or X-rays to evaluate for other conditions that can affect hand function. ### How Is Dupuytren Contracture Treated? Treatment is tailored to the severity of your symptoms and how much the condition affects your daily life. Because Dupuytren contracture progresses slowly, it may be months or years before a more advanced treatment becomes necessary. In many cases, early interventions are sufficient, and you may never need to move on to more intensive options. If symptoms return after initial treatment, some steps may need to be repeated. **Conservative treatment** — first-line, non-surgical approaches include: - Physical therapy or targeted stretching exercises. - Bracing or splinting to gently maintain or restore your fingers' normal range of motion. - Ultrasound therapy (using painless sound waves) or heat treatments to improve the flexibility of the fascia. - Corticosteroid injections to reduce the size of nodules and cords. **Radiation therapy** — your provider may refer you to a radiation oncologist to help treat Dupuytren contracture or slow its progression. Radiation therapy is a painless procedure that uses targeted X-rays or other energy beams to soften nodules and cords. While radiation therapy is commonly associated with cancer treatment, it is important to understand that Dupuytren contracture is not cancer — having this condition does not mean you have, or will develop, cancer. **Needle aponeurotomy** — if conservative treatments have not produced adequate improvement after several months, your provider may recommend needle aponeurotomy (also called percutaneous needle fasciotomy). This is a minimally invasive, in-office procedure performed under local anesthesia. Using a fine needle, your provider makes a series of small punctures in the thickened fascia to release tension and allow your fingers to straighten. **Collagenase injections** — another non-surgical option involves injecting collagenase — an enzyme that breaks down the collagen-rich tissue of the nodules and cords — directly into the affected area. You will return the following day, at which point your provider will numb your hand and carefully manipulate your fingers back toward their normal range of motion. **Surgery** — when contracture is severe enough to significantly interfere with daily activities and quality of life, surgery may be the best option. This is an outpatient procedure, meaning you will go home the same day. The surgical procedure is called a fasciectomy. Under local anesthesia, your surgeon removes part or all of the affected fascia. The extent of tissue removal depends on how much the fascia has thickened and how advanced the contracture is. Post-operative physical or occupational therapy is often recommended to help restore strength and mobility to your hand and fingers. ### Potential Complications of Treatment As with any medical procedure, treatment for Dupuytren contracture carries some risk of complications, which may include: - Pain. - Nerve damage. - Infection. - Scarring. - Damage to nearby blood vessels. - Impaired wound healing. ### Can It Be Prevented? Unfortunately, there is no known way to prevent Dupuytren contracture. Like many hereditary conditions, it can develop without warning and without a clear precipitating event. If someone in your family has been diagnosed with Dupuytren contracture, it is worth mentioning this to your provider so they can monitor you appropriately. ### Is There a Cure? There is currently no cure for Dupuytren contracture. That said, the vast majority of cases are effectively manageable with appropriate treatment. Because there is no cure, approximately 1 in 5 people experience a recurrence of symptoms — even after surgery — and may require additional treatment in the future. ### Managing Your Symptoms Day to Day The most important thing you can do is follow the guidance your provider gives you. If you have been prescribed a stretching routine or instructed to wear a splint or brace, consistency is key — make sure you are doing so as often and as faithfully as your provider recommends. ### Dupuytren Contracture vs. Dupuytren Disease: Is There a Difference? Healthcare providers often use the terms Dupuytren contracture and Dupuytren disease interchangeably. Some clinicians draw a distinction between the two, using "Dupuytren disease" to refer to the broader underlying condition and "Dupuytren contracture" to describe the specific physical result — the tightening and bending of the fingers — that it produces. ### Dupuytren Contracture vs. Trigger Finger: What's the Difference? Both Dupuytren contracture and trigger finger can cause a finger to become stuck in a bent, inward-flexed position — but the two conditions are quite different in origin and mechanism. **Dupuytren contracture** involves the abnormal growth and thickening of the fascia beneath the skin of the palm. Nodules form at the base of the fingers and can develop into cords that run along the length of the palm. **Trigger finger** happens when the A1 pulley (the mechanism that controls and guides the tendons in your fingers and thumb) is inflamed. This inflammation makes moving your finger as smoothly as you're used to difficult. People with trigger finger often feel a "catch" or bump as they bend their affected finger. Whatever the cause of your hand symptoms, do not wait to seek care. Speak with your healthcare provider as soon as you notice something new — especially if you are experiencing pain or difficulty moving your hand normally. ### A Closing Note Your hands are central to nearly everything you do — from the most ordinary daily tasks to the activities that bring you joy. A diagnosis of Dupuytren contracture, particularly in its more advanced stages, can feel daunting. But this condition is very treatable, and a wide range of options exist to help reduce your symptoms and restore function. You are not without options. **Source:** <https://my.clevelandclinic.org/health/diseases/16941-dupuytrens-contracture> **References:** - American Academy of Orthopaedic Surgeons. Dupuytren's Disease. <https://orthoinfo.aaos.org/en/diseases--conditions/dupuytrens-disease/> Accessed 1/23/2023. - American Academy of Orthopaedic Surgeons. Trigger Finger. <https://orthoinfo.aaos.org/en/diseases--conditions/trigger-finger/> Accessed 1/23/2023. - National Library of Medicine. Dupuytren contracture. <https://medlineplus.gov/genetics/condition/dupuytren-contracture/#resources> Accessed 1/23/2023. - Walthall J, Anand P, Rehman UH. Dupuytren Contracture. 2022 Oct 31. In: *StatPearls* [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan–. <https://pubmed.ncbi.nlm.nih.gov/30252330/> Accessed 1/23/2023. ---
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Care planDyslipidemiaCardiovascular diseases (CVD), including heart disease and stroke, account for nearly **40% of all annual deaths** in the U.S. — over **910,000 deaths annually**, equivalent to **1 death every 35 seconds**. Despite decades of research, standard cholesterol testing still misses a large portion of high-risk patients. This protocol takes a root-cause, whole-person approach to understanding and addressing cardiovascular risk. ## Understanding Heart Disease ### How Common Is Heart Disease — and Why It Matters - Cardiovascular disease is the leading cause of **disability and hospitalization**, with more than **6 million CVD-related hospitalizations per year** - Heart disease is increasingly striking younger adults (ages **15–34**) - Alarmingly, in approximately **35%** of CVD cases, the very first sign is **sudden cardiac death** **References:** - Tsao CW, et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. *Circulation*. 2022;145(8):e153–e639. <https://doi.org/10.1161/CIR.0000000000001052> - Kannel WB, Sorlie P, McNamara PM. Prognosis after initial myocardial infarction: the Framingham study. *Am J Cardiol*. 1979;44(1):53–59. --- ### What's Really Driving Heart Disease? According to **Dr. Mark Houston**, the most common root causes of abnormal cholesterol and heart disease are: - **Chronic inflammation** - **Immune system dysfunction** - **Oxidative stress in the blood vessels** **Common underlying contributors include:** - Pro-inflammatory diets - Persistent infections (bacterial, viral, fungal, parasitic) - Toxic burden: heavy metals and persistent organic pollutants (POPs) --- ### Cholesterol: It's Not Just About the Number - **Cholesterol** travels through your body inside **lipoprotein particles** — and your risk depends on the **type and number** of those particles, not just the cholesterol amount alone - **LDL-C**: The amount of cholesterol carried inside LDL particles - **LDL-P**: The total number of LDL particles — a **stronger predictor of heart disease risk** - **Apolipoprotein B (ApoB)**: Reflects the total number of harmful, artery-clogging particles - **Important disconnect**: You can have a low LDL-C but a high LDL-P — and still be at high risk **References:** - Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the ADA and ACCF. *J Am Coll Cardiol*. 2008;51(15):1512–1524. <https://doi.org/10.1016/j.jacc.2008.02.034> - Carmena R, Duriez P, Fruchart JC. Atherogenic lipoprotein particles in atherosclerosis. *Circulation*. 2004;109(1 Suppl 1):III-2–III-7. --- ### Size Matters: Not All LDL Particles Are Created Equal - **Small, dense LDL (sdLDL)** particles carry ≥3x higher risk of coronary heart disease (CHD) - Higher triglycerides are closely linked to more small, dense LDL (↑ TG = ↑ sdLDL) - **Large, buoyant LDL** particles appear to be significantly less harmful to arteries **References:** - Austin MA, King MC, Vranizan KM, Krauss RM. Atherogenic lipoprotein phenotype as a genetic marker for CHD risk. *JAMA*. 1988;260(15):1917–1921. <https://doi.org/10.1001/jama.1988.03410150089036> - Lamarche B, et al. Small, dense LDL particles and ischemic heart disease in men: Québec Cardiovascular Study. *Circulation*. 1997;95(1):69–75. <https://doi.org/10.1161/01.CIR.95.1.69> --- ### Cholesterol and Your Brain: A Surprising Connection Moderately high cholesterol levels in older adults may actually **support sharper thinking** and **protect the brain from oxidative damage**. Cholesterol plays an essential role in: - Maintaining the insulation around nerve fibers and the connections between brain cells - Producing brain hormones (neurosteroids) - Keeping cell membranes flexible and functional --- ### You Can Have a Heart Attack with "Normal" Cholesterol - Approximately **75%** of heart attack patients have LDL-C **<130 mg/dL** - Approximately **50%** have LDL-C **<100 mg/dL** - This tells us that other markers — **ApoB, LDL-P, and inflammation (hs-CRP)** — give us a much clearer picture of true risk - The **JUPITER Trial** confirmed that people with normal LDL-C but elevated **hs-CRP** (a marker of inflammation) still benefit significantly from treatment **References:** - Rosenson RS, et al. JUPITER Trial: Rosuvastatin in primary prevention of CVD. *N Engl J Med*. 2008;359:2195–2207. <https://doi.org/10.1056/NEJMoa0807646> - Thaulow E, et al. Oslo Ischemia Study: Silent ischemia in asymptomatic men. *Am J Cardiol*. 1993;72(9):629–633. ---
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Care planDysmenorrheaDysmenorrhea, or painful periods, is the second most common gynecologic complaint women experience — second only to premenstrual syndrome (PMS). It has long been recognized as its own distinct condition, often described as producing "labor-like" pains. Beyond the personal suffering it causes, dysmenorrhea takes a real-world toll: countless hours are lost at work and school every year because of it. ## Understanding Dysmenorrhea ### Three Types of Dysmenorrhea The first type is ***primary*** dysmenorrhea, which means the pain has no identifiable underlying cause. It most often begins in adolescence, roughly 6 to 10 months after a girl's first period. Primary dysmenorrhea is almost always tied to ovulatory cycles — meaning cycles in which an egg is released — which is why women on oral contraceptives rarely experience it. For many women, symptoms improve after pregnancy, likely because of changes in the sensitivity of nearby nerve fibers. That said, some women actually notice their primary dysmenorrhea worsens after pregnancy, and others continue to experience significant menstrual pain throughout most of their reproductive lives. The second type is ***secondary*** dysmenorrhea, where the pain is caused by an identifiable medical condition. Common culprits include endometriosis (the most frequent cause — and the most frequently missed diagnosis when primary dysmenorrhea is assumed), ovarian cysts, pelvic adhesions (scar tissue), pelvic inflammatory disease, fibroid polyps, adenomyosis, cervical narrowing, and in some cases, a displaced or fixed uterus. **Membranous dysmenorrhea** is the third and rarest form. It occurs when the entire inner lining of the uterus (the endometrium) sheds as a single, intact piece and passes through a cervix that has not dilated to accommodate it — an understandably painful process. ### How Common Is It? Research by Moos, Coppen, and Kessel found that 45% of women surveyed reported moderate to severe dysmenorrhea — and other studies have found similar numbers. In one survey of 113 patients in a family medicine practice, between 29% and 44% of women reported painful periods in any given two-month stretch. When we look at the broader picture, roughly 10% of women of reproductive age suffer from severe primary dysmenorrhea severe enough to interfere with their ability to work, attend school, or manage their daily responsibilities at home. According to researcher Budoff, dysmenorrhea accounts for 140 million lost work hours every year. One study found that 10 to 15% of teenage girls miss one to two days of school every single month because of menstrual pain. ### The Role of Vitamin D Vitamin D deficiency appears to be common among women dealing with hormonal imbalances — including PCOS, dysmenorrhea, endometriosis, and possibly fertility challenges — and may be contributing to some of the underlying biological disruptions seen in these conditions. In a study published in *Steroids* (1999;64(6):430–435), of 13 women with PCOS, 5 were found to have frank vitamin D deficiency (serum 25-hydroxyvitamin D concentration < 9 ng/mL) and 3 others had borderline-low vitamin D status. All 13 women were treated with vitamin D2 at a dose of 50,000 IU once or twice a week to maintain a serum 25-hydroxyvitamin D concentration of 30 to 40 ng/mL. Each woman also received 1500 mg of supplemental calcium per day. Of the 9 women with amenorrhea or oligomenorrhea prior to vitamin D treatment, 7 experienced normalization of their menstrual cycles within 2 months and the other 2 became pregnant. Dysfunctional uterine bleeding also resolved within 2 months in both women in whom it had been present. It's worth noting that vitamin D3 — the form your body naturally produces when your skin is exposed to sunlight — is at least 3.4 times more potent than vitamin D2, and possibly up to 9.4 times more potent, according to a study published in *J Clin Endocrinol Metab* (2004;89(11):5387–5391). This means that when supplementing with vitamin D3, you can achieve the same benefit at lower doses than those used in the study above. According to the Food and Nutrition Board of the Institute of Medicine, long-term vitamin D3 intake up to 5000 IU per day is unlikely to have any adverse effects in the general adult population. ---
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Care planDyspareuniaPainful intercourse (dyspareunia) is common during the premenopausal and menopausal stages of a woman's life. Emotional and psychological factors can dampen sexual arousal and contribute to physical discomfort. For women after menopause, a topical estrogen treatment may be prescribed to help restore vaginal lubrication. That said, there are also natural approaches worth exploring, including nutritional support for healthy hormone balance, topical bio-identical estrogen/progesterone creams, and the use of natural oils. ---
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Care planDyspneaWhen your body's urge to breathe is very high — as it can be during exercise or when fighting an infection — you may experience a powerful, distressing need for air, often described as air hunger. Your breathing also tends to become faster and deeper. Under these circumstances, trying to limit how deeply you breathe can actually make the discomfort worse. **Dyspnea is the medical term for shortness of breath, sometimes described as "air hunger."** Shortness of breath can range from mild and fleeting to serious and persistent. It can be challenging to pin down and treat, largely because so many different conditions can cause it. It is a surprisingly common problem. According to the Cleveland Clinic Center for Continuing Education, 1 in every 4 people who visit the doctor have dyspnea. --- ## Understanding Dyspnea ### What Does Dyspnea Feel Like? Dyspnea can occur after pushing your body hard, spending time at high altitude, or as a symptom of a wide range of medical conditions. Signs that you may be experiencing dyspnea include: - Shortness of breath after exertion or due to a medical condition - A feeling of being smothered or suffocated due to breathing difficulties - Labored breathing - Tightness in the chest - Rapid, shallow breathing - Heart palpitations - Wheezing - Coughing > ⚠️ **IMPORTANT NOTE:** If dyspnea comes on suddenly or if your symptoms are severe, it may be a warning sign of a serious medical condition requiring prompt attention. ### What Causes Dyspnea? Not every episode of shortness of breath points to a health problem. You can feel breathless after intense exercise, when traveling to a high altitude, or when moving between extreme temperatures. That said, dyspnea is most often tied to an underlying health issue. Sometimes it simply reflects being out of shape, and regular exercise can go a long way toward improving symptoms. But dyspnea can also signal something more serious that deserves medical attention. According to Dr. Steven Wahls, the most common causes of dyspnea are asthma, heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease, pneumonia, and psychogenic problems that are usually linked to anxiety. When shortness of breath comes on suddenly, it is called **acute dyspnea**. Acute dyspnea could be due to: - Asthma - Anxiety - Pneumonia - Choking on or inhaling something that blocks the breathing passageways - Allergic reactions - Anemia - Serious blood loss, resulting in anemia - Exposure to dangerous levels of carbon monoxide - Heart failure - Hypotension, which is low blood pressure - Pulmonary embolism, which is a blood clot in an artery supplying the lung - Collapsed lung - Hiatal hernia Dyspnea is also common among people living with a terminal illness. When shortness of breath persists for more than a month, it is called **chronic dyspnea**. Chronic dyspnea could be due to: - Asthma - COPD - Heart problems - Obesity - Interstitial pulmonary fibrosis, a disease that causes scarring of the lung tissue Certain other lung conditions can also cause shortness of breath, including: - Croup - Traumatic lung injury - Lung cancer - Tuberculosis - Pleurisy, an inflammation in the tissues surrounding the lungs - Pulmonary edema, when too much fluid collects in the lungs - Pulmonary hypertension, when the blood pressure in the arteries to the lungs rises - Sarcoidosis, when clusters of inflammatory cells grow in the lungs Shortness of breath has also been linked to the following heart conditions: - Cardiomyopathy, a range of diseases affecting the heart muscle - Heart rhythm problems - Heart failure - Pericarditis, when the tissue that surrounds the heart becomes inflamed ### What Can Trigger Dyspnea? Environmental pollutants — such as chemicals, fumes, dust, and smoke — can make breathing significantly harder for people with dyspnea. For people with asthma, exposure to allergens like pollen or mold can spark episodes of dyspnea. Some triggers, like tobacco smoking, are self-administered and preventable. COPD is an umbrella term for several obstructive lung diseases, including emphysema and chronic bronchitis. All of these conditions make breathing considerably more difficult. Not everyone with dyspnea has COPD, but 90 percent of people with COPD were tobacco smokers at one point, according to the COPD Foundation. ### Potential Complications Dyspnea can be associated with hypoxia or hypoxemia, which is low blood oxygen levels. This can lead to a decreased level of consciousness and other severe symptoms. When dyspnea is severe and goes on for an extended period, it carries a risk of temporary or permanent cognitive impairment. It can also signal the onset or worsening of other medical problems. ---
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Care planDysuria**Interstitial cystitis** is a chronic condition in which the bladder becomes persistently inflamed. In people with interstitial cystitis, the bladder wall is irritated, red, and sore. Over time, this ongoing inflammation can cause the bladder wall to scar and stiffen — and a stiff bladder simply can't stretch the way it needs to as it fills with urine. In some cases, the bladder wall may develop tiny spots of bleeding, and a small number of people develop open sores along the bladder lining. Interstitial cystitis affects more than 3 million American women and 1 million men. The hallmark symptoms of interstitial cystitis include a constant, overwhelming urge to urinate (known as Urgency and Frequency Syndrome), pain in the lower abdomen, pain during sex, and ongoing pelvic pain. ## Understanding Interstitial Cystitis ### What Does Interstitial Cystitis Feel Like? - A sudden, urgent need to urinate — day and night — even when only very small amounts of urine come out - Pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina, or between the anus and scrotum); this discomfort typically builds as the bladder fills and eases after urinating - A bladder that holds noticeably less urine than it used to - Pain during sexual intercourse - In men, discomfort or pain in the penis or scrotum - In many women, symptoms that flare up around the menstrual period; stress can also amplify symptoms, though it does not cause the condition ### What Causes Interstitial Cystitis? The exact cause of interstitial cystitis remains unknown — but one thing doctors are confident about is that it is not caused by a bacterial or viral infection. One leading theory is that a defect in the bladder's inner lining may be to blame. Under normal circumstances, this protective lining shields the bladder wall from the harsh effects of urine. In roughly 70% of people with interstitial cystitis, however, this protective barrier is "leaky," allowing urine to seep through and irritate the underlying bladder wall. Other possible contributors include an abnormal buildup of histamine-releasing cells within the bladder wall, or a misdirected immune response in which the body's own defenses mistakenly attack its own tissues — a process known as an autoimmune response. ### How Is Interstitial Cystitis Diagnosed? Your doctor will begin by reviewing your medical history in detail. You may also be asked to keep a diary tracking how much you drink, how frequently you urinate, and how much urine you produce each time. Before arriving at a diagnosis of interstitial cystitis, your doctor will work to rule out other conditions that can cause similar symptoms — including urinary tract infections, bladder cancer, endometriosis, kidney stones, sexually transmitted infections, chronic prostatitis (in men), and vaginal infections (in women). You may also be referred to a urologist — a specialist in urinary tract conditions. The urologist may use a thin, flexible viewing instrument called a cystoscope to examine the inside of your bladder, looking for signs of inflammation, tiny spots of bleeding, or ulcers — all of which can point to interstitial cystitis. ### How Is Interstitial Cystitis Treated? There is currently no cure for interstitial cystitis. Finding the right approach often takes time — you may need to try several treatments, or a combination of them, before you begin to notice meaningful relief. Most people experience improvement with one or more of the following treatments: - **Diet modifications.** Your doctor may recommend adjusting your diet, which often means cutting back on or eliminating alcohol, acidic foods, and tobacco. - **Bladder distension.** Under anesthesia, a doctor gently overfills your bladder with gas or fluid to stretch its walls. While the exact reason this helps isn't fully understood, it may increase the bladder's capacity to hold urine and may also disrupt the pain signals traveling through the bladder's nerves. - **Medications.** Your doctor may prescribe an oral medication called pentosan polysulfate, which helps reinforce the bladder lining's protective barrier against urine. Another option is the oral antihistamine hydroxyzine, which reduces histamine production in the bladder wall. Amitriptyline is a third medication that may help — it works by blocking pain signals and reducing bladder spasms; because it tends to cause drowsiness, it is typically taken at bedtime. Your doctor may also recommend an over-the-counter pain reliever to help manage day-to-day discomfort. - **Bladder instillation.** This procedure involves using a thin, flexible tube (called a catheter) to deliver liquid medication directly into the bladder. You hold the medication inside for anywhere from a few seconds to 15 minutes before releasing it by urinating. Treatments are typically given every 1–2 weeks over a course of 6–8 weeks and can be repeated as needed. ### Everyday Strategies That Can Make a Difference - **Watch what you eat and drink.** Alcohol, tomatoes, spices, carbonated drinks, chocolate, caffeine, citrus fruits and juices, pickled foods, artificial sweeteners, and other acidic foods can all aggravate the bladder and worsen symptoms. Try eliminating these items entirely for a couple of weeks, then slowly reintroduce them one at a time to identify your personal triggers. - **Quit smoking.** Many people with interstitial cystitis find that smoking significantly worsens their symptoms. And since smoking is also a leading cause of bladder cancer, quitting offers yet another compelling reason to put it behind you for good. - **Bladder training.** With practice, many people can gradually retrain their bladder to urinate less frequently. This involves sticking to a scheduled bathroom routine and using relaxation techniques to help manage urgency between visits. - **Physical therapy and biofeedback.** Interstitial cystitis often comes with painful spasms in the pelvic floor muscles. A physical therapist can teach you targeted exercises to both strengthen and relax these muscles, which can go a long way toward reducing pain and improving bladder control. - **TENS** ("transcutaneous electrical nerve stimulation"). A TENS device delivers gentle electrical pulses into the body through small adhesive pads placed on the skin. Some doctors believe these pulses improve blood flow to the bladder, which in turn strengthens the muscles supporting bladder control and triggers the release of natural hormones that help block pain signals. ---
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Care planEar Infection (Otitis Media)Acute otitis media is a viral or bacterial infection of the middle ear that typically follows an upper respiratory infection (URI). It peaks in children between 6 and 36 months of age and again between 4 and 7 years, making it the single most common diagnosis in pediatric clinical settings. Each year, an estimated 2 billion dollars is spent on conventional medical and surgical treatment of this condition. ## Understanding Ear Infections (Acute Otitis Media) ### What Is an Ear Infection? An ear infection — medically known as acute otitis media — is a sudden infection that takes hold in your middle ear. Think of the middle ear as a small, air-filled room tucked between your eardrum and your inner ear. Inside that room sit three tiny bones whose entire job is to capture sound vibrations from your eardrum and relay them to your inner ear so you can hear. Leading into that room are the eustachian tubes — narrow canals that connect each middle ear to the back of your throat. These tubes serve two important functions: they keep air pressure balanced on both sides of your eardrum, and they allow any fluid that builds up in the middle ear to drain away. When a eustachian tube isn't working properly, fluid can't drain efficiently and begins to pool behind the eardrum, causing that familiar muffled, underwater sensation. When viruses or bacteria enter the picture, that pooled fluid becomes infected — and now you have not only muffled hearing but also pain and discomfort. ### How Common Are Ear Infections? Aside from the common cold, ear infections are the most frequent illness of childhood. They occur most often in children between 6 months and 2 years of age and remain common through age 8. Older children and adults can certainly develop ear infections, but the condition is far less frequent once the childhood years have passed. ### Why Do Children Get Ear Infections More Often Than Adults? Children are more vulnerable to ear infections for several important reasons: - Their eustachian tubes are shorter, more horizontal, and less efficient than those of adults — all features that make it easier for fluid to collect behind the eardrum. - Their immune system — the body's built-in defense network — is still maturing and learning to fight off invaders. - They spend time in close contact with other children, making it easy for germs to spread from one child to the next. ### What Does an Ear Infection Feel Like? Recognizing the Symptoms Symptoms of an ear infection often appear on the heels of a cold. They can include: - Ear pain. - Loss of appetite. - Difficulty sleeping. - Muffled or reduced hearing in the affected ear. - A sensation of fullness or pressure deep in the ear. - Yellow, brown, or white drainage from the ear. (This may indicate that the eardrum has ruptured.) > ⚠️ **IMPORTANT NOTE:** If you notice drainage from the ear, do not insert anything into the ear canal. Contact with a torn (ruptured) eardrum can cause further damage. ### What to Watch For in Infants and Young Children Because babies and toddlers cannot always put their discomfort into words, it's essential to recognize the behavioral and physical signs. A child with an ear infection may: - Tug or rub at one or both ears. - Cry more than usual or seem unusually irritable. - Run a fever anywhere from 100.5 to 104 degrees Fahrenheit (38 to 40 degrees Celsius). (About half of children with ear infections develop a fever.) - Begin breathing through the mouth or snore more than usual — which can be a sign of enlarged adenoids. (Adenoids are small pads of immune tissue located above the throat, behind the nose, and near the eustachian tubes.) Adenoids can become infected or inflamed by the same germs that cause ear infections. - Refuse feedings or eat less than normal. (Swallowing shifts the pressure in the middle ear, which can intensify pain and dampen the appetite.) ### What Causes an Ear Infection? Ear infections are caused by viruses and bacteria, and they frequently follow a cold or other upper respiratory illness. The germs travel up into the middle ear through the eustachian tube. Once there, they can cause the tube to swell shut, trapping infected fluid in the middle ear — and that is where the pain, pressure, and hearing changes come from. ### Are Ear Infections Contagious? The ear infection itself is not contagious, but the viruses and bacteria that trigger it most certainly are. Many of the same germs responsible for colds and the flu can set the stage for an ear infection. ### Who Is Most at Risk for Ear Infections? Several factors can increase the likelihood of developing an ear infection: - **Age:** Infants and young children between 6 months and 2 years face the greatest risk. - **Family history:** A tendency toward ear infections can run in families. - **Colds:** Having a cold raises your risk. Children in daycare or group care settings are especially vulnerable because they are regularly exposed to colds and other contagious respiratory illnesses. - **Chronic illnesses:** Long-standing conditions — including immune deficiencies and chronic respiratory diseases such as cystic fibrosis and asthma — can make ear infections more likely. - **Ethnicity:** Native American, Hispanic, and Alaska Native children experience ear infections at higher rates than children of other ethnic groups. - **Poor air quality and secondhand smoke:** Regular exposure to air pollution or cigarette smoke raises the risk of developing an ear infection. ### What Complications Can Ear Infections Cause? Most ear infections resolve without lasting effects. When complications do occur, they tend to be associated with repeated or prolonged infections. Possible complications include: - **Hearing loss:** Temporary hearing changes — such as muffling or sound distortion — are common during an active infection. Repeated or persistent infections, or physical damage to the delicate structures inside the ear, can lead to more significant hearing loss over time. - **Delayed speech and language development:** Children depend on clear hearing to learn language and develop speech. Even a period of muffled hearing can meaningfully slow this process. - **Torn eardrum:** Roughly 5% to 10% of children with an ear infection develop a small tear in the eardrum. Most tears heal on their own, but if they don't, surgery may be needed. - **Spread of the infection:** Untreated infections or those that fail to improve can spread to nearby structures. Infection can travel to the bone behind the ear (mastoiditis) or, in rare cases, to the membranes that surround the brain and spinal cord, causing meningitis. ### Steps You Can Take to Reduce the Risk of Ear Infections There are practical, evidence-backed steps you can take to lower your child's — or your own — chances of developing an ear infection: - **Reduce exposure to colds and respiratory illnesses.** During your child's first year especially, take an active role in preventing colds. Teach them to wash their hands often and to cough or sneeze into their elbow. Avoid sharing food, cups, or utensils. If possible, delay large daycare settings until they are a bit older. - **Eliminate secondhand smoke.** Keep your child away from cigarette smoke, and make your home and car smoke-free environments. - **Breastfeed (chestfeed) your baby.** If you are able, breastfeeding for the first six to 12 months provides antibodies through breast milk (chest milk) that help fight the viruses and bacteria responsible for infections. - **Hold your baby upright during bottle-feeding.** Keep your baby's head higher than their stomach while feeding. This simple position change helps prevent formula or other liquids from flowing backward and pooling in the eustachian tubes. **Source:** <https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media> ---
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Care planEating DisordersEating disorders are a group of serious conditions defined by unhealthy or deeply troubled relationships with food. At their core, they usually involve an obsession with food, body weight, or body shape — and they can carry severe, even life-threatening, health consequences. The symptoms of eating disorders vary from person to person, but most involve some combination of severely limiting food intake, episodes of uncontrolled eating (bingeing), or harmful compensatory behaviors like self-induced vomiting or compulsive exercise. Eating disorders can affect anyone, regardless of gender or age — but they are most frequently diagnosed in teenagers and young women. Research suggests that as many as 13% of young people will develop at least one eating disorder before turning 20. ## Understanding Eating Disorders ### What Causes Eating Disorders? Eating disorders likely arise from a combination of factors working together, not a single cause. Genetics plays a role. Studies of twins — including twins raised apart in different families — suggest that eating disorders can run in families. On average, if one twin develops an eating disorder, the other has about a 50% chance of developing one as well. Personality is another contributing factor. Traits like emotional instability (neuroticism), perfectionism, and impulsivity have all been linked to a higher risk of developing an eating disorder. Cultural and social pressures matter too — particularly messages promoting thinness, whether from peers, media, or broader societal ideals. Interestingly, certain eating disorders appear to be nearly absent in cultures that haven't been exposed to Western beauty standards. Yet even in countries where those ideals are pervasive, most people don't develop eating disorders — suggesting that no single factor tells the whole story. More recently, researchers have begun exploring whether differences in brain chemistry and structure may also contribute. Levels of the neurotransmitters serotonin and dopamine — the brain's chemical messengers — may be involved, though more research is needed before firm conclusions can be drawn. ### Anorexia Nervosa Anorexia nervosa is perhaps the most widely recognized eating disorder. It most often emerges during the teenage years or early adulthood and is more commonly diagnosed in women than men. People living with anorexia typically perceive themselves as overweight — even when they are dangerously underweight. They often track their weight obsessively, avoid certain foods, and drastically cut their caloric intake. Common signs of anorexia nervosa include: - Being significantly underweight relative to others of the same age and height. - Extremely limited or restricted eating patterns. - An intense, persistent fear of gaining weight — or ongoing behaviors to prevent weight gain — even when already underweight. - An unrelenting drive to be thin, along with resistance to maintaining a healthy weight. - A sense of self-worth heavily tied to body weight or perceived body shape. - A distorted body image, including denial of how seriously underweight one actually is. Obsessive-compulsive tendencies often accompany anorexia. Many people with the disorder are consumed by thoughts of food — some collect recipes or hoard food despite rarely eating it. Eating in social settings may feel overwhelming, and many individuals with anorexia feel a strong need to control their environment, which can make spontaneity very difficult. **Anorexia is officially recognized in two subtypes** — the restricting type and the binge-eating and purging type. People with the restricting type lose weight exclusively through dieting, fasting, or excessive exercise. Those with the binge-eating and purging type may eat large quantities of food — or very little — and then compensate through vomiting, laxative or diuretic use, or compulsive exercise. Anorexia takes a serious physical toll over time. It can lead to bone loss, infertility, brittle hair and nails, and the growth of fine downy hair across the body — the body's attempt to stay warm. In the most severe cases, anorexia can cause heart, brain, or multi-organ failure and can be fatal. ### Bulimia Nervosa Bulimia nervosa is another well-known eating disorder. Like anorexia, it tends to emerge in adolescence or early adulthood and is diagnosed less frequently in men than in women. People with bulimia experience episodes of eating unusually large amounts of food in a short period of time — continuing until they feel painfully full — paired with a sense of being completely out of control during the episode. Binge episodes can involve any type of food, but often center on foods the person normally tries to avoid. After bingeing, the person then tries to compensate — or "purge" — through behaviors such as forced vomiting, fasting, laxative or diuretic use, enemas, or excessive exercise. The symptoms of bulimia can look similar to the binge-eating and purging subtype of anorexia. A key difference: people with bulimia typically maintain a relatively normal body weight rather than becoming dangerously underweight. Common signs of bulimia nervosa include: - Repeated episodes of binge eating accompanied by a feeling of being out of control. - Repeated use of purging behaviors to prevent weight gain. - Self-esteem that is heavily shaped by body shape and weight. - A fear of gaining weight, even when body weight is in a normal range. Physical side effects of bulimia can include a chronically inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, gastrointestinal irritation, severe dehydration, and hormonal disruption. In severe cases, bulimia can dangerously disrupt the body's balance of electrolytes — such as sodium, potassium, and calcium — which can trigger a stroke or heart attack. ### Binge Eating Disorder Binge eating disorder was only officially recognized as an eating disorder relatively recently — yet it is now considered one of the most prevalent eating disorders, particularly in the United States. It typically begins during adolescence or early adulthood, though it can develop later in life. People with binge eating disorder share some features with bulimia and the binge-eating subtype of anorexia: they regularly eat very large amounts of food in a short time and feel a loss of control while doing so. The critical distinction: people with binge eating disorder do not restrict calories or use purging behaviors — like vomiting or compulsive exercise — to compensate for their binges. Common signs of binge eating disorder include: - Eating large amounts of food rapidly, often in secret and to the point of uncomfortable fullness, even when not physically hungry. - Feeling out of control during binge episodes. - Experiencing significant emotional distress — such as shame, disgust, or guilt — about binge eating behaviors. - Not engaging in compensatory behaviors such as calorie restriction, purging, excessive exercise, or laxative or diuretic use. People with binge eating disorder are often overweight or obese, which can increase their risk of related medical complications — including heart disease, stroke, and type 2 diabetes. ### Pica Pica is an eating disorder defined by persistent cravings for and consumption of non-food substances — things like ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch. Pica can occur in people of any age, though it is most often seen in children, pregnant women, and individuals with intellectual disabilities. People with pica face elevated risks of poisoning, infection, gastrointestinal injury, and nutritional deficiencies — and depending on what is ingested, the disorder can be life-threatening. Importantly, for a diagnosis of pica, the consumption of non-food substances must not be a normal part of the person's cultural or religious practices, and must not be considered acceptable within their community. ### Rumination Disorder Rumination disorder is a more recently recognized eating disorder in which a person repeatedly regurgitates food that has already been chewed and swallowed, re-chews it, and then either swallows it again or spits it out. This typically happens within the first 30 minutes after eating, and — unlike medical conditions such as acid reflux — it is a voluntary behavior. Rumination disorder can begin in infancy, childhood, or adulthood. In infants, it most often develops between 3 and 12 months of age and frequently resolves on its own. In older children and adults, professional therapy is usually needed. Left untreated in infants, the disorder can lead to dangerous weight loss and malnutrition. In adults, it may cause people to limit their food intake — particularly in public — leading to weight loss and becoming underweight. ### Avoidant or Restrictive Food Intake Disorder (ARFID) Avoidant or restrictive food intake disorder (ARFID) is a newly renamed — though not entirely new — condition. It replaces the older term "feeding disorder of infancy and early childhood," which had previously only been applied to children under seven years old. Although ARFID often starts in infancy or early childhood, it can persist well into adulthood and affects men and women equally. People with ARFID have significant difficulties with eating — either because they have little interest in food, or because certain sensory characteristics of food (smell, taste, color, texture, or temperature) cause them genuine distress. Common signs of ARFID include: - Avoiding or restricting food to the degree that the person cannot take in enough calories or essential nutrients. - Eating behaviors that interfere with participating in normal social situations, like sharing meals with others. - Weight loss or failure to grow and develop appropriately for one's age and height. - Nutritional deficiencies, or dependence on supplements or tube feeding to meet basic nutritional needs. It's worth noting that ARFID goes well beyond ordinary picky eating in toddlers or reduced appetite in older adults. It also does not include food avoidance related to cultural traditions, religious practices, or limited food availability. ### Other Eating Disorders Beyond the six eating disorders described above, there are additional — less well-known or less common — conditions that also deserve recognition. These generally fall into one of three categories: - **Purging disorder**: People with this disorder use purging behaviors — such as vomiting, laxatives, diuretics, or compulsive exercise — to manage their weight or shape, but without episodes of binge eating. - **Night eating syndrome:** People with this syndrome consume excessive amounts of food during the night, often after waking from sleep. - **Eating disorder not otherwise specified (EDNOS)**: A catch-all category for conditions that share features of eating disorders but don't fit neatly into any of the established categories above. One condition that currently falls under the EDNOS umbrella is orthorexia. While it is increasingly discussed in the media and in scientific literature, orthorexia has not yet been formally recognized as a distinct eating disorder in the current DSM. People with orthorexia are preoccupied — to a harmful degree — with eating "perfectly" or "purely." They may eliminate entire food groups out of fear that those foods are unhealthy. This can lead to malnutrition, significant weight loss, difficulty eating outside the home, and considerable emotional suffering. Unlike some other eating disorders, orthorexia is rarely about losing weight. Instead, a person's sense of identity, self-worth, and satisfaction becomes bound up in how strictly they follow their own dietary rules. ### The Takeaway **The eating disorders described above represent the most common and well-characterized forms of these conditions — and understanding them is the first step toward dismantling the many misconceptions that still surround them.** Eating disorders are genuine mental health conditions with serious physical and emotional consequences. They are not lifestyle choices, passing phases, or signs of vanity. If you believe you — or someone you care about — may be struggling with an eating disorder, please reach out to a healthcare provider who specializes in this area. **Source:** <https://www.healthline.com/nutrition/common-eating-disorders#section10> ---
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Care planEczema / Atopic DermatitisEczema is a broad term for a family of skin conditions that cause rash-like symptoms. The most common form is called **atopic dermatitis**, which is rooted in an allergic response. Eczema tends to be intensely itchy — and the more you scratch, the more red and inflamed the skin becomes. It can affect people of all ages, but it's most common in babies. ## Understanding Eczema and Atopic Dermatitis ### What Is Atopic Dermatitis? Atopic dermatitis is a long-lasting (chronic) skin condition. The word "atopic" refers to an inherited tendency to develop not just dermatitis, but also asthma and hay fever. "Dermatitis" simply means that the skin is red and itchy. ### When Does It Start, and How Long Does It Last? Atopic dermatitis typically begins in infancy and often continues into childhood. The condition tends to follow a pattern of flare-ups — periods when symptoms worsen — followed by remission, when the skin clears and there may be no signs of the condition at all. Remission can last weeks, months, or even years. Some children outgrow atopic dermatitis entirely, while others carry it into adulthood. The good news is that flare-ups in adults are often less severe. ### Symptoms Atopic dermatitis and eczema often begin with dry, intensely itchy skin. Over time, the rash may become red, swollen, and tender. Scratching typically makes things worse. In some cases, a clear fluid may ooze from the rash, which eventually crusts over and begins to flake. The rash most commonly appears in the folds of the elbows, behind the knees, on the cheeks, and on the buttocks. ### Causes and Risk Factors If a family member has atopic dermatitis or eczema, you're more likely to develop it too. That said, these conditions are not contagious — you cannot catch them from another person. The exact underlying cause of eczema and atopic dermatitis is still not fully understood. ### Management While there is no cure for eczema or atopic dermatitis, both conditions can be effectively managed. A big part of that management involves learning to identify and avoid the specific triggers that cause your skin to flare. ---
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Care planEdemaEdema is the medical term for swelling caused by excess fluid that becomes trapped in your body's tissues. **Edema** develops when too much fluid builds up in your body's tissues — either inside your cells (cellular edema) or in the spaces between cells, known as the interstitial spaces (interstitial edema). **Edema** happens when the normal balance of fluids in your body is disrupted. When this occurs, an abnormal amount of fluid collects in your tissues (the interstitial space). Because gravity pulls this fluid downward, it tends to pool in your legs and feet. Peripheral edema is especially common in older adults and pregnant women, but it can affect people of any age. **Pulmonary interstitial edema** is a specific form of lung edema in which excess fluid accumulates in the spaces between the lung's air sacs due to an abnormal increase in the pressure driving fluid out of the blood vessels. **Interstitial lung edema** occurs almost exclusively when pressure builds up abnormally in the tiny blood vessels of the lungs (pulmonary capillaries). This is most often seen in left-sided heart failure, making it a hallmark feature of heart-related (cardiogenic) lung fluid buildup. ---
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Care planEhlers-Danlos SyndromeEhlers-Danlos syndrome (EDS) is a group of inherited conditions that affect your body's connective tissues — the complex network of proteins and other substances that give your skin, joints, and blood vessel walls their strength and flexibility. If you have EDS, your joints are likely unusually flexible and your skin may be unusually stretchy and delicate. This can create real challenges even in everyday situations — for example, if you have a cut that needs stitches, your skin may simply not be strong enough to hold them in place. One particularly serious form of EDS, called vascular Ehlers-Danlos syndrome, can cause the walls of your blood vessels, intestines, or uterus to tear. If you have this form of EDS and are thinking about having children, speaking with a genetic counselor beforehand is strongly encouraged. ## Understanding Ehlers-Danlos Syndrome The most common form of EDS typically presents with the following signs and symptoms: - **Unusually flexible joints.** Because the connective tissue holding your joints together is looser than normal, your joints can bend well beyond the typical range of motion. Smaller joints tend to be affected more than larger ones — some people can even touch the tip of their nose with their tongue. - **Stretchy skin.** Weakened connective tissue allows your skin to be pulled much farther than normal. If you pinch and lift a fold of skin, it will snap right back into place when released. Your skin may also feel unusually soft and velvety to the touch. - **Fragile skin.** Injured skin often has difficulty healing properly. Stitches used to close a wound may tear through the skin, leaving behind wide, irregular scars that look thin and crinkled. How severely EDS affects you can vary widely. Some people have highly flexible joints but little to no skin involvement. ### Vascular Ehlers-Danlos Syndrome People with the vascular form of EDS often share certain distinctive facial features — a slender nose, thin upper lip, small earlobes, and large, prominent eyes. Their skin tends to be thin and nearly see-through, bruising very easily. In lighter-skinned individuals, underlying blood vessels may be clearly visible beneath the skin's surface. Vascular EDS is among the most serious forms of the condition. It can weaken your body's largest artery — the aorta — as well as the arteries supplying your kidneys and spleen. A rupture in any of these vessels can be life-threatening. This form of EDS can also weaken the walls of the uterus or large intestine, which may also rupture. The various forms of EDS are linked to different genetic causes, some of which are passed down through families. If you have one of the more common forms of EDS, each of your children has a 50 percent chance of inheriting the gene responsible. Complications from EDS depend on which symptoms you have. Overly flexible joints, for example, can lead to frequent dislocations and early-onset arthritis. Fragile skin is prone to significant scarring over time. People with vascular EDS face the risk of life-threatening ruptures of major blood vessels. Organs such as the uterus and intestines may also rupture, and pregnancy can further increase these risks. Your family doctor is often the first point of contact, but you will likely be referred to a specialist in genetic conditions for further evaluation. ### How to Prepare for Your Appointment Before your appointment, it helps to write down answers to the following questions: - What symptoms have you been experiencing? - Have any parents, grandparents, or siblings had similar symptoms? - Has any blood relative died from a ruptured blood vessel or organ? - What medications and supplements do you take on a regular basis? ### What Your Doctor Will Want to Know Your doctor is likely to ask you questions such as: - Are any of your joints unusually flexible? - Is your skin more stretchy than normal? - Does your skin heal poorly after injuries? In many cases, a diagnosis can be made based on a combination of very loose joints, fragile or stretchy skin, and a family history of EDS. Genetic testing on a blood sample can confirm the diagnosis in certain cases and help rule out other conditions. There is currently no cure for EDS, but treatment can go a long way toward managing your symptoms and preventing complications from worsening. ### Medications Your doctor may recommend medications to help manage: - **Pain.** If over-the-counter options — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — are not providing enough relief, your doctor may prescribe stronger medications to address your joint or muscle pain. - **Blood pressure.** Because blood vessels are more fragile in certain forms of EDS, your doctor may recommend keeping your blood pressure low to reduce the strain on vessel walls. ### Physical Therapy Joints with weakened connective tissue are more vulnerable to dislocation. Strengthening the muscles around a joint through targeted exercises can help keep it stable. Your physical therapist may also recommend specific braces to reduce the risk of dislocations. ### Surgery and Other Interventions In rare situations, surgery may be recommended to repair joints that have been damaged by repeated dislocations. However, it is important to know that your skin and the connective tissue around the affected joint may not heal well after surgery. ---
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Care planElevated Liver EnzymesWhen your liver is stressed or injured, its cells begin to leak — releasing certain proteins called enzymes into your bloodstream in higher-than-normal amounts. These enzymes are measured through a routine blood test, and when they're elevated, it's often one of the earliest warning signs that your liver needs attention. The liver enzymes most commonly found to be elevated are: - Alanine transaminase (ALT), also known as SGPT - Aspartate transaminase (AST), also known as SGOT - Alkaline phosphatase (ALP) - Gamma-glutamyl transpeptidase (GGT) > *"...since elevated liver enzymes indicate inflammation or damage to cells in the liver. Inflamed or injured liver cells leak higher than normal amounts of certain chemicals, including liver enzymes, into the bloodstream, which can result in elevated liver enzymes on blood tests… The idea behind the 'narrower' range is to identify liver inflammation / damage sooner."* > > **Source:** Mayo Foundation for Medical Education and Research (MFMER), 1998–2012 --- ## Understanding Elevated Liver Enzymes ### Alanine Transaminase (ALT) — Also Known as SGPT ALT is an enzyme found in its highest concentrations in the liver. Think of it as a liver-specific alarm signal — when liver cells are injured, ALT spills into the bloodstream, and your blood test picks up on those elevated levels. An elevated ALT level may be a sign of: - Acute pancreatitis - Celiac disease - Cirrhosis - Death of liver tissue (liver necrosis) - Hepatitis (viral, autoimmune) - Hereditary hemochromatosis - Infectious mononucleosis - Lack of blood flow to the liver (liver ischemia) - Liver disease - Liver tumor - Use of drugs that are toxic to the liver (such as alcohol or prescription medications) ### Aspartate Aminotransferase (AST) — Also Known as SGOT AST is an enzyme found in large amounts in your liver, heart muscle, and skeletal muscle — and in smaller amounts throughout the rest of the body. Because it's not exclusive to the liver, an elevated AST on its own doesn't automatically point to liver disease, but it does indicate that injury has occurred somewhere. Diseases that stress or damage liver cells will raise AST levels. That said, a high AST alone isn't enough to diagnose liver disease — it's a signal of injury. An elevated AST may point to: - Acute hemolytic anemia - Acute pancreatitis - Acute renal failure - Cirrhosis - Heart attack - Hepatitis - Hereditary hemochromatosis - Infectious mononucleosis - Lack of blood flow to the liver (liver ischemia) - Liver necrosis - Liver tumor - Multiple trauma - Primary muscle disease - Progressive muscular dystrophy - Recent cardiac catheterization or angioplasty - Recent convulsion - Recent surgery - Severe deep burn - Skeletal muscle trauma - Use of drugs that are toxic to the liver (such as alcohol or prescription medications) ### Gamma-Glutamyl Transferase (GGT) GGT is an enzyme present throughout the body, but it's most concentrated in the liver. It's one of the most sensitive markers we have for detecting liver damage or disease — meaning it tends to rise early, often before other tests show abnormalities. A GGT blood test simply measures how much of this enzyme is circulating in your blood. Your liver is one of the hardest-working organs in your body — it produces essential proteins, filters toxins out of your blood, and produces bile, a substance your body relies on to properly digest and process fats. Your doctor may order a GGT test if they suspect your liver is under stress, or if liver disease is a concern — particularly when alcohol use may be a factor. Among all the enzyme tests available, GGT is currently considered the most sensitive indicator of liver damage and disease. This damage is most often driven by heavy alcohol use or exposure to other harmful substances, such as certain drugs or environmental toxins. Common signs that your liver may be struggling include: - Decreased appetite - Nausea or vomiting - Lack of energy - Abdominal pain - Jaundice (a yellowing of the skin) - Unusually dark urine - Light-colored feces - Itchy skin If you've completed an alcohol rehabilitation program and are working to stay sober, your doctor may use this test to confirm that your treatment is on track. It can also be used to monitor GGT trends over time in people recovering from alcoholic hepatitis. According to the Mayo Clinic, the normal range for GGT levels is 9–48 units per liter (U/L). Normal values can vary due to age and sex. GGT testing can confirm that liver damage is present, but it cannot tell us the cause on its own. If your GGT comes back elevated, additional testing will likely be needed to understand why. As a general rule, the higher the GGT level, the more significant the damage to the liver. Conditions commonly associated with elevated GGT include: - Overuse of alcohol - Chronic viral hepatitis - Lack of blood flow to the liver - Liver tumor - Cirrhosis, or scarred liver - Overuse of certain drugs or other toxins - Heart failure - Diabetes - Pancreatitis - Fatty liver disease GGT is often interpreted alongside another enzyme called alkaline phosphatase (ALP). When both GGT and ALP are elevated, doctors will look more closely at the liver and bile ducts as a likely source of trouble. If ALP is elevated but GGT is normal, the concern shifts toward bone disease rather than the liver. Your doctor can use this pairing strategically to help narrow down what's going on. ### Alkaline Phosphatase (ALP) Alkaline phosphatase (ALP) is a type of enzyme — a protein that helps drive chemical reactions in the body. Enzymes can break large molecules into smaller pieces, or help smaller building blocks link together into larger structures. ALP is found throughout the body, including in the liver, digestive system, kidneys, and bones. If you're showing signs of liver disease or a bone disorder, your doctor may order an ALP blood test to measure how much of this enzyme is in your bloodstream and help piece together what may be going wrong. In many cases, ALP testing is bundled into a broader panel called a liver or hepatic panel — a group of tests that together give a fuller picture of how your liver is functioning. When the liver isn't functioning properly, ALP levels in the blood often rise. Doctors frequently use this test to check for blocked bile ducts — the channels that carry digestive fluid from the liver to the small intestine. Other liver-related conditions that can drive ALP levels up include: - Liver cancer - Cirrhosis - Hepatitis - Blockage in the bile ducts ALP testing can also flag problems with your bones, including: - Cancers that have spread to your bones - Paget's disease, which affects how bones grow - Issues caused by vitamin D deficiency An ALP level that reads higher than normal for your age and sex doesn't automatically mean something is wrong. Children and teenagers naturally run higher levels than adults, simply because their bones are actively growing. If your ALP is elevated, your doctor may follow up with a more specific test called an ALP isoenzyme test. This test helps pinpoint whether the extra ALP in your blood is coming from your liver or your bones — a critical distinction that shapes what happens next. **Source:** <https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830> ---
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Care planEndometriosisEndometriosis is the growth of uterine lining tissue in places it doesn't belong. It's a surprisingly common condition with no clearly understood cause — though women who delay their first pregnancy appear to experience it more often. Today, thin fiber-optic cameras inserted through tiny incisions allow doctors to directly visualize and assess this misplaced tissue. Endometriosis is a painful, life-disrupting disease in which small islands of uterine lining tissue somehow find their way into the muscular wall of the uterus, along the Fallopian tubes, and even onto the surface of the ovaries and the surrounding pelvic organs — including the nearby colon. When seen during surgery, these small deposits appear as tiny, dark chocolate-colored spots scattered throughout the pelvis, some so small they're nearly impossible to see with the naked eye. Because this tissue is still functionally uterine lining, it responds to the monthly rise and fall of estrogen and progesterone just like the lining inside the uterus — swelling with blood throughout the month and then bleeding when menstruation arrives. This cyclical bleeding trapped within surrounding tissue turns dark brown over time, giving those characteristic chocolate-colored deposits their appearance. When this process is confined to the muscular wall of the uterus itself, it's called adenomyosis, which can cause significant menstrual pain — a condition known as dysmenorrhea. What causes endometriosis remains a genuine medical mystery. Unlike some cancers, there is no known biological mechanism that would allow uterine lining cells to migrate and take root throughout the pelvis. The theory that scattered deposits survive from embryonic development has never been proven. Interestingly, endometriosis also appears to be a relatively modern condition — it's hard to imagine that a disorder this painful could have existed centuries ago without leaving a clear record in medical history. One compelling theory points to the dramatically increased number of menstrual cycles modern women experience before their first pregnancy. In centuries past, women in the Northern Hemisphere typically had only two or three years of menstrual cycles before becoming pregnant — with menarche (first period) occurring around age 16 and first pregnancies arriving around ages 18 or 19. Today, periods commonly begin around age 12, and pregnancy is often delayed until the late 20s or beyond. By the numbers, the typical woman once experienced fewer than 30 menstrual cycles before her first pregnancy; now that number routinely exceeds 150. The theory is that this prolonged, uninterrupted stretch of monthly cycling — without the hormonal "pause" that pregnancy provides — may somehow encourage uterine lining cells to migrate outward. It's a fascinating hypothesis, but more research is clearly needed before we can say with confidence. Conventional medical treatments have included low-dose synthetic estrogen (to suppress the body's own estrogen production), high-dose synthetic progesterone-like medications taken daily or by long-acting injection (to suppress menstruation altogether), and pain medications ranging from codeine to stronger narcotics. Results are generally disappointing. For younger women with mild endometriosis, pregnancy is often the most effective recommendation — and when that path is possible, it frequently helps. Surgical treatment aims to remove all visible endometrial deposits, but complete removal is rarely achievable. In many cases, the ultimate surgical recommendation becomes removal of both ovaries, the Fallopian tubes, and the uterus — regardless of the patient's age. When the condition is confined to the uterine wall (adenomyosis), hysterectomy is typically the conventional recommendation. Natural progesterone offers a gentler alternative, since adequate levels of progesterone in the bloodstream can suppress the hormonal signals (FSH and LH) that drive the monthly cycle. --- ## Understanding Endometriosis ### What Does Endometriosis Feel Like? Signs and Symptoms Because misplaced endometrial tissue can grow near the lumbar nerve network or along the colon, symptoms can vary widely and may be difficult to connect to a single diagnosis. Common experiences include: - A dull, aching, or cramping pain - A heavy, bearing-down pressure in the lower back and pelvis - Pain during intercourse (called dyspareunia) - Abnormal uterine bleeding - Tender, nodular thickenings along the ligaments that support the uterus - A uterus that is tipped backward and tender to the touch - A thickening of the tissues surrounding the ovaries and tubes ### How Does Endometriosis Progress Over Time? The misplaced tissue can establish itself virtually anywhere in the pelvis, and because it responds to the same hormonal signals as normal uterine lining, it swells and bleeds with every menstrual cycle. Over time, pain typically worsens and tends to begin earlier and earlier in the monthly cycle. Conventional medicine currently favors laser-based procedures to destroy visible lesions, or surgical removal of the uterus and ovaries (and sometimes the appendix) to eliminate the hormonal cycle driving the disease altogether. ### Conditions That Can Look Like Endometriosis - Musculoskeletal problems causing back and pelvic pain - Dysmenorrhea (painful periods unrelated to endometriosis) - Pelvic inflammatory disease (PID) - Ovarian tumor ### Factors That May Contribute to Endometriosis - High levels of chronic stress - A diet high in unhealthy fats - Impaired conversion of essential fatty acids - Exposure to environmental estrogen mimics (xeno-estrogens) — synthetic compounds in the environment that behave like estrogen in the body ### The Surprising Link Between Endometriosis and Immune System Diseases According to data published in 2025 in the journal *Hum Reprod.*, endometriosis patients show a significantly increased risk of autoimmune, autoinflammatory, and mixed-pattern diseases, including rheumatoid arthritis, multiple sclerosis, coeliac disease, osteoarthritis, and psoriasis, with genetic correlations between endometriosis and osteoarthritis, rheumatoid arthritis, and multiple sclerosis, and a potential causal link to rheumatoid arthritis. **Main results and the role of chance:** In both retrospective cohort and cross-sectional analyses, endometriosis patients were at significantly increased (30–80%) risk of classical autoimmune (rheumatoid arthritis, multiple sclerosis, coeliac disease), autoinflammatory (osteoarthritis), and mixed-pattern (psoriasis) diseases. Osteoarthritis (genetic correlation (rg) = 0.28, P = 3.25 × 10⁻¹⁵), rheumatoid arthritis (rg = 0.27, P = 1.5 × 10⁻⁵) and multiple sclerosis (rg = 0.09, P = 4.00 × 10⁻³) were significantly genetically correlated with endometriosis. MR analysis suggested a causal association between endometriosis and rheumatoid arthritis (OR = 1.16, 95% CI = 1.02–1.33). eQTL analyses highlighted genes affected by shared risk variants, enriched for seven pathways across all four conditions, with three genetic loci shared between endometriosis and osteoarthritis (BMPR2/2q33.1, BSN/3p21.31, MLLT10/10p12.31) and one with rheumatoid arthritis (XKR6/8p23.1). **Wider implications of the findings:** Endometriosis patients have a moderately increased risk for osteoarthritis, rheumatoid arthritis, and to a lesser extent, multiple sclerosis, due to underlying shared biological mechanisms. Clinical implications primarily involve the need for increased awareness and vigilance. The shared genetic basis opens up opportunities for developing new treatments or repurposing therapies across these conditions. **Reference:** *Hum Reprod.* 2025 Apr 22:deaf062. doi: 10.1093/humrep/deaf062. Online ahead of print. The phenotypic and genetic association between endometriosis and immunological diseases. <https://pubmed.ncbi.nlm.nih.gov/40262193/> ---
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Care planEnuresis (Bedwetting)Bedwetting — the medical term is **enuresis** — simply means involuntary urination during sleep that isn't caused by any structural problem with the urinary tract. If your child has never had a dry night, this is called *primary enuresis*. If your child was previously dry but has started wetting the bed again, that's called *secondary enuresis*. You may also hear bedwetting referred to as "nocturnal enuresis," "nightwetting," or "sleep wetting" — that last term is actually the most accurate, since it can happen during naps too, not just at night. Here's the most important thing to understand: **bedwetting is not an emotional or psychological problem, and it does not mean something is wrong with your family.** It simply means your child sleeps too deeply to notice what their bladder is telling them. Bedwetting is a symptom, not a disease in itself. According to the American Academy of Child and Adolescent Psychiatry, it's remarkably common — about 15% of children still wet the bed after age three. That said, if your child is regularly wetting the bed past age three, it's worth a conversation with your doctor, as it can occasionally signal an underlying condition affecting the kidneys or bladder. Loss of bladder control can happen during the day, at night, or both — and it's not limited to young children. Many teenagers and adults experience this as well, whether on a regular basis or during periods of stress or anxiety. ## Understanding Bedwetting **Here are some bedwetting facts every parent should know:** ### How Common Is Bedwetting? The Numbers Might Surprise You - 15% of five-year-olds — or around 3–4 children in a first grade class — are not dry every night. - 85% of children eventually outgrow bedwetting without treatment. - In the teenage years, only 2%–5% of children continue to wet the bed. - Bedwetting boys outnumber girls by a ratio of 4 to 1. ### It Runs in the Family: The Genetics of Bedwetting Like many traits, bedwetting tends to run in families. If both parents were bedwetters themselves, their child has a seventy percent chance of being one too. If only one parent wet the bed as a child, the odds drop to about forty percent. Interestingly, many children feel far less embarrassed once they learn that a parent or grandparent shared the same experience. It's also worth knowing that some children simply have naturally smaller bladders that fill up more quickly — which can make nighttime dryness that much harder to achieve. Dr. John W. Gerard, Professor of Pediatrics at the University of Saskatchewan, presents evidence that bedwetting is sometimes the result of an allergy: *"The prime problem is that the bedwetting youngster has a small bladder capacity and the bladder capacity has shrunk because the detrusor muscle is in spasm, which is often a manifestation of an allergy. Certain foods such as milk, chocolate, and eggs can cause bladder hypersensitivity which, in turn, causes bedwetting. Removal of offender foods results in cessation of wetting."* To understand why bedwetting happens, it helps to know how children normally develop bladder control. In early infancy, the bladder empties automatically: once it fills to a certain point and the bladder wall stretches enough, the muscles squeeze and release. Between about 18 months and 2½ years, most children begin to sense when their bladder is full — a critical first step toward control. From there, children learn they can consciously hold back the urge to urinate, which gradually stretches the bladder and increases its capacity. Daytime control comes when a child can consciously override the urge; nighttime control arrives when that ability works even during sleep, without any conscious effort. Think of bedwetting as a communication breakdown between the bladder and the brain — one that only happens during sleep. The child isn't ignoring the signal; they genuinely don't hear it. This developmental lag can happen when bladder awareness develops slowly, when the bladder is naturally small, or when the automatic emptying reflex remains strong well into childhood. Just as some children walk or talk later than others, some children simply take longer to achieve dry nights — and that's okay. Under normal circumstances, the bladder is remarkably self-regulating at night — it fills slowly enough that it never demands to be emptied. In children who wet the bed, however, the bladder can overfill, and because these children sleep so soundly, that signal never breaks through. ### Bedwetting Is a Sleep Issue, Not a Behavior Problem It bears repeating: bedwetting is a sleep and developmental issue, not a behavioral one. Some children simply sleep so deeply that their brain never receives — or never acts on — their bladder's "wake up" signal. Observant parents have long recognized this: *"He sleeps so deeply, he doesn't even know he's wetting."* Modern research now confirms what those parents always suspected. Beyond the depth of sleep, hormonal factors may also play a role in some children. Some children who wet the bed may produce too little **ADH (anti-diuretic hormone)** — the hormone released during sleep that tells the kidneys to concentrate urine and produce less of it overnight, keeping the bladder from overfilling. If your child's doctor suspects this, there are safe and effective medical treatments available worth discussing. ### What You Can Do Right Now: Tips and Reassurance If your child is wetting the bed, you may feel confused, frustrated, or even isolated — it's not exactly dinnertime conversation. That's exactly why speaking openly with your pediatrician matters, and why bringing your child into that conversation can be so powerful. When children hear from trusted adults that they are not alone, it builds confidence and takes away shame. In the meantime, the single most helpful thing you can do is make your child feel safe and supported — let them know you're not angry or disappointed, and that this will pass. **Source:** <https://www.askdrsears.com/topics/health-concerns/sleep-problems/bedwetting/10-bedwetting-facts-parents-know> ---
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Care planEosinophilic Esophagitis**Eosinophilic esophagitis (EoE) is a condition in which a particular type of white blood cell — called an eosinophil — accumulates in the esophagus (the tube connecting your mouth to your stomach), triggering pain, difficulty swallowing, and heartburn.** Eosinophilic esophagitis is a chronic allergic and immune-driven condition. It's relatively uncommon, affecting about 1 in 2,000 people. --- ## Understanding Eosinophilic Esophagitis ### What Does EoE Feel Like? Recognizing the Symptoms The hallmark symptom of EoE is difficulty swallowing or eating — a direct consequence of eosinophils building up in the lining of the esophagus. Beyond that, symptoms can look quite different depending on whether you're a child or an adult. In children, symptoms can include: - difficulty eating or drinking - weight loss - vomiting - failure to thrive In adults, symptoms of EoE can include: - food getting stuck and failing to pass into the stomach - heartburn - chest pain - abdominal pain - regurgitation of food In rare cases, EoE can escalate into a medical emergency. If food becomes severely lodged in the esophagus, or if forceful vomiting occurs, a tear in the esophageal wall is possible. This is uncommon, but requires immediate emergency care. EoE is most often seen in people who already have environmental or food allergies, asthma, eczema, or celiac disease. ---
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Care planEstrogen Detoxification**"Estrogen dominance"** is a term used to describe a hormonal imbalance in which a woman may have low, normal, or even high estrogen levels — but has little or no progesterone to keep estrogen's effects in check. In fact, even a woman with low estrogen can experience estrogen dominance symptoms if her progesterone levels are insufficient. It is now well established that one of the leading contributors to breast cancer — as well as many other hormone-related health problems in both men and women — **is excessive estrogen exposure, whether it originates from within the body or from outside sources.** **Estrogen influences the growth, development, and function of tissues throughout the entire body — not just those involved in reproduction.** It plays a vital role in maintaining bone strength, protecting the heart and blood vessels, and shaping mood and behavior. **While healthy estrogen levels are essential for overall well-being, a growing body of research shows that as estrogen exposure increases,** the risk of several cancers — including breast, ovarian, prostate, and thyroid cancers — rises as well. Beyond cancer risk, too much estrogen can also contribute to premenstrual syndrome (PMS), endometriosis, and fibrocystic or painful breasts. **A wide range of lifestyle and environmental factors can tip estrogen levels out of balance.** These include a poor diet, excess body weight, heavy alcohol consumption, elevated insulin levels, medications such as hormone replacement therapy and hormonal birth control, overexposure to chemicals found in pesticides and industrial products, and agricultural hormones present in animal-derived foods. --- ## Understanding Estrogen Dominance in Women ### What Causes Estrogen Dominance in Women? - **Diet —** Animal products are among the biggest contributors to estrogen dominance. Non-organic produce and processed foods made from these ingredients can also play a role, since they are often grown using herbicides and pesticides that mimic estrogen in the body. - **Endocrine disruptors —** Endocrine disruptors are a class of chemicals that interfere with the normal workings of your hormonal system. Under healthy conditions, the endocrine system releases hormones that travel through the body and tell different tissues what to do. When hormone-disrupting chemicals enter the body from the outside, they can impersonate your natural hormones — blocking or binding to hormone receptors in ways they shouldn't. This is especially harmful to hormone-sensitive organs such as the prostate, uterus, and breasts, as well as to the immune and nervous systems, and to normal human development. These synthetic disruptors interfere with estrogen's activity — first by mimicking it, then by working against it — either by directly binding to hormone receptors or by indirectly altering the rate at which hormones are made or broken down. Research has also shown that these compounds can disrupt a much broader range of hormonal systems, including those governed by estrogen, androgens, progesterone, and the thyroid. - **Xenoestrogens** are a specific subgroup of endocrine disruptors that act like estrogen in the body. Estrogen is a hormone naturally produced in both men and women, where it plays key roles in bone development, blood clotting, and reproduction. The body tightly controls how much estrogen it makes through carefully orchestrated biochemical processes. When xenoestrogens enter the body, they add to the total estrogen load — leading to the condition known as estrogen dominance. Because xenoestrogens are not biodegradable, they accumulate in fat cells over time. This buildup has been linked to a number of serious conditions, including breast, prostate, and testicular cancers, obesity, infertility, endometriosis, early puberty, miscarriage, and diabetes. We encounter these substances constantly in daily life. Common sources of xenoestrogen exposure include: pesticide-treated fruits and vegetables, plastic water bottles and food storage containers, nail polish, cosmetics, and hormonal birth control, among many others. - **Excess Body Weight —** Fat tissue is rich in an enzyme that converts protein into testosterone, and testosterone into estradiol — so the more body fat you carry, the higher your estradiol levels are likely to be. Estrogen is also directly stored in fat cells, which means that losing excess body fat is a key step in reversing estrogen dominance. - **Caffeine and Alcohol —** Caffeinated beverages are significant triggers for estrogen dominance. Alcohol is also problematic, because the plants used to produce alcoholic beverages contain estrogen-like compounds that can mimic estrogen's effects once inside the body. **Supporting healthier estrogen metabolism can be beneficial for women with a variety of personal and family health histories,** including a family history of breast, uterine, or ovarian cancer, or personal experience with conditions such as endometriosis, premenstrual syndrome, uterine fibroid tumors, fibrocystic or painful breasts, cervical dysplasia, or systemic lupus erythematosus. --- ## Understanding Estrogen Dominance in Men **"Estrogen dominance"** is often mistakenly considered a women's-only concern — but men are affected too. In fact, widespread exposure to estrogen-mimicking compounds (xenoestrogens and endocrine disruptors) has made estrogen dominance increasingly common in men. In men, a healthy estradiol level falls between 15 and 60 pg/ml. When estradiol climbs above that range — or when testosterone levels drop too low to properly balance it — estrogen dominance takes hold. ### Symptoms of Estrogen Dominance in Men Estrogen dominance in men can manifest in many ways, including: - Mental fatigue, memory difficulties, and trouble concentrating - Moodiness, irritability, and emotional hypersensitivity - Insomnia and persistent physical exhaustion - Depression and weight gain - Gynecomastia (enlarged male breast tissue) - Bone loss, back pain, and headaches - Elevated cholesterol ### Estrogen Dominance and Sexual Health Estrogen dominance can also take a toll on sexual health, contributing to: - Reduced sex drive - Difficulty achieving or maintaining an erection - Low sperm count and infertility - Difficulty reaching orgasm - Male breast enlargement ### Estrogen Dominance and Prostate Health As estradiol levels rise, both prostate size and the amount of fibrous tissue in the prostate tend to increase as well. This can make urination difficult and raises the risk of prostate cancer and benign prostatic hyperplasia (BPH). ### What Causes Estrogen Dominance in Men? - **Diet —** Animal products are among the biggest contributors to estrogen dominance. Non-organic produce and processed foods made from these ingredients can also play a role, since they are often grown using herbicides and pesticides that mimic estrogen in the body. - **Endocrine disruptors —** Endocrine disruptors are a class of chemicals that interfere with the normal workings of your hormonal system. Under healthy conditions, the endocrine system releases hormones that travel through the body and tell different tissues what to do. When hormone-disrupting chemicals enter the body from the outside, they can impersonate your natural hormones — blocking or binding to hormone receptors in ways they shouldn't. This is especially harmful to hormone-sensitive organs such as the prostate, uterus, and breasts, as well as to the immune and nervous systems, and to normal human development. These synthetic disruptors interfere with estrogen's activity — first by mimicking it, then by working against it — either by directly binding to hormone receptors or by indirectly altering the rate at which hormones are made or broken down. Research has also shown that these compounds can disrupt a much broader range of hormonal systems, including those governed by estrogen, androgens, progesterone, and the thyroid. - **Xenoestrogens** are a specific subgroup of endocrine disruptors that act like estrogen in the body. Estrogen is a hormone naturally produced in both men and women, where it plays key roles in bone development, blood clotting, and reproduction. The body tightly controls how much estrogen it makes through carefully orchestrated biochemical processes. When xenoestrogens enter the body, they add to the total estrogen load — leading to the condition known as estrogen dominance. Because xenoestrogens are not biodegradable, they accumulate in fat cells over time. This buildup has been linked to a number of serious conditions, including breast, prostate, and testicular cancers, obesity, infertility, endometriosis, early puberty, miscarriage, and diabetes. We encounter these substances constantly in daily life. Common sources of xenoestrogen exposure include: pesticide-treated fruits and vegetables, plastic water bottles and food storage containers, nail polish, cosmetics, and hormonal birth control, among many others. - **Excess Body Weight —** Fat tissue is rich in an enzyme that converts protein into testosterone, and testosterone into estradiol — so the more body fat you carry, the higher your estradiol levels are likely to be. Estrogen is also directly stored in fat cells, which means that losing excess body fat is a key step in reversing estrogen dominance. - **Caffeine and Alcohol —** Caffeinated beverages are significant triggers for estrogen dominance. Alcohol is also problematic, because the plants used to produce alcoholic beverages contain estrogen-like compounds that can mimic estrogen's effects once inside the body. - **Tight Underwear —** Wearing tight underwear compresses the testicles against the body, restricting blood flow and causing them to overheat. Both of these effects can push estradiol levels up while driving testosterone levels down. ---
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Care planExostosis (Bone Spurs)A bone spur — known medically as an *exostosis* — is a new growth of bone that forms on the surface of an existing bone. Depending on where it develops and how large it grows, a bone spur can be completely painless or cause chronic, sometimes debilitating discomfort. They most commonly appear on the ribs as small, subtle growths, but can also develop on the ankles, knees, shoulders, elbows, and hips. In rare cases, they have been found on the skull. Some bone spurs take on a spur-like shape, such as those that form on the heel bone (calcaneal spurs). Bone spurs are bony projections that develop along the edges of bones. Also called osteophytes, they frequently form at joints — where two bones meet — and along the bones of the spine. The most common underlying cause of bone spurs is the gradual wear-and-tear damage of osteoarthritis. Many bone spurs produce no symptoms whatsoever and may go undetected for years. Treatment is not always necessary; decisions about whether to treat depend on where the spur is located and whether it is affecting your health or quality of life. ### What You Might Feel Most bone spurs cause no noticeable signs or symptoms. In fact, they are often discovered by accident — spotted on an X-ray taken for an entirely different reason. In some cases, however, bone spurs can cause pain and reduced range of motion in the affected joint. What you experience depends largely on where the bone spur has formed. Most treatments aim to reduce the associated inflammation and pain. Here is what bone spurs can feel like at different locations in the body: - **Knee.** Bone spurs in your knee may make it painful to straighten or bend your leg. The bony growths can interfere with the bones and tendons that are needed for smooth, comfortable knee movement. - **Spine.** Bone spurs along the vertebrae of your spine can narrow the channel that houses your spinal cord. This can compress the spinal cord itself, or the nerve roots branching off of it, sometimes causing weakness or numbness in your arms or legs. - **Hip.** Bone spurs in the hip can make movement painful — and that pain sometimes travels down toward the knee. Depending on where the spur has formed, it can also limit how far you can move your hip. - **Shoulder.** Bone spurs can rub against your rotator cuff — the group of muscles and tendons responsible for controlling your shoulder movements. Over time, this friction can cause swelling (tendinitis) and even tears in the rotator cuff. - **Fingers.** Bone spurs in the fingers appear as firm lumps beneath the skin, giving the finger joints a knobby appearance. - **Heel spur.** A bony growth that usually begins on the front of your heel bone and points toward the arch of your foot. Heel spurs don't always cause pain. In fact, heel spurs often show up unexpectedly on X-rays taken for some other problem. Heel spurs occur in about half the people who have plantar fasciitis (PLAN-tur fas-e-I-tis), a painful condition involving the thick tissue that runs between your heel bone and your toes. In the past, doctors often performed surgery to remove heel spurs, believing them to be the cause of the pain associated with plantar fasciitis. In treating plantar fasciitis now, doctors rely more on ice, arch supports, physical therapy, and pain medications. ### What Causes Bone Spurs The most common culprit is osteoarthritis — the gradual "wear-and-tear" form of arthritis. As osteoarthritis erodes the protective cartilage at the ends of your bones, your body attempts to compensate by generating new bone near the damaged area. These extra bony growths may help increase the surface area available for load bearing — your body's way of trying to stabilize an injured joint. ### When Bone Spurs Become a More Serious Problem Bone spurs can sometimes break away from the larger bone, creating what doctors call "loose bodies." These fragments may float freely within the joint space or become embedded in the joint's inner lining (called the synovium). When loose bodies drift into the narrow space between the bones of a joint, they can physically get in the way of normal movement — creating a sensation of intermittent "locking," as though something is blocking your joint from moving freely. This locking tends to come and go as the fragment shifts in and out of position within the joint. ---
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Care planEye Floaters (Benign)Eye floaters are those tiny, drifting specks or shapes that seem to float across your field of vision. You may notice them most when looking at something bright — like a blank white page or a clear blue sky. Eye floaters can be frustrating, but in most cases they won't meaningfully interfere with your vision. Occasionally, a particularly large floater may cast a faint shadow across part of your visual field — though this tends to happen only in certain lighting conditions. Most people simply learn to live with their floaters and tune them out over time. They often fade or become less noticeable over months to years. It's only rarely that floaters become troublesome enough to warrant treatment. That said, floaters can sometimes signal a more serious problem. If you notice a sudden surge in the number of floaters you're seeing, seek medical attention right away. > ⚠️ **IMPORTANT NOTE:** A sudden increase in floaters — especially when accompanied by flashes of light or loss of peripheral (side) vision — requires immediate evaluation by an eye doctor. Without prompt treatment, you risk permanent vision loss. These warning signs may point to retinal detachment, retinal tear, or bleeding within the eye. --- ## Understanding Eye Floaters ### What Do Eye Floaters Look Like? Eye floaters tend to move as your eyes move — and they characteristically seem to dart away just when you try to look directly at them. They can take many different forms, including: - Black or gray dots - Squiggly lines - Threadlike strands, which can be knobby and semi-transparent - Cobwebs - Ring shapes Once eye floaters develop, they typically don't disappear entirely — though they do tend to become less bothersome with time. ### What Causes Eye Floaters? Most floaters originate from tiny fragments of a protein called collagen. The back portion of your eye is filled with a clear, gel-like substance called the **vitreous humor**. As we age, the vitreous — along with its millions of delicate collagen fibers — gradually shrinks and breaks down into shred-like fragments. These shreds accumulate inside the vitreous, subtly altering the way light hits the retina (the light-sensitive tissue lining the back of the eye). This disruption in light transmission is what produces the floater symptoms you experience. These changes can occur at any age, but they are most common between ages 50 and 75, particularly in people who are significantly nearsighted or who have undergone cataract surgery. - **Aging.** The most common cause of floaters is simply the natural aging process. Over time, the vitreous gel — which helps maintain the shape of the back of your eye — gradually liquefies, releasing protein (connective tissue) into the gel. This process affects more than half of people over age 70. Some areas of the vitreous may also clump together, forming visible floaters inside the eye. - **Diabetes.** Floaters are relatively common in people with diabetes. The disease can weaken the tiny blood vessels in the eyes, causing them to leak. That blood can clot and settle into the vitreous as floaters. - **Prenatal Development.** In some people, floaters appear as remnants of tiny cell clusters from blood vessels that formed during the eye's development before birth and never fully dissolved. - **Eye Trauma.** Physical injury to the eye can also trigger the appearance of spots and floaters. Many of these floaters persist for an extended period before they gradually resolve. - **Nearsightedness.** People who are nearsighted face a higher risk of developing floaters. This risk is also elevated in those with food allergies and/or candidiasis (chronic yeast infections). - **Organ Congestion.** From the perspective of Chinese Medicine, congestion affecting the kidney, liver, and colon may contribute to the development of floaters. Less commonly, eye floaters can result from other eye surgeries or from: - Eye disease - Eye injury - Diabetic retinopathy - Crystal-like deposits that form in the vitreous - Eye tumors such as lymphoma (rarely) Serious eye conditions associated with eye floaters include: - Retinal detachment - Retinal tear - Vitreous hemorrhage (bleeding) - Vitreous and retinal inflammation caused by viral infections, fungal infections, or auto-immune inflammation - Eye tumors It's also worth noting that a distinct type of floater is associated with the visual aura that can accompany migraine headaches. ### When Should You See a Doctor? If you have just a few stable floaters that haven't changed over time, they usually don't signal a serious problem. That said, it's important to see a doctor if: - Your floaters seem to be getting worse over time — especially if the change comes on suddenly. - You notice flashes of light or any vision loss alongside your floaters. - Floaters develop following eye surgery or an eye injury. - You experience eye pain along with your floaters. ### How Are Eye Floaters Treated? Benign eye floaters almost never require medical intervention. When they are bothersome, you can often shift them out of your line of sight simply by moving your eyes — this maneuver redistributes the fluid inside the eye. Moving your eyes up and down is typically more effective than moving them side to side. If floaters are so dense and numerous that they significantly impair your vision, your eye doctor may discuss a surgical option called a **vitrectomy**. In this procedure, the vitreous — along with all the floating debris within it — is removed and replaced with a sterile salt solution. Vitrectomy carries real risks, including: - Retinal detachment - Retinal tears - Cataracts These complication rates are significant, which is why most surgeons reserve vitrectomy only for patients whose vision is seriously and substantially affected by floaters. **Reference:** Adapted from WebMD. ---
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Care planFacet Syndrome / Lumbar Facet SyndromeFacet syndrome describes chronic or acute inflammation of the small joints — called facet joints — that guide and stabilize the movement of your vertebrae (the bones of your spine). These joints are cushioned by cartilage and wrapped in tough ligament tissue, both of which are densely packed with pain-sensing nerve fibers. Facet joints can become inflamed through trauma — such as a flexion/extension "whiplash" injury — or from overloading, as when you lift something heavy and arch your back to carry the load. Once inflamed, this condition tends to get worse over time without treatment. The muscles surrounding the affected joints may go into spasm, causing abnormal joint movement. The local connective tissue then becomes inflamed and begins to scar, which further disrupts normal movement and perpetuates the cycle of pain. Over time, deteriorating facet joints can trigger the growth of bone spurs (called osteophytes) along the edges of the openings in the vertebrae — the spine's attempt to compensate for lost stability. If these bone spurs press against nearby nerve roots or the sciatic nerve in the lower back, they can cause pain, tingling, numbness, and muscle weakness that radiates into the buttocks, legs, and feet. Lumbar facet syndrome refers specifically to the pain and dysfunction caused by arthritis of the facet joints in the lumbar (lower back) region of the spine. Because the lower back bears so much of our body weight and is constantly in motion, it is the most common location for facet joint breakdown. The exact causes are not fully understood, but age is a well-established factor — people over 50 are significantly more likely to develop this condition. ### Signs and Symptoms - Back and neck pain - Muscle spasms - Localized swelling and tenderness that can be felt directly over the affected facet joint - Leaning or shifting posture to one side to avoid pain (antalgia) - Holding the neck in a forward, flexed position to reduce pressure on the facet joint - Pain that worsens when bending the spine backward (extension) - Pain that worsens with downward pressure on the spine (axial loading) ---
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Care planFailure to Thrive SyndromeFailure to thrive describes a situation in which a child is not getting adequate nutrition — either they aren't taking in enough calories, or their body isn't able to make use of the calories they do receive. It is not a disease or disorder in itself, but a signal that something is interfering with normal growth. Doctors most often identify and diagnose this condition during the infant and toddler years. ## Understanding Failure to Thrive ### What Is It? A child is said to have "failure to thrive" when their growth falls short of recognized standards. A classic example is a child whose weight consistently falls below the normal range for their age. To determine whether a child's weight is where it should be, a doctor compares their weight, height, age, and sex against national averages. Children with failure to thrive typically fall well below that expected range. The diagnosis may also apply if a child's rate of weight gain — and often height gain — levels off when it should be steadily climbing. ### Could My Child Be at Risk? Certain underlying health conditions can increase a child's risk of failure to thrive, including: - Down syndrome - Cerebral palsy - Heart disease - Infections - Milk allergy - Cystic fibrosis - Celiac disease - Acid reflux disease Children who face serious medical challenges in their early years can develop failure to thrive, as can babies who are born prematurely or with a low birth weight. **That said, the single most common cause of failure to thrive is simply not consuming enough calories.** Other factors that can contribute to poor nutrition include: - Poor feeding habits - Neglect - Physical abuse - Mental trauma - Mental health conditions, such as depression - Other factors, such as poverty ### What Are the Signs of Failure to Thrive? In most cases, a child's weight falls below the 3rd percentile on standard growth charts. However, a shift in the pattern of growth can be just as telling as any specific number. For instance, if your child had been growing steadily but their growth has suddenly plateaued, that alone may signal a problem. Growth may also follow an unpredictable, unsteady pattern. Beyond weight concerns, some children with failure to thrive show the following signs: - Lack of weight gain - Delays in reaching developmental milestones, such as rolling over, crawling, and talking - Learning disabilities - Lack of emotions, such as smiling, laughing, or making eye contact - Delayed motor development - Fatigue - Irritability - Delayed puberty in teens ### When Should I See a Doctor? Routine checkups are one of the best tools for preventing failure to thrive — or for catching it early when it does occur. Ideally, these visits begin during pregnancy and continue right through adulthood. At each visit, your doctor should be tracking and plotting your child's growth on standardized growth charts. A child with failure to thrive may appear noticeably small compared to peers of the same age and sex, and their growth pattern may be irregular. Staying consistent with pediatric checkups gives you and your child's doctor the clearest, most accurate picture of how they're growing over time. Because failure to thrive can lead to lasting delays in mental, emotional, and physical development, keeping up with regular checkups — so your doctor can monitor your child closely — is especially important. ### How Is Failure to Thrive Diagnosed? Several tests can help pinpoint an underlying cause and assess how failure to thrive is affecting your child's health and development. These may include: - Blood tests - Urine tests - X-rays - Developmental screenings If the doctor suspects that unhealthy family dynamics are playing a role, caregivers may be referred for counseling as part of the evaluation. Ask your doctor for a growth chart showing the ideal height and weight ranges for children — these are recommended for children between the ages of 2 and 20, and can be a helpful tool for tracking your child's progress at home. ### How Is Failure to Thrive Treated? Treatment is tailored to each child and depends on a number of factors, including the: - Severity of symptoms - Overall health of the child - Preferences of parents or caretakers - Family environment - Cause of condition In some cases, treating an underlying condition is all that's needed for a child to begin growing normally again. When additional support is necessary, a doctor may recommend nutritional supplements or a specialized diet based on the root cause of the problem. If home environment or family dynamics appear to be contributing factors, your doctor may involve social services. In severe cases, hospital care — including the use of feeding tubes — may be needed to ensure your child is receiving adequate nourishment. Even after your child's growth returns to normal, they may benefit from ongoing support to maintain healthy physical and cognitive development. A team of specialists can help with this, including: - Physical therapists - Speech therapists - Occupational therapists - Dietitians ### What Can I Expect Long-Term? With early treatment and no serious underlying medical issues, most children go on to grow and develop normally. However, failure to thrive that goes unaddressed can lead to lasting complications, including: - Learning disabilities - Emotional problems - Restricted growth If you notice that your child is having difficulty eating, appears to be losing weight, or simply isn't gaining weight the way you'd expect, don't hesitate to reach out to your doctor. Getting answers early can ease your worry and put your child on a path toward better health and nutrition. **Sources:** - Failure to thrive. (2014). <http://kidshealth.org/en/parents/failure-thrive.html> - Failure to thrive (FTT) in children. (n.d.). <http://stanfordchildrens.org/en/topic/default?id=failure-to-thrive-90-P02297> - Growth charts. (2010). <http://cdc.gov/growthcharts/index.htm> - Homan GJ. (2016). Failure to thrive: A practical guide. <http://aafp.org/afp/2016/0815/p295.html> - <https://www.healthline.com/symptom/failure-to-thrive#outlook> ---
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Care planFamilial HypercholesterolemiaFamilial hypercholesterolemia (FH) is a genetic condition that disrupts the way your body handles cholesterol. If you have FH, your risk of developing heart disease — and suffering a heart attack at an early age — is significantly higher than average. FH is inherited, meaning you are born with it. From the very beginning of life, this condition sets the stage for aggressive, premature cardiovascular disease — including heart attacks, strokes, and even narrowing of the heart valves. Importantly, FH is not caused by diet or lifestyle choices. Instead, specific genetic mutations prevent the liver from properly clearing excess LDL ("bad" cholesterol) from the bloodstream. The result is dangerously high LDL levels that, over time, dramatically increase the risk of cardiovascular disease (CVD). Here's something worth knowing: the vast majority of the cholesterol in your body is actually made by your liver — not consumed through food. Cholesterol itself is not the enemy; it is a necessary building block for healthy cells. But in people with FH, the body cannot efficiently recycle the cholesterol it naturally produces. This causes cholesterol to accumulate in the bloodstream, where it can silently build up as dangerous blockages in the arteries supplying the heart and brain. The longer LDL levels remain elevated, the greater the likelihood of a serious cardiovascular event. Because FH is present from conception, even unborn children with this condition are already being exposed to high cholesterol levels — meaning the seeds of vascular disease can be sown before birth. **FH comes in two forms.** If you inherited the genetic mutation from only one parent, you have **Heterozygous FH (HeFH)** — the more common form, affecting 1 in 250 people worldwide. If you inherited the mutation from both parents, you have **Homozygous FH (HoFH)**, a far rarer and more severe form that occurs in approximately 1 in 160,000 to one million people worldwide. **The encouraging news: with the right medications and healthy lifestyle choices, the risks associated with FH can be meaningfully reduced.** **Source:** <https://www.mayoclinic.org/diseases-conditions/familial-hypercholesterolemia/symptoms-causes/syc-20353755> --- ## Understanding LDL Particle Number (LDL-P) and Cardiovascular Risk ### Why Standard Cholesterol Testing May Not Tell the Whole Story Adapted from **"LDL Cholesterol vs. LDL Particle Number, LDL-P and ApoB Measurements"** by Thomas Dayspring MD and **"Role of Nutrition and Nutritional Supplements in Dyslipidemia"** by Mark Houston, MD — *Clin Lipidology*. 2014;9(3):333-354. Explaining the relationship between blood fats (lipids) and cardiovascular disease (CVD) risk is more nuanced than it might seem. There are many types of lipids, most of which serve essential roles in the body. Yet certain lipid measurements can signal an elevated risk of heart disease — and understanding what those measurements mean can help you make more informed decisions about your health. It is also important to keep in mind that a link between a specific type of fat or lipoprotein and heart disease risk does not automatically mean one causes the other. In science, correlation does not prove causation. Cholesterol is the fat most commonly associated with heart disease risk. Elevated blood cholesterol — particularly LDL cholesterol (LDL-C) — has been linked to a higher risk of CVD. While this relationship is debated by some researchers, reducing LDL-C levels is widely recommended as a strategy to lower cardiovascular risk. ### Not All LDL Is Created Equal: The Role of Particle Size Triglycerides are the most abundant type of fat in the human body and in the food we eat. About two percent of dietary fats are phospholipids, and only a small fraction are sterols — the most common of which in animals is cholesterol. Because cholesterol and triglycerides cannot travel through the bloodstream on their own, they are packaged together with proteins into structures called lipoproteins. Most people are familiar with the two main types of cholesterol carriers: HDL-C, often called "good" cholesterol, and LDL-C, often called "bad" cholesterol. HDL and LDL are two of five major lipoproteins involved in transporting fats throughout the body. The others are chylomicrons, IDL (intermediate density lipoprotein), and VLDL (very low density lipoprotein, which primarily carries triglycerides). LDL is the lipoprotein most directly involved in atherosclerosis — the buildup of plaque inside artery walls. But not all LDL particles are the same. They come in different sizes: large, fluffy particles on one end of the spectrum, and small, dense particles on the other. Research has taken a closer look at whether size matters when it comes to heart risk. Studies show that people whose LDL particles are predominantly small and dense face a threefold greater risk of coronary heart disease. Large, fluffy LDL particles, by contrast, may actually be protective. However, the elevated risk seen with small LDL particles may also reflect a greater overall number of LDL particles circulating in the blood. This means that the total count of LDL particles — not just their size — could be the more important factor when assessing cardiovascular risk. There is a meaningful inverse relationship between triglyceride levels and LDL particle size: the higher your triglycerides, the greater the proportion of small, dense LDL particles. Conversely, lower triglyceride levels are associated with more large, fluffy LDL particles. ### What Is LDL-P, and Why Should You Care? The standard LDL-C value reported on most routine lab panels is typically calculated using a formula called the Friedewald equation. This approach can underestimate true LDL-C levels when triglycerides are elevated. While direct LDL-C measurements are more accurate and do a better job of capturing individual variation, they are used less frequently due to marginally higher costs. Either way, LDL-C reflects the total amount of cholesterol contained within LDL particles — but because the amount of cholesterol packed into each particle can vary, LDL-C alone does not tell you how many particles are actually circulating in your blood. That's where LDL-P comes in. **LDL-P** (LDL particle number) measures the actual count of LDL particles in your bloodstream (expressed as particle concentration in nmol/L). Research suggests that LDL-P may be a stronger predictor of cardiovascular events than LDL-C alone. A low LDL-P is a much more reliable indicator of low cardiovascular risk than a low LDL-C. Strikingly, approximately **30–40% of people with low LDL-C** may still have an elevated LDL-P — meaning they appear "safe" on a standard lipid panel, yet may remain at significant risk for CVD. When LDL-C and LDL-P point in different directions, this is referred to as *discordance*. Lipoproteins are central to both the initiation and progression of atherosclerosis. Understanding what drives their production and clearance — and how those processes can be modified — is therefore critical. LDL-C only measures the cholesterol mass contained within LDL particles, which means it only indirectly reflects the true atherogenic (plaque-forming) potential of LDL. Apolipoprotein B (apoB) and LDL-P, on the other hand, directly reflect the number of atherogenic particles in circulation, independent of cholesterol content. For this reason, both apoB and LDL-P are considered more accurate risk predictors than LDL-C alone. In a 2008 consensus statement on lipoprotein management in patients with cardiometabolic risk, the American College of Cardiology and the American Diabetes Association recommended that both apoB and LDL-P be given more prominent roles as therapeutic targets. This also helps explain a puzzling but well-documented clinical reality: many patients who suffer a heart attack do not have elevated LDL-C on standard testing. When LDL-P is high but LDL-C is not, the standard panel simply misses the risk. ### Understanding Your LDL-P Results LDL-P is measured using a specialized test called an NMR (nuclear magnetic resonance) lipid profile. A value below 1,000 is considered ideal. A value above 2,000 is considered very high. | **LDL-P Level (nmol/L)** | **Classification** | |---|---| | < 1,000 | Ideal | | 1,000–1,299 | Moderate | | 1,300–1,599 | Borderline High | | > 1,600 | High | ### Choosing the Right Lipid Test According to Dr. Mark Houston, because LDL-P is the primary driver of coronary heart disease (CHD) risk, the most informative lipid testing available is "LPP advanced lipid testing," which evaluates both HDL and LDL particle numbers as well as ApoB. Optimal targets are an LDL-P below 700 and an ApoB below 70 mg/dL. > *"Clinical outcome studies in CVD clearly demonstrate that in patients with discordance between total LDL and HDL levels and measures of LDL and HDL particle numbers (LDL-P and HDL-P), CVD risk tracks with the particle measurements of both. LDL-P direct. HDL-P inverse."* **Advanced lipid testing options include:** - Lipoprotein Particle Analysis (LPP) — Spectracell - NMR (Nuclear Magnetic Resonance) — Liposcience - Boston Heart Lab (BHL) - Cleveland Heart Lab - Berkley Heart Lab (BEHL) — Quest Lab - Health Diagnostics Lab (HDL) - VAP (Vertical Analytic Profile) — Atherotec ---
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Care planFatigueFatigue is the medical term for a persistent lack of energy and an overwhelming sense of tiredness. Nearly everyone feels tired at some point — that's perfectly normal. What's more concerning is fatigue that just won't go away, no matter what you do. The causes of fatigue can be broadly divided into two groups: - Fatigue as a result of non-medical factors - Fatigue due to medical factors (illness) ---
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Care planFemale AlopeciaFemale pattern hair loss is a distinctive and recognizable pattern of hair thinning and loss in women, driven by a combination of hormones, stress, aging, and genetics. Each hair grows from its own follicle at an average rate of about 1/2 inch per month. Individual hairs grow actively for 2 to 6 years, then enter a resting phase before falling out — at which point a new hair normally begins growing in its place. At any given moment, roughly 85% of your hair is actively growing, while the remaining 15% is resting. Baldness happens when hair falls out and healthy new hair simply doesn't grow back to replace it. Why new hair fails to grow in female pattern hair loss isn't fully understood, but it is likely connected to one or more of the following: - Aging - Shifts in androgen (male hormone) levels driven by the hormonal changes of the menopausal transition — for example, many women notice that their scalp hair becomes thinner after menopause, even as facial hair becomes coarser — and/or a stress-driven androgenic hormonal shift. - A family history of male or female pattern hair loss **Hair loss in women can also stem from causes unrelated to female pattern baldness, including:** - **Hair breakage** — from chemical treatments, excessive styling, twisting or pulling, or structural abnormalities of the hair shaft that may be present from birth. - **Certain skin conditions** that cause scarring of the hair follicles, permanently disrupting hair growth. - **Hormonal imbalances**, such as excess testosterone or abnormal thyroid hormone levels — conditions that are very often triggered or worsened by chronic stress. - **Iron deficiency:** Multiple studies have linked low ferritin (stored iron) levels to hair loss. In one study, researcher Hard examined 140 women with diffuse hair loss and found that 19% had iron deficiency without anemia. All iron-deficient patients were treated with oral iron, and in every case, hair loss stopped and regrowth occurred. **The target ferritin level for treatment is greater than 40 mcg/L.** **Source:** <https://www.medscape.com/s/viewarticle/995576?ecd=mkm_ret_230908_mscpmrk_neuro_movement_etid5832010&uac=149193PV&impID=5832010> - **Certain medications, including chemotherapy drugs and beta blockers.** - **Patchy hair loss (alopecia areata).** - **Syphilis** - **Temporary hair shedding (telogen effluvium)** — a common response to major illness, surgery, or pregnancy. - **Nutritional deficiencies** essential to healthy hair growth, including biotin, vitamins A, C, and E, sulfur-containing amino acids, protein, and essential fatty acids. In older women, digestive issues that impair nutrient absorption may be an important contributing factor. ### Androgenetic Alopecia: The Hormonal Hair Loss Connection Androgenetic alopecia is one of the most common forms of hair loss in both men and women. In men, it is widely recognized as male-pattern baldness — hair that is lost in a predictable pattern, typically beginning above both temples. Over time, the hairline recedes into a characteristic "M" shape, and thinning at the crown of the head often progresses to partial or complete baldness. The pattern in women looks quite different. Rather than a receding hairline, women with androgenetic alopecia experience overall thinning across the scalp. Complete baldness from this condition is rare in women. In men, androgenetic alopecia has been associated with several other health conditions, including coronary heart disease, prostate enlargement, prostate cancer, insulin resistance disorders (such as diabetes and obesity), and high blood pressure (hypertension). In women, androgenetic alopecia is associated with an increased risk of polycystic ovary syndrome (PCOS) — a hormonal condition that can cause irregular periods, acne, excess facial or body hair (hirsutism), and weight gain. **Is androgenetic alopecia inherited?** The inheritance pattern of androgenetic alopecia is not straightforward, as both genetic and environmental factors are likely at play. That said, the condition clearly tends to run in families — having a close relative with patterned hair loss is a meaningful risk factor for developing it yourself. --- ## Understanding Hair Loss: Genes, Hormones, and Other Root Causes ### Getting to the "why" behind hair loss is the first step toward a personalized, effective approach to treatment. *by Blanca Garilli, ND* Hair loss, or alopecia, is a concern that brings many patients — men and women alike — into the clinic. It can affect specific areas (like the temples and crown seen in male-pattern baldness), the entire scalp, or even extend to other parts of the body. Losing roughly 50–100 hairs per day is considered normal, but those experiencing more significant hair loss often notice it when brushing or styling their hair — or when they're cleaning the sink and sweeping the floor.[1] Beyond the physical changes, hair loss can carry a real emotional and social weight. Understanding what's driving it is a crucial step toward building an effective plan to address it. While genetics certainly play a role in many cases of hair loss, there are also non-genetic, modifiable factors that contribute — factors that can potentially be changed. Below, we explore some of the most common underlying causes of hair loss, including genetics, along with targeted strategies to slow or reverse the loss.[1,2] **Genetics (heredity):** Many people suspect their hair loss runs in the family — and for male-pattern or female-pattern baldness (both formally called "androgenetic alopecia"), they're often right. This type of hair loss tends to develop gradually with age, following recognizable patterns: a receding hairline in men, and diffuse thinning across specific areas or the entire scalp in women.[3] The genetics behind hair loss are complex. For example, a large-scale genome-wide association study (GWAS) identified over 200 distinct genetic markers linked to male-pattern baldness — most located on autosomal chromosomes, with some on the X chromosome.[4] Another well-studied gene, the androgen receptor (AR) gene, is associated with hormone-related hair loss and likely contributes to androgenetic alopecia.[5] Androgenetic alopecia is the most common hair loss condition worldwide.[6] In the United States alone, it affects more than 80 million people — creating significant demand for effective treatments.[7] In some cases, hereditary hair loss may be driven in part by excess androgens: specifically, when testosterone is converted into dihydrotestosterone (DHT) by the enzyme 5-alpha reductase (5AR) at higher-than-normal rates.[8] Approaches to slowing this process include reducing DHT levels or using 5AR inhibitors.[8] Beyond prescription treatments, a wide range of non-prescription options exist, including: L-cystine, caffeine-based lotions and shampoos, capsaicin, marine protein supplements, melatonin, procyanidins (a class of anti-inflammatory plant flavonoids found in apples, barley, cocoa, cinnamon, grapes, and tea), pumpkin seed oil, rosemary oil, saw palmetto, zinc, and more.[9] **Hormones:** Hormonal shifts tied to life stages — including pregnancy, childbirth, and menopause — as well as fluctuations in thyroid function can contribute to both temporary and, in some cases, permanent hair loss. Working with a healthcare provider who practices personalized, lifestyle-based medicine is key to restoring hormonal balance through individualized lifestyle changes, targeted nutritional support, or medications such as hormone replacement therapy (HRT) when appropriate.[1] **Medical conditions and medications:** Certain medical conditions can also be responsible for hair loss — including infections such as ringworm, conditions with mental health roots (such as trichotillomania, a disorder characterized by recurrent, difficult-to-resist urges to pull out one's own body hair), and the relatively common condition called alopecia areata.[1,7] Alopecia areata has a lifetime incidence of 2% globally; it is an immune-driven condition that produces smooth, round patches of hair loss on the scalp or body, and is characterized by its unpredictability — with periods of spontaneous regrowth as well as possible relapse.[6] Identifying and treating the root causes of an underlying medical condition can lead to hair regrowth, which is why it is worth seeking out clinicians skilled in Functional Medicine approaches. In some cases, medications used to treat other health conditions — including cancer, arthritis, depression, heart disease, gout, and high blood pressure — can cause hair loss as a side effect.[1] **Stress:** The effects of stress on the body extend well beyond the brain and heart. Stress affects whole-body health — including increasing the risk of hair loss through multiple pathways, one of which is the pro-inflammatory environment (i.e., hormones, cytokines, and other signaling molecules) that chronic stress creates.[10] **In recent years, the concept of a "brain-skin" connection has gained traction as a framework for understanding how stress may worsen difficult-to-treat skin conditions such as psoriasis, atopic dermatitis, and hives — as well as its role in hair loss.**[11] Specifically, it is thought that "**neurohormones, neurotransmitters, and cytokines, released during a stress response may also significantly influence the hair cycle.**"[11] Hair growth, hair shaft production, and even hair pigmentation may all be affected by the body's stress-related signaling molecules.[12] When stress appears to be an underlying driver of hair loss — as it may be in telogen effluvium, alopecia areata, trichotillomania, and hormone-related hair loss — a broad range of mind-body, naturopathic, and Functional Medicine strategies may prove beneficial.[13] **Nutritional deficiencies:** Sudden significant weight loss or insufficient protein intake can trigger hair loss.[2] Specific nutritional deficiencies can also worsen hair thinning and shedding — including deficiencies in iron, niacin, fatty acids, selenium, and zinc. Interestingly, excessive intake of vitamins E and A may also increase the risk of hair loss.[2] While biotin (vitamin B7) is popularly associated with hair health, the published research suggests that biotin supplementation is only likely to make a meaningful difference if a significant biotin deficiency or a specific hair syndrome (such as uncombable hair syndrome) is present.[14,15] A thorough evaluation — including lab testing and a physical exam — is the best way to identify nutritional gaps, so that dietary and supplement recommendations can be truly personalized and effective. In addition to the causes described above, hair loss can also result from radiation treatments, excessive or harsh hair styling, and certain hair treatment procedures. To summarize: hair loss is common, but it is not always permanent. Partnering with a Functional Medicine provider to uncover the root causes of hair loss is the most important first step — both for understanding why it's happening and for building a treatment plan that is truly tailored to you. **Citations:** 1. Mayo Clinic. Hair Loss. <https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926>. Accessed January 11, 2019. 2. Guo EL et al. Diet and hair loss: effects of nutrient deficiency and supplement use. *Dermatol Pract Concept.* 2017;7(1):1–10. 3. NIH. Androgenetic alopecia. <https://ghr.nlm.nih.gov/condition/androgenetic-alopecia>. Accessed January 14, 2019. 4. Hagenaars S et al. Genetic predication of male pattern baldness. *PLoS Genet.* 2017;13(2):e1006594. 5. NIH Genetics Home Reference. AR gene. <https://ghr.nlm.nih.gov/gene/AR>. Accessed January 16, 2019. 6. Villasante Fricke AC et al. Epidemiology and burden of alopecia areata: a systematic review. *Clin Cosmet Investig Dermatol.* 2015;8:397–403. 7. American Academy of Dermatology. Hair loss. <https://www.aad.org/public/diseases/hair-and-scalp-problems/hair-loss>. Accessed January 14, 2019. 8. US Pharmacists. Treatment options for androgenetic alopecia. <https://www.uspharmacist.com/article/treatment-options-for-androgenetic-alopecia>. Accessed January 14, 2019. 9. Hosking AM et al. Complementary and alternative treatments for alopecia: a comprehensive review. *Skin Appendage Disord.* 2018. doi: 10.1159/00049203.5 10. Hadshiew IM et al. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. *J Invest Dermatol.* 2004;123(3):455–457. 11. Botchkarev V. Stress and the hair follicle: exploring the connections. *Am J Pathol.* 2003;162(3):709–712. 12. Paus R. Exploring the "brain-skin connection": leads and lessons from the hair follicle. *Curr Res Transl Med.* 2016;64(4):207–214. 13. Mayo Clinic. Stress management. <https://www.mayoclinic.org/healthy-lifestyle/stress-management/expert-answers/stress-and-hair-loss/faq-20057820>. Accessed January 16, 2019. 14. Trüeb RM. Serum biotin levels in women complaining of hair loss. *Int J Trichology.* 2016;8(2):73–77. 15. NIH. Biotin fact sheet for health professionals. <https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/>. Accessed January 16, 2019. ---
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Care planFemale InfertilityFertility rates are declining around the world, with two thirds of countries now falling below the population replacement level. "Fertility is a public health issue, with 1 in 6 individuals experiencing infertility," said Rachel Lévy, professor of developmental and reproductive biology and medicine at the Faculty of Medicine, Sorbonne University, and head of the Laboratory of Reproductive Biology-CECOS, Tenon Hospital, both in Paris, France. Sperm counts have reportedly dropped by half over the last 50 years, with environmental and lifestyle factors — including obesity and poor diet — playing major roles. Men account for 40% of failures to conceive. Among women, hormonal imbalance or failure to ovulate accounts for 30% of infertility problems; hormonal imbalance and pelvic factors (such as tubal disease and endometriosis) account for 50%; cervical pathology is responsible in 10%; and in 10–20% of women, no cause is ever found. ## Understanding Female Fertility ### What Makes It Harder for Women to Conceive? - Poor diet - Too little or too much body fat - High caffeine intake - High alcohol intake - Deficiency in key nutrients, including vitamin C, zinc, B12, folic acid, selenium, and iron - Endometriosis - Blocked fallopian tubes - Immune system dysfunction - Polycystic ovary syndrome (PCOS) - Celiac disease, non-celiac gluten sensitivity, or gluten sensitivity ### The Modern Fertility Challenge - Our definition of "old" is shifting. People are living longer — and waiting longer to start families. - In women, conditions like endometriosis, PCOS, and blocked fallopian tubes become more common with age. - In men, both the quality and quantity of sperm decline as the years go by. - In the United States, at least 15–30% of all couples have great difficulty conceiving a child. - 30–40% of these cases are due to male infertility. ### How Hormone-Disrupting Chemicals Threaten Fertility - The term "endocrine disruption" made its debut in 1996. - In response, various government agencies and ministries — including the Environmental Protection Agency and the Ministry of Health and Welfare — began developing measures to address synthetic chemical hormone disruptors. - Zoologist Theo Colborn, director of the Wildlife and Contaminants Program at the World Wildlife Fund, was among the first to document that synthetic chemicals in the environment can mimic or interfere with the natural hormones that guide development from the moment a sperm meets an egg through birth. - Synthetic compounds can interfere with the way estrogens work — first by impersonating them, then by blocking them. - This interference can be direct (by binding to a specific hormone receptor) or indirect (by altering the rate at which a hormone is made or broken down). - Today, hormone disruptors are known to interfere with far more than estrogen — including androgen blockers, progesterone blockers, and compounds that disturb thyroid function. - The sobering implication: every chemically-mediated communication system in the body — hormones being just one — may be vulnerable to disruption. - And the threat doesn't stop with the endocrine system. - Chemical signals guide life at every level — within cells, between cells, between organs, and even between different species. - In principle, any of these signals can be disrupted. - Research has shown that female rats exposed to environmental estrogens gave birth to male pups with significantly fewer Sertoli cells — the cells essential for sperm production. - These chemicals can also disrupt testosterone production by the Leydig cells. - Endocrine-disrupting chemicals may also cause sperm to mature too quickly — causing them to lose the enzymes they need to penetrate an egg and achieve fertilization. - The good news: targeted lifestyle changes and nutritional support can help protect and nourish your overall health and fertility. > *"The most alarming of all man's assaults upon the environment is the contamination of air, earth, rivers, and sea with dangerous and even lethal materials…The poisons circulate mysteriously by underground streams until they emerge and, through the alchemy of air and sunlight, combine into new forms that kill vegetation, sicken cattle, and work unknown harm on those who drink from once pure wells…They travel from link to link of the food chain…"* > > — Rachel Carson, 1907–1964 ### Smoking and Fertility According to one study, women who smoked while trying to get pregnant were 2.7 times more likely to have primary tubal infertility than non-smokers. ### Alcohol and Fertility Alcohol intake was not associated with infertility in younger women, but emerged as a significant predictor of infertility in women over age 30. ### Mercury Exposure Women with high occupational exposure to mercury were less fertile than unexposed controls. The fecundability (probability of conception each menstrual cycle) of women who prepared 30 or more amalgams per week and who had five or more mercury hygiene factors was only 63% of that for unexposed women. ### Body Fat and Reproductive Health How much body fat a woman carries — and where she carries it — significantly influences the health of her reproductive system. ### The Role of Nutrition The evidence is clear: what you eat before you conceive matters. Poor nutritional intake, especially in the months leading up to conception, can meaningfully affect pregnancy outcomes. ### Polycystic Ovary Syndrome (PCOS) - Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterized by irregular, abnormal, or absent periods; excess body hair; weight gain; and reduced fertility. - It is driven by elevated levels of testosterone and other hormones that disrupt the normal menstrual cycle. Environmental estrogen-mimicking chemicals may contribute to this hormonal imbalance. - Abnormal insulin responses are also suspected to play a role, though they don't account for every case. - It's estimated that this condition affects 6% to 10% of premenopausal women, beginning between puberty and the early 20s. The most recognizable symptom of PCOS is irregular menstruation, which can look different from woman to woman: - **Oligomenorrhea:** 8 or fewer periods per year. - **Polymenorrhea:** Too many periods with excessive bleeding, and periods that may stop and start. - **Amenorrhea:** No menstrual cycles at all. All three patterns share the same underlying cause: the ovaries aren't releasing an egg each month. Women with PCOS do not ovulate regularly, and while fertility specialists can help many of these women become pregnant, PCOS may account for as many as half of all cases of infertility. ### Insulin Resistance Insulin resistance may contribute to hormonal imbalance, PCOS, and other conditions tied to reduced fertility. If insulin resistance is a factor, restoring healthy blood sugar regulation with nutrients such as green tea catechins, cinnamon, and other insulin-sensitizing compounds may help. In more severe cases of blood sugar dysregulation, strict dietary changes and the inclusion of targeted functional foods may be necessary. ### Endometriosis Endometriosis is one of the more common — and frequently overlooked — causes of female infertility. It's a condition in which tissue that normally lines the inside of the uterus begins growing outside of it, attaching to nearby structures like the ovaries and fallopian tubes. Endometriosis is progressive, meaning it tends to worsen over time, and it can return even after treatment. Symptoms include painful periods, abnormal bleeding, and pain during or after intercourse. The exact cause remains unknown. Notably, the condition appears to be of modern origin — raising the possibility of a connection to hormonal imbalance and/or endocrine disruption. ### Blocked Fallopian Tubes Sexually transmitted infections can lead to pelvic adhesions and tubal blockages that compromise a woman's fertility. These adhesions can seal off the end of a fallopian tube, an ovary, or both — preventing an egg from ever reaching the tube. Even minor adhesions can substantially reduce the chances of conception. ### Celiac Disease and Gluten Sensitivity Celiac disease is linked to fertility problems, miscarriages, and preterm deliveries. > *"While there are many more common causes of pregnancy complications, women who don't know why they can't conceive or carry a baby to term should find out if they have celiac disease. When I see patients who have had fertility or pregnancy complications I feel it is appropriate to consider testing for celiac disease."* > > — Dr. Stephanie Moleski, Thomas Jefferson University Hospital, Philadelphia. *Ann Gastroenterol.* 2015 ### Everyday Lifestyle Habits That Support Fertility - Eat more organic vegetables — especially cruciferous ones like broccoli, cauliflower, and Brussels sprouts - Include foods rich in essential fatty acids, such as salmon, mackerel, sardines, nuts, and avocados - Enjoy dairy products in moderation, and choose organic whenever possible - Boost your intake of fiber and high-quality protein - Avoid cigarettes and all tobacco products - Avoid alcohol - Reduce your exposure to environmental toxins - Move your body — exercise matters! ---
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Care planFemale Sexual Dysfunction**Female sexual dysfunction** is an umbrella term for any difficulty with sexual interest, desire, or physical response to sex. ## Understanding Female Sexual Dysfunction ### What Causes Sexual Problems in Women? There are many well-recognized reasons why women experience sexual difficulties. Some of the most common include: - **Aging** — Sexual desire (also called libido) and sexual activity naturally tend to decline as women get older. This is completely normal and usually not a cause for concern — though it can become a source of friction when partners have mismatched levels of interest. - **Hormonal changes** — Hormonal shifts at key life stages can significantly alter a woman's sexual interest and physical response. For example, the drop in estrogen that happens during perimenopause and menopause can cause vaginal dryness, making sex painful. - **Stress and anxiety** - **Relationship challenges** - **Illness**, including depression and metabolic syndrome - **Past negative sexual experiences** ### What Types of Sexual Problems Affect Women? Sexual problems generally fall into four categories, which frequently overlap with one another: - Desire problems - Arousal problems - Orgasmic problems - Sexual pain disorder ### What Are Desire Problems? Low sexual desire is the most common sexual concern women report. It's worth noting that many women simply don't feel a strong urge for sex before it begins — and that's perfectly normal. Desire often only surfaces once sexual activity and arousal are already underway. Low desire becomes a diagnosable concern when a woman: - Has no interest in any form of sexual activity, including masturbation - Has few or no sexual thoughts or fantasies - Feels troubled or distressed by either of the above ### What Are Arousal Problems? Arousal refers to the physical and emotional changes your body goes through in response to sexual stimulation. Many things can interfere with arousal, including medications, alcohol, smoking, and recreational drug use, as well as certain medical conditions. Anxiety, stress, relationship tension, and past negative sexual experiences can also make arousal difficult. ### What Are Orgasmic Problems? Not reaching orgasm during sex isn't necessarily a problem. For many women, the emotional closeness and pleasure of sexual intimacy are deeply satisfying on their own. But for others, the inability to orgasm is genuinely distressing — and worth addressing. Women with orgasmic disorders may have never experienced an orgasm during sex, or they may have had them before but find they no longer can — even when arousal itself is healthy. The intensity of orgasm can also diminish over time, which is not uncommon with age. Orgasmic difficulties can stem from poor body image, fear of losing control, or lack of trust in a partner. It's also common for women who struggle to orgasm to also have difficulty with arousal. ### What Is Sexual Pain Disorder? Pain during sex can be either long-standing or something that develops more recently. Pain that occurs during sexual activities other than intercourse is called "noncoital sexual pain disorder." Pain specifically during intercourse is known as dyspareunia. Most sexually active women experience some degree of pain during sex at some point in their lives — but if it happens frequently or is severe, it's important to speak with your healthcare provider (see the FAQ "When Sex Is Painful"). ### Can Certain Substances Interfere With Sexual Response? Yes — smoking, alcohol, and recreational drugs can all affect sexual response in both women and men. Smoking restricts blood flow to the genitals, which can dampen arousal. Alcohol and drugs alter the way your body responds to stimulation. One of the most impactful steps you can take to improve your sexual health is to quit or significantly cut back on smoking, alcohol, and drug use. ### What Can I Do to Rekindle Desire? - Take time to address relationship tensions, miscommunications about sex, and other stressors that may be creating distance between you and your partner. - Shift focus away from intercourse and toward emotional and physical intimacy more broadly. - Expand your knowledge of your own sexuality and explore new ways to connect with your partner. - Intentionally carve out time for sexual activity, with an emphasis on pleasure and mutual enjoyment rather than performance. ### What Can I Do to Improve Arousal? - Make sure you're well rested — fatigue is a major arousal killer. - Extend the time spent on foreplay. - Try a vaginal lubricant if dryness is an issue. - Practice Kegel exercises (repeatedly contracting and relaxing your pelvic floor muscles). - Quit smoking. ### What Can Help Me Reach Orgasm? - Increase the amount and variety of sexual stimulation. - Explore sexual toys. - Engage your imagination through mental imagery and fantasy. ### How Can I Reduce Sexual Pain? - Experiment with different positions or forms of intimacy that don't involve penetration. - Allow ample time for arousal before attempting penetration. - Use a lubricant. - Empty your bladder before sex. - Take a warm bath beforehand to help relax pelvic muscles. ### Treatment **What can I expect when I see a healthcare provider about a sexual concern?** Your provider will likely perform a physical exam, including a pelvic exam. If you experience pain during intercourse, they may gently attempt to reproduce that pain through touch in order to better understand what's happening. Depending on your symptoms, bloodwork may be ordered to evaluate your hormone levels. You may also be referred to a specialist for further testing or more targeted treatment. **What does treatment for a sexual problem actually look like?** Different types of female sexual dysfunction call for different treatment approaches, and because these problems often overlap, treatment can involve several strategies working together. This might include adjusting medications you're already taking, or starting new ones — such as estrogen to address vaginal dryness. If an underlying medical condition appears to be contributing, treatment will be aimed at that condition as well. Even when you're receiving medical treatment, you may also be referred to a sex therapist. Sex therapists are trained to help people navigate the emotional, physical, and relational dimensions of sexual difficulties. Couples therapy may be recommended to work through interpersonal issues that are affecting your sexual relationship. Individual counseling can also be deeply valuable — helping you build confidence in your sexuality by exploring how past experiences may be shaping your present. **Source:** "Sexual Problems in Women," from the The American College of Obstetricians and Gynecologists ---
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Care planFibrocystic Breast SyndromeYou may have heard many different names used to describe the monthly breast changes that occur under the natural hormonal influence of your menstrual cycle. Some of the most common terms include: cyclic mastalgia, fibrocystic disease, aberrations of normal development (ANDI), benign breast disease, fibrous disease, benign breast syndrome, cystic breast disease, and mammary dysplasia. Throughout this nutritional guide, we will use the term **Fibrocystic Breast Syndrome (FBS)** — a name that captures the two most characteristic breast changes (cystic and fibrous), and appropriately frames this condition as a syndrome, not a disease. Fibrocystic breasts are considered a syndrome, and medical experts no longer classify this as a true disease. In fact, as far back as 1985, physician Hutter raised a compelling point: "Is it reasonable to define as a disease any process that occurs clinically in 50% and histologically in 90% of women?" For a time, fibrocystic breasts were mistakenly thought to raise a woman's risk of breast cancer by 2 to 4 times — but this is no longer believed to be true. The vast majority of women who experience cyclic fibrocystic breast changes are not at increased cancer risk. Only a small, specific group of women need to be concerned. A landmark 1985 study by Dupont and Page, which examined 10,366 breast biopsies over 17 years, showed that elevated cancer risk only applies when the breast tissue shows a specific microscopic pattern called **atypical hyperplasia** and/or when there is a family history of breast cancer. The good news: 70% of the women in that study who had a breast biopsy were not in the higher-risk group. ### Who Is Most Affected? FBS most commonly affects women between the ages of 30 and 40, and tends to occur more often in the left breast. For most women, it shows up as a mild to moderate aching, burning, or occasional sharp discomfort in one or both breasts during the days leading up to their period — anywhere from ovulation through the start of menstruation. ### Factors That May Contribute to FBS - High fat diet - Iodine deficiency - Caffeine intake - Alcohol intake - Obesity - Impaired fatty acid conversion ---
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Care planFibromuscular Dysplasia**Fibromuscular dysplasia (FMD)** is a rare arterial disorder in which the normal, strong, elastic cells that make up artery walls are gradually replaced by stiffer, more fibrous cells. This shift in the composition of the artery wall makes arteries less resilient and more vulnerable to injury. Over time, FMD can cause high blood pressure, narrowing of the arteries (stenosis), arterial bulging (aneurysm), and, in some cases, a tear in the artery wall (dissection). Unlike most other vascular diseases, FMD does not involve inflammation or the buildup of plaque in the arteries — making it a uniquely challenging condition to recognize and understand. FMD affects between 1 percent and 5 percent of Americans. About one-third of people living with this condition have it in more than one artery. ## Understanding Fibromuscular Dysplasia ### How Are Arteries Built? Arteries are composed of three distinct layers, each serving an important role: - **Tunica intima** — the innermost layer, which comes into direct contact with blood as it flows through. - **Tunica media** — the middle and thickest layer, made up of smooth muscle cells and elastic fibers. This layer allows arteries to stretch and recoil with each heartbeat without tearing. - **Tunica externa** (also called the adventitia) — the outermost layer, composed of elastic fibers and collagen. Collagen is a tough, fibrous protein that anchors the artery in place within surrounding tissues. ### How Does FMD Affect the Arteries? A healthy artery rhythmically expands and contracts in response to the surge of blood with each heartbeat. When FMD is present, this elegant balance is disrupted. If the artery wall becomes too rigid, it cannot expand properly when blood rushes through — leading to high blood pressure. Conversely, if the wall becomes too weak, the artery can balloon outward, forming an aneurysm. In one of the most common patterns of FMD, the middle layer of the artery alternates between areas of stiffness and weakness, creating a distinctive "string of beads" appearance on imaging — a hallmark that physicians look for when making the diagnosis. ### Where in the Body Does FMD Occur? FMD can technically develop in arteries anywhere in the body, but it most often affects the renal arteries (which carry blood to the kidneys) and the carotid and vertebral arteries in the neck (which supply blood to the brain). Less commonly, the mesenteric arteries — which feed the digestive system — may also be involved. FMD typically targets medium-sized arteries that supply blood to the: - kidneys (renal arteries) - brain (carotid arteries) - abdomen and intestines (mesenteric arteries) - arms and legs When blood flow to any of these organs is significantly reduced, permanent damage can result. It's also worth knowing that FMD frequently shows up in more than one location in the body at the same time. ### What Are the Signs and Symptoms? FMD doesn't always announce itself with obvious symptoms. When it does, what you experience will depend largely on which arteries and organs are affected. **Symptoms of reduced blood flow to the kidneys include:** - side pain - high blood pressure - shrinkage of the kidney - abnormal kidney function when measured by a blood test **Symptoms of reduced blood flow to the brain include:** - headache - dizziness - neck pain - ringing or swooshing sound in ears - droopy eyelids - uneven-sized pupils - stroke or ministroke **Symptoms of reduced blood flow to the abdomen include:** - stomach pain after eating - unexplained weight loss **Symptoms of reduced blood flow to the arms and legs include:** - pain in the affected limb when walking or running - weakness or numbness - temperature or color changes in the affected limb ### What Causes Fibromuscular Dysplasia? The precise cause of FMD remains unknown, but researchers have identified three leading theories that may help explain why it develops: - **Genes** — About 10 percent of FMD cases occur within the same family, suggesting that genetics may play a meaningful role. That said, having a parent or sibling with FMD does not guarantee you will develop it — and when multiple family members are affected, the disease may involve different arteries in each person. - **Hormones** — Women are three to four times more likely to develop FMD than men, pointing toward a potential role of female hormones. More research is needed to confirm this connection. - **Abnormal artery development** — If arteries don't receive adequate oxygen during their development, they may form abnormally, leading to reduced blood flow over time. ### Who Is at Risk? While the exact cause of FMD is still not fully understood, certain factors appear to raise the likelihood of developing it. These include: - being a woman under the age of 50 - having one or more family members with the condition - smoking ### How Is Fibromuscular Dysplasia Diagnosed? A physician may first suspect FMD after hearing an abnormal swooshing sound — called a bruit — while listening to your arteries with a stethoscope. After a thorough review of your symptoms, they will likely order imaging tests to confirm the diagnosis. Imaging tests commonly used to diagnose FMD include: - **Duplex (Doppler) ultrasound** — This test uses high-frequency sound waves and a computer to create images of your blood vessels, showing how well blood is moving through your arteries — with no radiation involved. - **Magnetic resonance angiography (MRA)** — This test uses powerful magnets and radio waves to generate detailed pictures of your blood vessels. - **Computed tomography angiography (CTA)** — This test uses X-rays and contrast dye to produce highly detailed cross-sectional images of your blood vessels. - **Arteriography** — If noninvasive tests cannot confirm the diagnosis, a more direct approach may be needed. In this procedure, a contrast dye is injected through a thin wire (catheter) inserted into your groin or the area of concern, and X-ray images are taken of your blood vessels in real time. ### How Is Fibromuscular Dysplasia Treated? There is currently no cure for FMD, but the condition is manageable. A range of treatments can help control your symptoms and reduce the risk of serious complications. Many people find meaningful relief from blood pressure medications, including: - **Angiotensin II Receptor Blockers:** candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan) - **Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors):** benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinvil, Zestril) - **Beta-Blockers:** atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL) - **Calcium Channel Blockers:** amlodipine (Norvasc), nifedipine (Adalat CC, Afeditab CR, Procardia) Blood thinners, such as aspirin, may also be recommended to help prevent clot formation and improve blood flow through narrowed arterial segments. Additional treatment options include: - **Percutaneous transluminal angioplasty** — A thin, flexible tube called a catheter — with a small balloon at its tip — is carefully guided into the narrowed artery. The balloon is then inflated to open the artery and restore normal blood flow. - **Surgery** — For severe narrowing or complete blockage, surgery may be necessary. Your surgeon will either remove the affected segment of artery or redirect blood flow around the problem area using a bypass. ### Does Fibromuscular Dysplasia Affect Life Expectancy? FMD is typically a lifelong condition — but here's the reassuring part: researchers have found no evidence that it shortens life expectancy. In fact, many people living with FMD go on to enjoy full, active lives well into their 80s and 90s. Work closely with your doctor to develop the best management plan for your individual situation, and be sure to report any new or changing symptoms promptly, including: - vision changes - speech changes - unexplained changes in your arms or legs **Sources:** - <https://www.hopkinsmedicine.org/health/conditions-and-diseases/fibromuscular-dysplasia-fmd> - <https://www.healthline.com/health/fibromuscular-dysplasia#life-expectancy> - Cleveland Clinic Staff. (n.d.). Fibromuscular dysplasia (FMD). <https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd/symptoms--diagnosis> - Fibromuscular dysplasia. (n.d.). <https://massgeneral.org/vascularcenter/services/fibromusculardysplasia.aspx> - Fibromuscular dysplasia (FMD) clinic. (n.d.). <https://my.clevelandclinic.org/departments/heart/depts/fibromuscular-dysplasia-clinic> - Fibromuscular dysplasia (FMD) fact sheet. (2013). <https://fmdsa.org/dynamic/files/Fact%20Sheet%20Final.pdf> - Gornik H, et al. (2015). Fibromuscular dysplasia (FMD) (Dr. Gornik and Pam Mace RN, FDMSA). <https://my.clevelandclinic.org/departments/heart/patient-education/webchats/fmd/1736_fibromuscular-dysplasia-fmd> - Gornik H, et al. (2016). What is FMD? <https://fmdsa.org/fmd_info/what_is_fmd> - Mayo Clinic Staff. (2017). Fibromuscular dysplasia. <https://mayoclinic.org/diseases-conditions/fibromuscular-dysplasia/symptoms-causes/syc-20352144> ---
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Care planFibromyalgiaFibromyalgia is a syndrome defined by widespread muscle and joint pain, stiffness, persistent aching, fatigue, and multiple tender spots that a clinician can identify during a physical exam. Research suggests that fibromyalgia pain likely arises from a combination of factors that affect both muscle cell function and the central nervous system. Many conventional treatments have been tried in fibromyalgia patients — unfortunately, they often fall short and can carry unwanted side effects. A natural approach that provides nutritional support for the specific body processes thought to drive fibromyalgia holds real promise for the millions of people living with this challenging chronic condition. Fibromyalgia (FM) is a syndrome that presents with overlapping signs and symptoms, including fatigue; widespread musculoskeletal pain; and tenderness at specific locations in the neck, spine, shoulders, and hips known as "tender points." Sleep disturbances, morning stiffness, headaches, irritable bowel syndrome (IBS), depression, and anxiety are also commonly seen alongside this syndrome. --- ## Understanding Fibromyalgia Because FM is a complex, multi-factorial syndrome involving a wide range of body systems, addressing the underlying biochemical imbalances is an important part of effective treatment. A well-rounded treatment plan targets four key areas that are known to play a role in the development or worsening of the disease: **mitochondrial dysfunction**, **hypothalamus-pituitary-adrenal (HPA) dysregulation**, **toxic burden**, and **gut/nervous system abnormalities**. ### Your Cellular Powerhouses: Mitochondria and Why They Matter Dysfunction of the mitochondria — the tiny energy-generating structures found in virtually every cell — is thought to be a primary driver of FM. Abnormalities in the mitochondrial membranes of FM patients have been documented in the research literature. Because mitochondria are especially concentrated in muscle tissue, and because they are the cell's primary source of energy (in the form of ATP), their impairment has far-reaching consequences. Chronic pain affects more than 20% of adults in the U.S. and up to 27.5% of people worldwide. While opioids are frequently prescribed, their long-term use offers limited benefit and carries significant risks — including dependence, hormonal disruption, depression, cardiovascular events, and overdose. This reality underscores how important it is to integrate non-drug and multidisciplinary strategies into chronic pain management. Emerging research has shed light on the role of *mitochondrial dysfunction* in neuropathic and inflammatory pain, where oxidative stress and reactive oxygen species (ROS) impair how neurons' mitochondria function. Conditions like diabetic neuropathy, chemotherapy-induced nerve damage, and HIV-associated neuropathy all show signs of mitochondrial involvement. Functional medicine approaches that nourish mitochondrial health — such as the anti-inflammatory **IFM Mito Food Plan**, intermittent fasting (when appropriate), and regular physical activity — may improve mitochondrial biogenesis, enhance energy metabolism, and reduce damaging ROS. **What you eat matters deeply.** Diet directly shapes inflammation levels and mitochondrial function. Elimination diets can help uncover immune-reactive foods — such as dairy, wheat/gluten, eggs, or soy — that may be quietly fueling systemic inflammation and worsening pain. Anti-inflammatory dietary patterns like the **Mediterranean diet** have been linked to reduced arthritis progression and pain symptoms. In **fibromyalgia** specifically, oxidative stress and mitochondrial dysfunction appear to play a meaningful role. A 2021 systematic review found that plant-based diets (vegetarian or vegan) were associated with improvements in pain, sleep, and overall quality of life compared to a typical Western diet. Additionally, **vitamin D** deficiency has been linked to chronic musculoskeletal pain, particularly in the lower back. Correcting a deficiency through supplementation may help improve mitochondrial function, prevent muscle wasting, and support early rehabilitation efforts. **The Bottom Line:** Nutritional and mitochondria-targeted therapies offer well-supported, non-opioid options for managing chronic pain. Combining thoughtful dietary changes, regular movement, and targeted mitochondrial support is a hallmark of functional medicine's whole-person, systems-based model of care. When mitochondria aren't working properly, the effects ripple outward — impairing muscle function and disrupting the nervous system, immune system, and even the heart. Specific nutritional factors play an important role in maintaining the integrity and healthy function of the mitochondria. **The following supplement formulas have been used in FM patients in clinical practice:** **Mitochondrial Antioxidant Formula:** A carefully chosen combination of nutrients that support mitochondrial energy production, paired with powerful antioxidants, can help boost ATP synthesis and shield mitochondria from free radical damage. Nutrients like lipoic acid and B vitamins act as cofactors for cellular energy production and metabolism; thiamin supports the enzymes involved in the citric acid cycle and the respiratory chain; amino acids like creatine help muscles regenerate ATP; and N-acetyl-L-carnitine assists in shuttling nutrients (particularly fatty acids) into the mitochondria to be used as fuel. Antioxidants such as coenzyme Q10, L-glutathione, N-acetylcysteine, and vitamins C and E help guard against oxidative damage that can negatively impact cellular and mitochondrial function. **Malic Acid/Magnesium Complex:** Malic acid is a naturally occurring compound that is essential for ATP production. When combined, supplementation with 1,200 mg of malic acid and 300 mg of magnesium — introduced gradually at increasing doses — produced meaningful reductions in the severity of 3 primary pain and tenderness measures in FM patients. In a separate study, supplementation with malic acid (1,200–2,400 mg) and magnesium (300–600 mg) led to noticeable improvements in muscle pain within 48 hours, and reduced tender point scores were recorded at 8 weeks. **Magnesium/Potassium Complex:** Magnesium, potassium, and aspartate each play roles in the body's intermediary metabolism — the enzyme-driven processes that extract energy from nutrients and use it to build new cells — and together they may help combat physical fatigue. In a study examining the effects of potassium, magnesium, and aspartate (1,000 mg potassium aspartate and 1,000 mg magnesium aspartate per day for 1–2 weeks) in 4 subjects undergoing intensely fatiguing physical exercise, non-athletes showed improved physical endurance. Potassium-magnesium-aspartate supplementation at 1.75 g every 6 hours for 4 days was also shown to extend exercise capacity. Researchers believe this anti-fatigue effect works by supporting the resynthesis of ATP and phosphocreatine in the muscles. ### Your Stress Response System: The HPA Axis Many people with FM have experienced significant life stress or tend to react more intensely to everyday stressors than most. In these patients, the hypothalamic-pituitary-adrenal (HPA) axis — the body's central stress-response system — often shows altered reactivity, resulting in lower-than-normal secretion of adrenal androgens like cortisol. One study has proposed that HPA dysfunction may involve the serotonin signaling system and changes in the activity of arginine-vasopressin (AVP) and corticotropin-releasing hormone (CRH). HPA dysregulation can have broad downstream effects, including interference with the proper functioning of the hypothalamus-pituitary-thyroid (HPT) axis. Neuroendocrine irregularities along the HPT axis are also commonly found in FM patients. Given the known connection between hypothyroidism and symptoms like muscle pain and fibrositis, it is recommended that FM patients receive a comprehensive thyroid hormone evaluation. **Using adaptogens** — herbs that help normalize body processes and strengthen the ability to "adapt" to stress — along with B vitamins, provides a foundational approach to managing the effects of stress on the body. **Traditional Holy Basil Combination:** Adaptogens such as holy basil (*Ocimum sanctum*), ashwaganda (*Withania somnifera*), and brahmi (*Bacopa monnieri*) have deep roots in Ayurvedic medicine and are well-supported by scientific research for their ability to improve stress tolerance. Ashwaganda has been shown in animal studies to enhance adaptability to both physical and chemical stress, with the ability to suppress adrenal enlargement as well as the stress-driven depletion of adrenal ascorbic acid and corticosterone. Ashwaganda also promotes favorable changes in stress-related prostaglandin and catecholamine production. In separate animal research, brahmi improved adaptive responses in sensory, motor, and motivational systems. In human studies, it has shown beneficial effects on anxiety as well as mental performance, including reductions in mental fatigue. **B6/Pantothenic Acid Complex:** The B vitamins pantothenic acid and B6 are essential for both energy production and the body's ability to respond to stress, primarily by supporting adrenal hormone production and regulation. In combination with ATP and cysteine, pantothenic acid plays a central role in synthesizing coenzyme A, which initiates a range of metabolic processes including the production of glucocorticoids. An animal study found that vitamin B stimulates the secretion of adrenal catecholamines. **Thyroid Support:** While normalizing stress-driven changes in HPA function will have a beneficial effect on the HPT axis, some patients may require additional targeted thyroid support. Several nutrients are known to support healthy thyroid hormone synthesis, promote the conversion of thyroxine (T4) into the more biologically active triiodothyronine (T3), and positively influence thyroid hormone receptor dynamics and gene expression. These nutrients include iodine, selenium, zinc, and vitamins E, A, and D. ### Toxic Burden Exposure to environmental toxins has been suggested to play a significant role in both the development and the worsening of FM and chronic fatigue syndrome (CFS). Approximately 47–67% of patients with FM and 53–67% of patients with CFS report at least one episode of symptom flare following a specific chemical exposure. ### Your Gut and Your Nervous System: A Crucial Connection Another important area of investigation is the relationship between gut dysfunction and FM. While estimates vary, research suggests that up to 70% of FM patients experience symptoms consistent with irritable bowel syndrome (IBS) — a functional disorder characterized by chronic abdominal pain alternating between diarrhea and constipation. Compared to healthy individuals, IBS patients also tend to experience symptoms beyond the gut that overlap significantly with FM complaints, including heightened nerve sensitivity, morning stiffness, headaches, sleep disturbances, and fatigue. Improving gut health can be achieved through a nutritional program known as the **5R® GI Restoration Program**, which systematically works through five stages of healing: Remove, Replace, Reinoculate, Repair, and Retain. ### SIBO (Small Intestine Bacterial Overgrowth) According to research by Alex Vasquez, DC, DO, ND, in a study of 42 patients with confirmed fibromyalgia, all 42 were also found to have SIBO — and the severity of SIBO directly correlated with the severity of fibromyalgia symptoms. > *"How small intestine bacterial overgrowth (SIBO) causes fibromyalgia: bacterial overgrowth of the small intestine leads to chronic low-grade tryptophan insufficiency resulting in reduced endogenous production of serotonin (important for positive mood and relief from anxiety and pain), and of melatonin (important for restful sleep and protection of the mitochondria from oxidative stress). Bacterial mitochondrial toxins such as endotoxin, H2S, and D–lactate cause impaired mitochondrial energy production, which leads to mitophagy, muscle fatigue, pain, and cognitive impairment."* ### Natural Treatment Approaches A strong nutritional foundation is essential for optimal health and healing — in both healthy individuals and those living with chronic conditions like FM. This foundation includes a diet rich in fruits and vegetables, adequate intake of omega-3 fatty acids, and a balanced multivitamin/mineral supplement. It is worth noting that when patients were asked to list the top 10 most beneficial therapies for fibromyalgia, no drugs were mentioned. When asked to list what they considered the 10 most harmful therapies, they named only approved drugs. **Reference:** *Clin Exp Rheumatol.* 2013;31(6 Suppl 79):S34–S40. ---
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Care planFolliculitisFolliculitis is one of the most common skin conditions out there — and if you've ever had it, you know how uncomfortable and frustrating it can be. Put simply, it's an inflammation of the hair follicles: those tiny, tube-shaped pockets in your skin from which each individual hair grows. Most of the time, a bacterial or fungal infection is to blame. It often starts out looking like a cluster of small red bumps or white-headed pimples around the hair follicles — easy to mistake for ordinary acne. Left untreated, however, those bumps can spread and develop into open, crusty sores that stubbornly refuse to heal. The good news? Folliculitis is not life-threatening. The less-good news is that it can be persistently itchy, sore, and — let's be honest — embarrassing. In severe cases, it can cause permanent scarring and hair loss in the affected areas. If your case is mild, it will likely clear up on its own within a few days with some simple at-home care. For more stubborn or frequently recurring folliculitis, however, a visit to your doctor for prescription treatment may be necessary. You may have heard of folliculitis by its more colorful nicknames: hot tub rash, razor bumps, or barber's itch — all are specific forms of the same condition. ## Understanding Folliculitis ### Recognizing the Symptoms Folliculitis can show up in a number of ways. Here's what to look for: - Clusters of small red bumps or white-headed pimples that develop around hair follicles - Pus-filled blisters that break open and crust over - Itchy, burning skin - Painful, tender skin - A large swollen bump or mass ### Understanding the Types of Folliculitis Folliculitis comes in two main varieties: superficial and deep. Superficial folliculitis affects only a portion of the follicle, while deep folliculitis involves the entire follicle and tends to be more severe and harder to treat. **The superficial forms include:** - **Bacterial folliculitis.** This is the most common type, and it presents as itchy, white, pus-filled bumps. It happens when hair follicles become infected with bacteria — most often *Staphylococcus aureus*, commonly known as staph. Staph bacteria are actually normal residents of our skin, but they only cause problems when they find a way in through a cut or other break in the skin. - **Hot tub folliculitis (pseudomonas folliculitis).** If you've spent time in a poorly maintained hot tub or heated pool, you may develop a rash of red, round, itchy bumps 1–2 days later. This type is caused by pseudomonas bacteria, which thrive in water where chlorine levels and pH aren't properly regulated. - **Razor bumps (pseudofolliculitis barbae).** This form is a skin irritation triggered by ingrown hairs — most commonly affecting men with curly hair who shave very close to the skin. It's most noticeable on the face and neck, though people who get bikini waxes may develop it in the groin area as well. In some cases, razor bumps can leave behind dark, raised scars called keloids. - **Pityrosporum (pit-ih-ROS-puh-rum) folliculitis.** This type is caused by a yeast infection and produces chronic, red, itchy pustules primarily on the back and chest, and sometimes on the neck, shoulders, upper arms, and face. **The deeper forms include:** - **Sycosis barbae.** This type tends to affect males who have just begun shaving. - **Gram-negative folliculitis.** This type can sometimes develop as a complication of long-term antibiotic therapy for acne. - **Boils (furuncles) and carbuncles.** These occur when hair follicles become deeply infected with staph bacteria. A boil typically appears suddenly as a painful pink or red bump. A carbuncle is a cluster of boils. - **Eosinophilic (e-o-sin-o-FILL-ik) folliculitis.** This type mainly affects people living with HIV/AIDS. It causes intense itching and recurring patches of bumps and pimples near hair follicles on the face and upper body. Once healed, the affected skin may appear darker than it was before (a change called hyperpigmentation). The exact cause of this type remains unknown. ### How to Prevent Folliculitis from Coming Back Once you've dealt with folliculitis, you'll understandably want to keep it from returning. Here are some practical strategies that can help: - **Avoid tight clothes.** Loose-fitting clothing reduces friction against the skin — and friction is one of folliculitis's best friends. - **Dry out your rubber gloves between uses.** If you regularly wear rubber gloves, turn them inside out after each use, rinse them with soap and water, and let them dry thoroughly before putting them on again. - **Avoid shaving**, if possible. For men prone to razor bumps (pseudofolliculitis), letting a beard grow in may be the simplest solution — if a clean-shaven face isn't a requirement for you. - **Shave smarter, not closer.** If shaving is unavoidable, a few mindful adjustments can make a big difference in protecting your skin: - Shaving less frequently - Washing your skin with warm water and antibacterial soap before shaving - Using a washcloth or cleansing pad in a gentle circular motion to raise embedded hairs before shaving - Applying a good amount of shaving lotion before shaving - Shaving in the direction of hair growth, though one study found that men who shaved against the grain had fewer skin bumps — see what works best for you - Avoiding shaving too close by using an electric razor or guarded blade and by not stretching the skin - Using a sharp blade and rinsing it with warm water after each stroke - Applying moisturizing lotion after you shave - Avoiding the sharing of razors, towels, and washcloths - **Consider hair-removing products (depilatories) or alternative hair removal methods.** Keep in mind, though, that these can also irritate the skin in some people. - **Only use well-maintained hot tubs and heated pools.** If you own one, clean it regularly and maintain chlorine levels as recommended. - **Have a conversation with your doctor.** Depending on how often folliculitis recurs for you, your doctor may suggest strategies to control bacterial growth — such as a five-day course of antibacterial ointment in the nose or using a body wash containing chlorhexidine (Hibiclens, Hibistat). It's worth noting that further research is still needed to fully confirm the effectiveness of these approaches. ### Treatment Options The right treatment for folliculitis depends on the type you have and how severe it is. Mild cases often respond well to home remedies alone. More severe or persistent cases, however, typically require prescription medication or other medical therapies. **Medications** Several medications can be used to treat folliculitis, targeting either bacterial or fungal infections depending on the underlying cause. Anti-inflammatory medications may also be part of the treatment plan. Medication options include: - Topical antibiotic creams - Oral antibiotics - Topical antifungal creams - Antifungal shampoos - Oral antifungals - Steroid creams - Oral corticosteroids **Light Therapy** Research suggests that light therapy — also known as photodynamic therapy — can help improve symptoms of deep folliculitis. It's a technique already used to treat acne, and it works by combining a specific wavelength of light with a photosensitizing chemical to destroy bacteria, fungi, and viruses. **Lancing (Incision and Drainage)** For boils and carbuncles, a doctor may choose to make a small incision directly into the lesion to drain the accumulated pus. This procedure can significantly reduce pain and help speed up the healing process. **Laser Hair Removal** Laser therapy is another option that can help reduce folliculitis and clear the infection by permanently destroying the hair follicles — eliminating the very structures that become inflamed or infected. Multiple treatment sessions are typically needed before results become apparent. **Home Remedies** Many people find effective relief from folliculitis using simple at-home approaches. Here are some of the most helpful: - **Warm compresses.** A warm compress applied to the affected area can soothe itching and help draw out pus. Simply soak a clean cloth in warm water, wring out the excess, and apply it to the skin for up to 20 minutes. Repeat as needed throughout the day. - **Over-the-counter products.** A variety of topical creams, gels, and washes formulated for folliculitis are available without a prescription and can be a helpful first line of defense. - **Good hygiene.** Gently washing the affected area twice daily with a mild soap can help keep the infection from spreading. Always use clean hands — avoid washcloths on the affected skin, as they can cause additional irritation. Pat the area dry with a clean towel, and wash towels after every use to prevent reinfection. - **Soothing baths.** Soaking in a warm bath can ease the itching and discomfort associated with folliculitis. Adding colloidal oatmeal or an oatmeal-based bath product may provide additional relief, as research has shown it has anti-inflammatory properties. Alternatively, adding one cup of baking soda or apple cider vinegar to your bath may help ease symptoms and fight the bacteria responsible for folliculitis. Be sure to thoroughly dry your skin after bathing. - **Protect your skin.** Steer clear of tight or irritating clothing, minimize exposure to harsh chemicals and skincare products, and try to limit shaving — trimming instead whenever possible. When you do shave, always use a lubricant and keep your blade clean and sharp. **References:** 1. Folliculitis. American Osteopathic College of Dermatology. <http://www.aocd.org/skin/dermatologic_diseases/folliculitis.html>. Accessed July 12, 2017. 2. Folliculitis. Merck Manual Professional Version. <http://www.merckmanuals.com/professional/sec11/ch129/ch129e.html>. Accessed July 12, 2017. 3. Hot tub rash (pseudomonas dermatitis/folliculitis). Centers for Disease Control and Prevention. <http://www.cdc.gov/healthywater/swimming/rwi/illnesses/hot-tub-rash.html>. Accessed July 17, 2017. 4. Pseudofolliculitis barbae. Merck Manual Professional Version. <http://www.merckmanuals.com/professional/sec11/ch134/ch134d.html>. Accessed July 17, 2017. 5. Rajendran P, et al. HIV-associated eosinophilic folliculitis. <http://www.uptodate.com/content/search>. Accessed July 17, 2017. 6. Ferri FF. Folliculitis. In: *Ferri's Clinical Advisor 2018*. Philadelphia, Pa.: Elsevier; 2018. <https://www.clinicalkey.com>. Accessed Aug. 10, 2017. 7. Goldsmith LA, et al., eds. Bacterial colonizations and infections of skin and soft tissues: Introduction. *Fitzpatrick's Dermatology in General Medicine*. 8th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. <http://accessmedicine.mhmedical.com>. Accessed July 17, 2017. 8. Alexis A, et al. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: Are prevention and effective treatment within reach? *Dermatologic Clinics*. 2014;32:183. 9. AskMayoExpert. Folliculitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. 10. Jackson JD. Infectious folliculitis. <https://www.uptodate.com/content/search>. Accessed July 17, 2017. 11. Compton GA. Bacterial skin and soft tissue infections in older adults. *Clinics in Geriatric Medicine*. 2013;29:443. 12. Fraes Diernaes JE, et al. Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy. *Photodiagnosis and Photodynamic Therapy*. 2013;10:651. 13. Panchaprateep R, et al. Clinical, dermoscopic and histopathologic features of body hair disorders. *Journal of the American Academy of Dermatology*. 2015;72:890. 14. Jasterzbski TJ, et al. Pseudofolliculitis cutis: A vexing disorder of hair growth. *British Journal of Dermatology*. 2015;172:878. 15. Laureano AC, et al. Facial bacterial infections: Folliculitis. *Clinics in Dermatology*. 2014;32:711. 16. Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 21, 2017. 17. Fraes Diernaes JE, et al. Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy. *Photodiagnosis and Photodynamic Therapy*. Volume 10, Issue 4, December 2013, Pages 651–653. 18. Oatmeal in dermatology: a brief review. *Indian J Dermatol Venereol Leprol*. 2012 Mar–Apr;78(2):142–5. doi: 10.4103/0378-6323.93629. ---
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Care planFood PoisoningSalmonella bacteria is one of the leading causes of food poisoning in the United States and Europe — and chances are, you've heard about it. Whether it's a recall on packaged spinach or a warning about undercooked chicken, Salmonella is never far from the headlines. It ranks among the most common causes of gastroenteritis (what most people call "stomach flu"), and its impact is far greater than many realize. The Centers for Disease Control and Prevention (CDC) estimates that Salmonella causes approximately 1.35 million infections, 26,500 hospitalizations, and 420 deaths in the United States every year. With food recalls becoming increasingly common, it pays to understand this illness — including what you can do naturally to support your recovery if you or someone in your family is affected. There are currently 32 known Salmonella serotypes, or "strains," capable of making people sick. Most fall under the category of non-typhoidal Salmonella, which is responsible for the vast majority of cases. What makes Salmonella particularly concerning is that it takes only a microscopic amount of bacteria to cause illness. Nearly anyone can be affected, and symptoms can range from mild digestive discomfort to life-threatening complications. Other bacteria that cause food poisoning include Campylobacter, E. coli, and several other pathogens. Disease-causing bacteria are most commonly found in meats, seafood, and dairy products — but outbreaks have also been traced to lettuce, melons, and other fruits and vegetables, as well as certain packaged and prepared foods. Experts agree that harmful bacteria can never be completely eliminated from the food supply, and there is growing consensus that bacterial food contamination is increasing — posing a serious and ongoing threat to public health. ## Understanding Salmonellosis ### What Are the Symptoms of Salmonella Food Poisoning? The hallmark symptoms of Salmonella food poisoning are diarrhea, fever, stomach cramps, and nausea. Symptoms typically begin anywhere from 6 hours to 6 days after exposure and can last 4 to 7 days. Most people recover on their own without specific medical treatment — but in some cases, the illness can become severe enough to require hospitalization. ### How Can You Prevent Salmonella Food Poisoning? When it comes to food poisoning, prevention truly is the best medicine. Fortunately, a few straightforward habits go a long way. Always wash your hands and kitchen utensils thoroughly with soap and water before preparing or eating food. Avoid raw or undercooked eggs, poultry, meat, and fish. And make sure your food is stored and refrigerated properly — proper refrigeration and thorough cooking are among the most well-established ways to reduce your risk of foodborne illness. Additionally, keeping animal products and non-animal products separate during meal preparation helps prevent cross-contamination, which is how bacteria can easily travel from one food to another. ### What Does Conventional Treatment Look Like? The good news is that most Salmonella infections clear up on their own within 5 to 7 days and typically don't require prescription treatment beyond staying well hydrated. Taking frequent sips of an electrolyte-replenishing drink (such as **[Hydrate](https://nutridyn.com/dynamic-hydrate)**) is strongly recommended — aim for 6 to 8 ounces for each significant bout of diarrhea. Some physicians suggest a gentle diet of broths (like chicken soup), toast, pasta, bananas, and applesauce during recovery. However, the research supporting this restricted approach over a generally balanced, wholesome diet is limited. That said, it's wise to avoid high-fat and high-sugar foods, along with spicy foods, alcohol, and coffee, while symptoms are active and for at least two days after they resolve. In cases of severe diarrhea, hospitalization and intravenous fluids may be necessary to prevent dangerous dehydration. Antibiotics — such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin — are generally not recommended, as they can actually prolong the infection. They are typically reserved for cases where the bacteria has spread beyond the intestines into the bloodstream, or when bloody stools are present. It's also worth noting that some strains of Salmonella have become antibiotic-resistant, largely due to the widespread use of antibiotics in commercial livestock farming. ### Factors That Can Increase Your Risk of Salmonella Exposure - **Travel:** International travel, particularly to regions with limited sanitation infrastructure, is associated with a higher risk of Salmonella infection. - **Pet Ownership:** Birds and reptiles are known carriers of Salmonella, and pet owners should take extra care when handling their animals or cleaning up after them — especially when it comes to feces. - **Antacid Use:** Regular use of antacids for conditions like acid reflux can reduce stomach acid, which is one of your body's natural defenses against harmful bacteria like Salmonella. - **Inflammatory Bowel Disease:** Conditions like Crohn's disease or ulcerative colitis can damage the intestinal lining, potentially making it easier for bacteria to escape the digestive tract and cause more widespread infection. - **Recent Antibiotic Use:** A recent course of antibiotics can deplete the beneficial bacteria in your gut microbiome, temporarily reducing your body's ability to fend off new infections. - **A Weakened Immune System:** Certain medical conditions and treatments — including HIV/AIDS, sickle cell disease, malaria, organ transplant medications, and long-term corticosteroid use — can compromise immune function, making it harder to fight off infections like Salmonella. One potential complication of Salmonella poisoning is a condition called reactive arthritis — a reversible inflammatory condition that, unlike many other forms of arthritis, typically resolves on its own. It most commonly affects men between the ages of 20 and 50 who have recently had a bacterial infection such as Salmonella. Previously known as Reiter Syndrome, reactive arthritis is now classified within the spondyloarthritis family of conditions. If Salmonella enters the bloodstream, a more serious condition called bacteremia can develop. Bacteremia involves bacterial infection spreading to tissues throughout the body and can lead to meningitis (infection of the brain and spinal cord), endocarditis (infection of the heart and heart valves), and osteomyelitis (infection of the bones or bone marrow). ### What Is Staphylococcal Food Poisoning? Staphylococcal food poisoning occurs when *Staphylococcus aureus* bacteria contaminate food and leave behind toxins that, once consumed, irritate the gastrointestinal tract. Food handlers are particularly at risk, as they can easily pick up staph bacteria through contact with contaminated products, surfaces, or other people. Symptoms — most notably severe nausea and vomiting — typically come on quickly, usually within 2 to 8 hours of eating contaminated food. To help prevent the spread of staph food poisoning, food service workers should always wash their hands thoroughly after handling food or using the restroom, stay home when they are sick, and ensure food is properly refrigerated. Foods that carry a higher risk of staph contamination include raw foods prepared by hand without gloves, unpasteurized milk and cheese products (especially those left at room temperature for extended periods), salty pork products, processed meats, puddings or custards, and any food prepared using unclean equipment. Can cooking eliminate staph bacteria? Unfortunately, no. The CDC confirms that the toxins produced by staph bacteria in food are generally heat-resistant and cannot be reliably destroyed through cooking or reheating. This is why staph food poisoning can occur even from meals that have been thoroughly cooked. **Sources:** - <https://www.drweil.com/health-wellness/body-mind-spirit/insects-parasites/salmonellosis/> - <https://www.foodpoisoningnews.com/5-essential-natural-remedies-for-salmonella/> - <https://www.prevention.com/life/a20448712/how-to-treat-food-poisoning-naturally/> - <https://draxe.com/health/salmonella-poisoning/> - <https://www.cdc.gov/salmonella/reportspubs/salmonella-atlas/serotype-reports.html> - <https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329> - <https://draxe.com/health/staph-infection/#:~:text=Prevention%20and%20natural%20treatments%20for,with%20heat%20and%20essential%20oils> - <https://my.clevelandclinic.org/health/diseases/21165-staph-infection-staphylococcus-infection> ---
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Care planFrozen ShoulderFrozen shoulder is a condition in which the shoulder becomes painfully stiff, limiting your ability to move it — whether you're trying to move it yourself or someone else is moving it for you. You may also hear it called adhesive capsulitis, periarthritis, or pericapsulitis. Frozen shoulder involves two joints: the joint between your shoulder blade and your chest wall (scapulothoracic), and the ball-and-socket joint of the shoulder itself (glenohumeral). Importantly, the bones themselves aren't fused together — the restriction comes from the soft tissues surrounding them. The condition can be triggered by almost any source of shoulder pain that leads to reduced movement, including injury and prolonged immobility. Interestingly, frozen shoulder tends to develop most often in people who are prone to tension, anxiety, and a kind of passive withdrawal — sometimes described as the "periarthritis personality" — especially when combined with a lower tolerance for pain. Here's how frozen shoulder is thought to develop: pain in the shoulder — from a nerve, blood vessel, muscle, or even an internal organ — triggers spasms in the surrounding blood vessels and muscles. These spasms lead to poor circulation and reduced movement, which together promote the growth of scar-like fibrous tissue. This fibrous tissue is what ultimately restricts the shoulder's function. Without treatment, the process can end in a completely immobile shoulder joint. Frozen shoulder is typically diagnosed when someone has persistent shoulder stiffness and pain lasting at least several weeks. It's most likely to develop when inflammation builds up around the shoulder as a result of immobility or difficulty moving the shoulder through its normal range of motion. This often happens during recovery from an injury. Frozen shoulder can develop while someone is in a sling or cast, healing from surgery, managing arthritis, or dealing with limited arm movement for any reason — including simply being too sedentary. According to the American Academy of Orthopedic Surgeons, between 2 and 5 percent of adults are living with frozen shoulder at any given time. Most people develop it gradually, experiencing persistent muscle or joint pain along with progressive stiffness over the course of several months or more. ### Who Is Most at Risk for Frozen Shoulder? - Being over the age of 40; frozen shoulder affects people between 40 and 70 most often - Healing from an injury or surgery that limits normal range of motion of the shoulder and arm - Having hormonal imbalances, including a thyroid disorder or recently going through menopause - Being a woman; researchers estimate that up to 70 percent of adults with frozen shoulder are women — researchers believe that hormonal imbalances are one reason why more women experience frozen shoulder than men - Recovering from a stroke or cervical disc disease that affects the nerves around the shoulder - Not moving your arm due to other pain or injuries (such as arthritis, a rotator cuff tear, bursitis, or tendonitis) - Having a pre-existing inflammatory medical condition, including heart disease or diabetes - Recently undergoing open heart surgery or spinal surgery - Having high levels of inflammation, due to factors like eating a poor diet and living a sedentary lifestyle If left untreated, frozen shoulder can linger for up to a year — making it difficult to exercise, sleep comfortably, and carry out everyday activities without pain. As a general rule, the longer shoulder pain persists without treatment, the more your mobility suffers. And the less you move, the worse the pain tends to become — a frustrating cycle that's best interrupted early. Fortunately, beginning treatment early — with targeted shoulder exercises, gentle stretching, and natural anti-inflammatory strategies — can help manage symptoms and prevent further stiffness from taking hold. Harvard Medical School considers shoulder stretching exercises "the cornerstone of treating frozen shoulder." ---
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Care planFructose IntoleranceFructose Intolerance / Sensitivity / Malabsorption — once called dietary fructose intolerance — happens when the cells lining your intestines can't efficiently break down fructose. When fructose passes through undigested, it encounters naturally occurring bacteria in your gut and triggers the production of carbon dioxide and hydrogen gases. The result? Bloating, abdominal pain, heartburn, diarrhea, and gas. Fructose is a simple sugar — technically a monosaccharide — found mostly in fruit and some vegetables. You'll also find it in honey, agave nectar, and a wide range of processed foods loaded with added sugars. Between 1970 and 1990 alone, our consumption of fructose from high fructose corn syrup skyrocketed by more than 1,000 percent. This dramatic rise may well be driving the growing number of people struggling with fructose malabsorption and intolerance. If you regularly experience digestive discomfort after eating, fructose malabsorption could be playing a role. Fructans are another piece of the puzzle — fermentable carbohydrates made up of short fructose chains with a single glucose unit attached. Fructan intolerance can exist alongside fructose malabsorption, or it may actually be the root cause of your symptoms. Fructose Sensitivity / Intolerance, as a distinct condition, occurs when the body is missing a key enzyme called aldolase B — the substance responsible for breaking fructose down. When the body fails to absorb fructose properly, the condition is called fructose malabsorption or fructose intolerance. This is actually quite common — and importantly, it is entirely different from hereditary fructose intolerance, which is a rare, genetically inherited, and potentially life-threatening disorder that affects the liver. In people who lack aldolase B, eating fructose or sucrose (the sugar in table sugar, cane sugar, or beet sugar) sets off a dangerous chain of events in the body. The body loses its ability to convert glycogen — its stored energy — back into usable glucose. Blood sugar drops, and harmful substances begin to accumulate in the liver. ## Understanding Fructose Intolerance ### Hereditary Fructose Intolerance: A Separate Condition Hereditary fructose intolerance (HFI) is a far more serious and completely separate condition from everyday fructose malabsorption. This rare genetic disorder affects roughly 1 in 20,000 to 30,000 people and stems from the body's inability to produce the enzyme needed to break down fructose. Without strict adherence to a fructose-free diet, HFI can lead to severe complications, including liver failure. The condition is most often identified when an infant begins eating baby food or formula. Early symptoms can resemble those of galactosemia, while later symptoms tend to reflect liver disease. ### What Causes Fructose Intolerance? Fructose Intolerance / Sensitivity / Malabsorption can stem from a number of contributing factors, including: - An imbalance between beneficial and harmful bacteria in the gut - A diet high in refined and processed foods - Pre-existing gut conditions, such as irritable bowel syndrome (IBS) - Chronic inflammation - Stress ### Symptoms Symptoms of Fructose Intolerance / Sensitivity / Malabsorption may include: - Digestive trouble after eating fruits or foods containing fructose or sucrose — such as gas, bloating, stomach upset, diarrhea, vomiting, chronic fatigue, and difficulty absorbing certain nutrients like iron - Convulsions - Excessive sleepiness - Irritability - Jaundice - Feeding difficulties in infancy Beyond digestive symptoms, research suggests a meaningful link between fructose malabsorption and mood disorders, including depression. One study found that fructose malabsorption was associated with lower levels of tryptophan — an amino acid that plays a central role in the development of depressive disorders. ### Who Is Most at Risk? If you already live with a gut condition such as IBS, Crohn's disease, colitis, or celiac disease, your risk of dietary fructose malabsorption or intolerance is higher than average. Whether one condition causes the other remains an open question. However, in a study of 209 patients with IBS, roughly one-third were found to have fructose intolerance — and those who successfully reduced their fructose intake saw meaningful improvement in their symptoms. If you're managing IBS or Crohn's disease, cutting back on high-fructose foods may be a worthwhile step. It's also worth noting: if you're already following a gluten-free diet but still experiencing symptoms, fructose may be the missing piece. For anyone dealing with a significant gut condition, testing for fructose malabsorption is always a reasonable consideration. ### How Is It Diagnosed? The hydrogen breath test is one of the most commonly used tools to identify fructose digestion problems. It's a straightforward, needle-free test. You'll be asked to limit carbohydrates the evening before and to fast the morning of the test. At your appointment, you'll drink a high-fructose solution, and your breath will then be analyzed every 20 to 30 minutes over the course of several hours — the entire process takes about three hours. When fructose isn't absorbed properly, it leads to elevated hydrogen levels in the intestines, and this test measures exactly that — the hydrogen present in your breath as a result of malabsorption. Another approach is an elimination diet — removing fructose entirely from your meals to see whether your symptoms improve. Working with a registered dietitian, you can build a personalized plan to systematically eliminate fructose-containing foods and monitor your response. Keep in mind that everyone's tolerance for fructose is different. Some people experience more severe reactions than others. Keeping a food journal is a simple and effective way to track what you're eating alongside any symptoms that arise. ### Treatment For most people, removing fructose and sucrose from the diet is the most effective treatment available. Eating a low-sugar, fructose-limited diet is the best strategy for keeping uncomfortable symptoms at bay. That said, many people with fructose intolerance can still tolerate small amounts of fructose without trouble. A food diary can help you find your personal threshold — the point at which fructose becomes too much for your body to handle. Limit your intake of: - Fruit, fruit juices, and dried fruit - Honey - Sodas and other beverages containing high fructose corn syrup - Alcohol **Source:** <https://www.healthline.com/health/fructose-malabsorption#outlook> ---
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Care planGastritisGastritis is a condition in which the stomach lining — known as the mucosa — becomes inflamed and irritated. Your stomach lining is a remarkable structure: it contains specialized cells that produce acid and enzymes to break down your food, as well as a protective layer of mucus that shields the lining itself from that same acid. When the stomach lining becomes inflamed, these functions are compromised, and it produces less acid, fewer enzymes, and less protective mucus. Gastritis can be either short-lived or long-lasting. When inflammation comes on suddenly and severely, it is called acute gastritis. When inflammation persists over a long period of time, it is called chronic gastritis. Without treatment, chronic gastritis can linger for years — or even a lifetime. It is worth noting that the term "gastritis" has a specific medical meaning: it refers to actual, measurable inflammation of the stomach lining — not just any discomfort in the upper belly. Many different conditions can cause upper abdominal pain or discomfort, and in fact, most people who experience those symptoms do not have true gastritis. **The two most common culprits behind gastritis are infection with the bacterium H. pylori and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin.** - Many people with gastritis have no symptoms at all. Those who do may experience what doctors call dyspepsia — upper abdominal discomfort or pain, nausea, or vomiting. - Treating an H. pylori infection matters even when you feel fine. Left untreated, this infection can progress to peptic ulcer disease or, in some cases, cancer. **Reference:** <http://digestive.niddk.nih.gov/ddiseases/pubs/gastritis/> --- ## Understanding Gastritis ### A Closer Look: Erosive Gastritis Erosive gastritis is a particular type of gastritis that behaves a bit differently than you might expect — it often causes little visible inflammation, yet it can quietly wear away the stomach lining, creating erosions, bleeding, or ulcers. Like gastritis in general, erosive gastritis can be either acute (sudden) or chronic (long-lasting). One of the puzzling things about gastritis is that there is no neat, predictable relationship between how inflamed the stomach lining looks and how a person feels. Some people with significant gastritis have no discomfort whatsoever, while others experience notable upper abdominal pain. ### What Causes Gastritis? **The most common cause of chronic, non-erosive gastritis is infection with the bacterium *Helicobacter pylori* (H. pylori).** H. pylori is a type of bacteria that takes up residence in the stomach lining. It spreads mainly from person to person through close contact. In areas with poor sanitation, it can also be transmitted through contaminated food or water. In industrialized countries like the United States, 20–50% of the population carries H. pylori. That number climbs much higher in regions with dense populations and limited sanitation — infection rates can exceed 80% in some developing countries. **When it comes to erosive gastritis — both the sudden and long-lasting varieties — the leading cause is prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.** Other substances that can trigger erosive gastritis include alcohol, cocaine, and radiation exposure. Physical trauma, critical illness, severe burns, and major surgery can also bring on acute erosive gastritis. When stress is the trigger, it is appropriately called stress gastritis. Less commonly, gastritis — both erosive and non-erosive — can result from: - Autoimmune disorders, in which the body's immune system mistakenly attacks healthy cells in the stomach lining - Certain digestive diseases and disorders, such as Crohn's disease and pernicious anemia - Viruses, parasites, fungi, or bacteria other than H. pylori **Reference:** Lee Y, Liou J, Wu M, Wu C, Lin J. Review: Eradication of Helicobacter pylori to prevent gastroduodenal diseases: Hitting more than one bird with the same stone. *Therapeutic Advances in Gastroenterology*. 2008;1(2):111–120. > 📝 **NOTE:** Many people reach for over-the-counter antacids to ease an upset stomach, and while they can bring temporary relief, there is a potential downside to long-term use. Regularly suppressing stomach acid may actually disrupt normal digestion and create conditions that favor bacterial overgrowth — including H. pylori infection. **Reference:** Naylor G, Axon A. Role of bacterial overgrowth in the stomach as an additional risk factor for gastritis. *Can J Gastroenterol.* 2003;17(B Suppl):13B–17B. ### Recognizing the Symptoms Many people with gastritis never experience any symptoms. When symptoms do occur, they may include: - Upper abdominal discomfort or pain - Nausea - Vomiting (Together, these symptoms are referred to as dyspepsia.) **Erosive gastritis can create open sores (ulcers) or erosions in the stomach lining that bleed.** Signs that there may be bleeding in your stomach include: - Blood in vomit - Black, tarry stools - Bright red blood in the stool ### What Are the Long-Term Risks of Gastritis? Most forms of chronic gastritis do not cause noticeable symptoms, but that does not mean they are harmless. Chronic gastritis raises the risk of peptic ulcer disease, gastric polyps, and both benign and malignant stomach tumors. Over time, some people with chronic H. pylori gastritis or autoimmune gastritis develop what is called atrophic gastritis — a condition in which the acid- and enzyme-producing cells of the stomach lining are progressively destroyed. Atrophic gastritis can ultimately increase the risk of two serious cancers: gastric (stomach) cancer and a type of lymphoma called gastric mucosa-associated lymphoid tissue (MALT) lymphoma. ### How Is Gastritis Diagnosed? The most reliable way to diagnose gastritis is through an endoscopy combined with a biopsy of the stomach lining. Before the procedure begins, you will typically receive medication to help you stay comfortable and relaxed. Your doctor then gently passes a thin, flexible tube — called an endoscope — equipped with a tiny camera through your mouth or nose and into your stomach. This allows a direct, real-time view of your esophagus, stomach, and the first section of your small intestine. If anything looks concerning, your doctor can use the endoscope to collect small tissue samples (a biopsy) for closer examination under a microscope. Additional tests that may be used to identify the cause of gastritis or check for complications include: - **Upper gastrointestinal (GI) series.** You swallow a liquid called barium, which coats the digestive tract and makes it visible on X-ray. The resulting images can reveal changes in the stomach lining, such as erosions or ulcers. - **Blood test.** Your doctor may check for anemia — a condition in which the blood's iron-carrying protein, hemoglobin, is lower than normal. Anemia can be a clue that chronic bleeding is occurring in the stomach. - **Stool test.** This test checks for hidden blood in your stool, which can be another indicator of stomach bleeding. - **Tests for H. pylori infection.** Your doctor may test your breath, blood, or stool for evidence of H. pylori. The infection can also be confirmed by analyzing biopsy samples taken from the stomach during endoscopy. ---
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Care planGastroesophageal Reflux Disease (GERD)GERD is a condition in which the contents of your stomach or small intestine wash back up into your esophagus (the tube connecting your mouth to your stomach), causing symptoms like heartburn, regurgitation, and irritation of the esophageal lining. The root of the problem is usually a weak or poorly functioning **lower esophageal sphincter (LES)** — a ring of muscle that acts as a one-way valve — which allows stomach acid and digestive enzymes to travel upward and damage tissue that isn't built to handle them. ## Understanding GERD ### How Does It Happen? The Underlying Mechanisms - A weak or low-pressure LES valve - Spontaneous, temporary relaxations of the LES - Hiatal hernia (when part of the stomach slides up into the chest cavity) - Poor movement of food through the esophagus - Slow stomach emptying - Low stomach acid (hypochlorhydria), which — perhaps surprisingly — can paradoxically weaken the LES and worsen reflux ### Common Symptoms - Heartburn (especially after meals or at night) - Regurgitation (food or acid coming back up) - Belching and bloating - Chronic cough, hoarseness, or sore throat - Chest pain - Nausea or vomiting **Warning signs in children:** persistent coughing or wheezing; frequent vomiting or poor weight gain. ### What Triggers or Worsens GERD? - Low stomach acid - Pregnancy, excess body weight, smoking, and alcohol use - Certain medications: calcium channel blockers, NSAIDs (like ibuprofen), anticholinergics, beta blockers, and bisphosphonates - Eating large meals, eating late at night, or lying down soon after eating - Psychological stress ### How Is GERD Diagnosed? - Your medical history and symptoms - Confirmatory tests: upper endoscopy, pH monitoring, manometry, barium swallow ### Standard Medical Treatments - Proton pump inhibitors or PPIs (e.g., omeprazole), H2 blockers (e.g., famotidine), and antacids - Surgery in severe or treatment-resistant cases > ⚠️ **IMPORTANT NOTE:** A [2020 study](https://www.nature.com/articles/s41467-019-14177-z) published in *Nature Communications*, which analyzed the impact of common medications on the composition and metabolic function of gut bacteria, showed that of 41 classes of medications, **19 were associated with changes in the microbiome** — most notably antibiotics, proton pump inhibitors, laxatives, and metformin. ### Why Long-Term PPI Use Deserves a Closer Look - PPIs reduce Nitric Oxide (NO) production by **95%** — people on PPIs for 3–5 years have a 35–40% increased incidence of heart attacks and strokes due to reduced NO production - Reduced absorption of key nutrients (B12, magnesium, calcium, and iron) - Increased risks: kidney disease, *C. difficile* infection, osteoporosis, and a rebound surge in acid production when stopped - They simply don't work for everyone **References:** - Lundberg JO, Weitzberg E, Lundberg JM, et al. Intragastric nitric oxide production in humans: measurements in expelled air. *Gut.* 1994;35:1543–1546. - Weitzberg E, Lundberg JON. Nonenzymatic Nitric Oxide Production in Humans. *Nitric Oxide.* 1998;2(1):1–7. ---
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Care planGastroparesisGastroparesis — sometimes called "delayed gastric emptying" — is a condition in which the stomach takes too long to empty its contents into the small intestine. Under normal circumstances, the stomach's muscles work in a coordinated rhythm, directed by a powerful nerve called the vagus nerve, to churn food and steadily push it through the gastrointestinal (GI) tract. Think of the GI tract as a long, winding passageway that runs from your mouth all the way to your anus — a system of hollow organs working in concert with hormones and digestive enzymes to break down everything you eat. In gastroparesis, the vagus nerve has been damaged — by illness or injury — and the stomach muscles lose their rhythm. Food either crawls slowly toward the small intestine, or it simply stalls. ## Understanding Gastroparesis ### What Causes Gastroparesis? For most people with gastroparesis, there is no identifiable cause — even after thorough medical evaluation and testing. Doctors call this "idiopathic" gastroparesis, meaning the origin remains unknown. When a cause can be found, diabetes tops the list. People with diabetes carry chronically elevated blood glucose (blood sugar) levels, and over time, that persistent elevation can quietly erode the vagus nerve. Other known culprits include prior abdominal or intestinal surgery and neurological conditions such as Parkinson's disease or multiple sclerosis. Interestingly — and not yet fully explained by science — gastroparesis is diagnosed more often in women than in men. ### What Are the Symptoms of Gastroparesis? The hallmark symptoms of gastroparesis are nausea, an uncomfortable sense of fullness after eating only a small amount of food, and vomiting — sometimes bringing up undigested food hours after a meal. Beyond these core symptoms, gastroparesis can also cause: - Gastroesophageal reflux (GER), also called acid reflux or acid regurgitation — a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach - Pain or discomfort in the stomach area - Abdominal bloating - Loss of appetite Certain foods and drinks tend to make symptoms worse — particularly greasy or rich foods, large amounts of high-fiber foods like raw fruits and vegetables, and beverages that are high in fat or carbonation. Symptoms range widely in intensity: some people experience them frequently and severely, while others have milder, more intermittent episodes. Even within the same person, symptom severity can shift over time. Because many of these symptoms overlap with other GI conditions, gastroparesis can be challenging to pin down with a diagnosis. ### How Is Gastroparesis Diagnosed? Arriving at a diagnosis of gastroparesis typically involves a combination of a physical exam, a thorough medical history, blood work, and specialized tests designed to rule out structural or mechanical problems in the GI tract — as well as tests that directly measure how well the stomach is emptying. Here are the key tests your doctor may use: - **Upper gastrointestinal (GI) endoscopy.** This procedure involves using an endoscope — a small, flexible tube with a light — to see the upper GI tract, which includes the esophagus, stomach, and duodenum (the first part of the small intestine). The test is performed at a hospital or outpatient center by a gastroenterologist — a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars — solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach — that are sometimes softened, dissolved, or broken up during the procedure. - **Upper GI series.** An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist — a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x-rays. Gastroparesis is likely if the x-ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test, and barium causes stools to be white or light colored for several days afterward. - **Ultrasound.** Ultrasound uses a device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider's office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease or pancreatitis — rather than gastroparesis — could be the cause of a person's digestive symptoms. - **Gastric emptying scintigraphy.** This test involves eating a bland meal — such as eggs or an egg substitute — that contains a small amount of radioactive material. An external camera scans the abdomen to show where the radioactive material is located, allowing the radiologist to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. - **SmartPill.** The SmartPill is a small electronic device in capsule form, available at specialized outpatient centers. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person's waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. - **Gastric emptying breath test.** The person eats a special test meal that includes a natural material with a special type of carbon in it. Breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath, and the results allow the health care provider to calculate how fast the stomach is emptying. ### How Is Gastroparesis Treated? Treatment for gastroparesis is tailored to how significantly your symptoms affect your daily life. It's important to understand upfront that for most people, treatment manages the condition rather than curing it — gastroparesis is typically a chronic condition that can wax and wane over time. The goal is to keep you as comfortable, nourished, and active as possible. **Eating, diet, and nutrition** What you eat — and how you eat — can make a meaningful difference in managing gastroparesis. One of the most effective strategies is shifting from three large daily meals to six smaller ones. Smaller portions give your stomach less work to do at any one time, making it easier to empty. Other helpful habits include chewing food thoroughly, sipping non-carbonated beverages with meals, and staying upright — walking or sitting — for at least 2 hours after eating rather than lying down. Your care team may also advise limiting high-fat and high-fiber foods. Fat naturally puts the brakes on digestion, and certain raw fruits and vegetables are harder for a sluggish stomach to process. Foods like oranges and broccoli, for instance, have fibrous components that resist digestion and can linger in the stomach — sometimes long enough to clump together into what are called bezoars. When symptoms become more severe, a liquid or puréed diet may be the best path forward. Liquids tend to clear the stomach more quickly, and blended or puréed meals — think smoothies, soups, and blended fruits and vegetables — can deliver solid nutrition without overwhelming a compromised stomach. A registered dietitian can be an invaluable partner in designing a meal plan that eases your symptoms while meeting all of your nutritional needs. In the most severe cases — when nausea, vomiting, and dehydration become serious — urgent care at a medical facility may be necessary, where fluids and nutrients can be delivered directly into a vein (intravenously). **Medications** Several prescription medications exist to help manage gastroparesis, and sometimes a combination approach works best to find the right fit for each individual. - **Metoclopramide (Reglan).** This medication stimulates stomach muscle contractions to help with gastric emptying and also helps reduce nausea and vomiting. It is taken 20 to 30 minutes before meals and at bedtime. Possible side effects include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesia — a disorder that affects movement. - **Erythromycin.** This antibiotic, prescribed at low doses, may improve gastric emptying by increasing the contractions that move food through the stomach. Possible side effects include nausea, vomiting, and abdominal cramps. Additional medications may be used to address specific symptoms associated with gastroparesis. Antiemetic medications, for example, are commonly used to help bring nausea and vomiting under control. **Botulinum toxin** Botulinum toxin — widely recognized by the brand name Botox — acts as a nerve-blocking agent. Using an endoscope, a physician injects Botox directly into the pylorus, the muscular gateway between the stomach and the duodenum (the first segment of the small intestine). The idea is that relaxing this gateway allows it to stay open longer, giving the stomach a better chance to empty. Early research suggested modest improvements in both symptoms and gastric emptying rates, though subsequent studies have not consistently confirmed the same level of benefit. **Reference:** Bai Y, Xu MJ, Yang X, et al. A systematic review on intrapyloric botulinum toxin injection for gastroparesis. *Digestion.* 2010;81(1):27–34. **Gastric electrical stimulation** For people whose nausea and vomiting persist despite dietary changes and medications, gastric electrical stimulation offers another option. A small, battery-powered device is surgically implanted in the abdomen, where it delivers gentle electrical pulses to the stomach muscles to help curb nausea and vomiting. The implantation is typically done laparoscopically — through tiny incisions, using a miniature camera to guide the surgeon — and may require general anesthesia. Once in place, the device settings can be fine-tuned to find what works best for each individual. **Jejunostomy** When medications and dietary adjustments are not sufficient — particularly if someone is losing weight or requiring frequent hospitalizations for dehydration — a surgical feeding tube may become necessary. In a procedure called a jejunostomy, a tube is surgically placed through the abdominal wall directly into the jejunum, a section of the small intestine. By bypassing the stomach entirely, the tube delivers specially formulated liquid nutrition straight to the small intestine, where it can be absorbed. This option is reserved for the most severe cases of gastroparesis. **Parenteral nutrition** When gastroparesis is so severe that neither dietary strategies nor other treatments are providing adequate nutritional support, parenteral nutrition may be considered. This approach delivers liquid nutrition directly into the bloodstream through a thin, flexible catheter surgically placed into a large vein in the chest. A bag of nutrient-rich solution connects to the catheter, bypassing the digestive system altogether. Parenteral nutrition is generally seen as a last resort compared to jejunostomy, and it is typically used as a temporary bridge through a particularly difficult period. ### How Is Gastroparesis Managed When Diabetes Is Also Present? High blood glucose levels directly interfere with normal stomach emptying, which is why keeping blood sugar well-controlled is especially important for people with both diabetes and gastroparesis. The challenge is that gastroparesis makes blood sugar control harder: food that has been sitting in the stomach can suddenly surge into the small intestine, causing unpredictable spikes in blood glucose. This erratic absorption makes it difficult to time insulin doses effectively. The primary goals when managing gastroparesis in the setting of diabetes are to improve gastric emptying and restore more stable blood glucose control. In addition to the dietary and treatment strategies already described, your care provider will likely need to adjust your insulin regimen. Practical adjustments for people managing both diabetes and gastroparesis may include: - Taking insulin more often or switching to a different type of insulin - Taking insulin after meals, instead of before - Checking blood glucose levels frequently after eating and administering insulin when necessary Your care provider will tailor insulin instructions to your specific situation and the severity of your gastroparesis. In some cases, a dietitian may recommend transitioning to several liquid or puréed meals per day until symptoms stabilize and blood glucose levels become more predictable. ### What Complications Can Gastroparesis Cause? Left unmanaged, gastroparesis can lead to a range of serious complications, including: - Severe dehydration from persistent vomiting - Gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis — irritation of the esophagus - Bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form - Difficulty managing blood glucose levels in people with diabetes - Malnutrition from poor nutrient absorption or insufficient caloric intake - A significantly reduced quality of life, including missed work due to severe or unpredictable symptoms ### Key Takeaways - Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. - Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. - Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. - Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. - The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food — sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. - Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. - Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. - Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. - For people with gastroparesis and diabetes, a health care provider will likely adjust the person's insulin regimen. **Source:** National Institute of Diabetes and Digestive and Kidney Diseases ---
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Care planGestational DiabetesDiabetes is a condition in which blood glucose — or blood sugar — rises to unhealthy levels. During pregnancy, elevated blood sugar can be harmful to both you and your baby. In fact, between 3 and 8 out of every 100 pregnant women in the United States will develop gestational diabetes — a form of diabetes that appears for the first time during pregnancy. The good news is that gestational diabetes typically resolves after delivery, but it is important to know that it does increase your risk of developing diabetes later in life. If you were already living with diabetes before becoming pregnant, carefully monitoring and managing your blood sugar levels throughout your pregnancy is essential. Either way, diabetes during pregnancy raises real risks — for both you and your baby. To help protect you both, we recommend following a low glycemic index, Mediterranean-style eating plan, staying physically active, and regularly checking your blood sugar levels. **The safest functional medicine approach *during* pregnancy includes:** - Eat something healthy and low glycemic index every two waking hours. Eating frequently helps keep your blood sugar steady throughout the day. Recent research suggests that frequent blood sugar spikes during pregnancy can negatively affect pregnancy outcomes — so any steps you can take to smooth out those peaks are genuinely worthwhile. - Take a high-quality prenatal vitamin formula that includes omega-3 fatty acids, active folate, and choline (such as Everyday Essentials Pregnancy). - Because gestational diabetes typically appears for the first time during pregnancy and resolves after delivery, it is vital that you understand the longer-term picture: gestational diabetes is a meaningful signal that your risk for developing type 2 diabetes in the future is elevated. It is something worth taking seriously — and acting on. Think of gestational diabetes as your body's early warning system — an opportunity to make meaningful, lasting changes to your diet, lifestyle, and activity level that can significantly lower your future risk of diabetes. Once you have finished breastfeeding, targeted nutritional supplements to support healthy blood sugar balance can also be incorporated into your plan. ---
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Care planGilbert's Syndrome**Gilbert's** (zheel-BAYRS) **Syndrome** is a common, benign liver condition in which the liver struggles to properly process bilirubin — the yellow pigment released when your body breaks down aging red blood cells. If you have Gilbert's syndrome — also called constitutional hepatic dysfunction or familial nonhemolytic jaundice — you were born with it. It's caused by an inherited gene variant (UGT1A1 polymorphism) that's been passed down through your family. Many people discover they have it entirely by accident, when a routine blood test unexpectedly shows elevated bilirubin levels. Gilbert's syndrome is a frequently missed condition rooted in a mutation of the UGT1A1 gene. This mutation reduces your body's production of a critical enzyme called bilirubin-UGT — the very enzyme responsible for breaking bilirubin down. Because your body can't produce enough of it, bilirubin gradually accumulates in your bloodstream over your lifetime. The result is persistently elevated bilirubin levels, which can occasionally lend a faint yellow hue to your skin and eyes — a phenomenon known as jaundice. While the yellowing can be unsettling to notice, bilirubin levels in Gilbert's syndrome rarely reach dangerous heights. Here's something surprising: Gilbert's syndrome may actually come with meaningful health advantages. Because bilirubin is a potent antioxidant with hormone-like properties, people with Gilbert's syndrome appear to enjoy a degree of natural protection against many of the so-called "diseases of civilization" — including cardiovascular disease, certain cancers, and autoimmune or neurodegenerative conditions. Fascinatingly, Gilbert's syndrome has also been linked to a reduced tendency to accumulate body fat as you age. The benefits extend even further. Higher bilirubin levels in the blood are independently associated with improved insulin sensitivity and a lower risk of metabolic syndrome and type 2 diabetes — regardless of body weight. This same protective effect appears to carry over into reducing the risk of vascular complications related to diabetes. Most people with Gilbert's syndrome live entirely symptom-free, aside from occasional mild yellowing of the eyes. Some individuals report fatigue and abdominal discomfort, though researchers have not established a direct link between these symptoms and elevated bilirubin levels. --- ## Understanding Gilbert's Syndrome ### What You Might Notice The most recognizable sign of Gilbert's syndrome is a subtle, intermittent yellowing of the skin and whites of the eyes, caused by mildly elevated bilirubin circulating in your bloodstream. In people with Gilbert's syndrome, bilirubin levels may spike and jaundice may become more visible in response to: - Illness, such as a cold or the flu - Fasting or eating a very low-calorie diet - Dehydration - Menstruation - Stress - Strenuous exercise - Lack of sleep ### What Causes It Gilbert's syndrome is caused by an abnormal gene inherited from your parents. Under normal circumstances, this gene directs the production of an enzyme that helps your liver break down bilirubin. When the gene isn't functioning properly, your liver can't produce enough of this enzyme — and bilirubin builds up in your blood as a result. ### How Your Body Normally Handles Bilirubin Bilirubin is a yellowish pigment generated when your body recycles old red blood cells. Normally, it travels through the bloodstream to the liver, where enzymes break it down and clear it from circulation. From the liver, bilirubin moves into the intestines via bile, and is ultimately eliminated through your stool. A small amount naturally remains in the bloodstream at all times. ### How This Gene Runs in Families The gene variant responsible for Gilbert's syndrome is actually quite common — many people carry one copy without ever developing the condition. In most cases, you need to inherit two abnormal copies of the gene (one from each parent) for Gilbert's syndrome to manifest. ### Who Is at Risk Although Gilbert's syndrome is present from birth, it typically goes undetected until puberty or later — largely because bilirubin production naturally increases during adolescence, making it more likely to be noticed. Your risk is higher if: - Both of your parents carry the abnormal gene associated with the condition - You are male ### Potential Complications to Be Aware Of The same enzyme deficiency that underlies Gilbert's syndrome also plays a role in clearing certain medications from your body. As a result, people with Gilbert's syndrome may experience amplified side effects from some drugs. Medications of particular concern include: - Irinotecan (Camptosar), a cancer chemotherapy drug - Some protease inhibitors used to treat HIV If you have Gilbert's syndrome, it's wise to consult your doctor before starting any new medication. Additionally, if you have any other condition that accelerates the breakdown of red blood cells, you may face a higher risk of developing gallstones. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/gilberts-syndrome/symptoms-causes/syc-20372811> - <https://www.medicalnewstoday.com/articles/166971.php#symptoms> - *Journal of Hepatology.* Volume 79, Issue 4, P1049–1055, October 2023. doi: <https://doi.org/10.1016/j.jhep.2023.06.004> — <https://www.journal-of-hepatology.eu/article/S0168-8278(23)00421-X/fulltext> ---
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Care planGI Restoration Program (10-Day)> *"Gut dysfunction can be improved in a short period of time."* > > — Dr. Robert Rakowski This program has helped people with long-standing gut problems that seemed impossible to overcome. People who had struggled with diarrhea for 5 years regained normal bowel movements. People who had suffered from constipation for 40 years began to experience the relief of regular, daily bowel movements. It has even helped those dealing with debilitating anxiety, hormonal imbalances, and chronic fatigue and pain conditions. The connection is undeniable: healing the gut opens the door to greater health and vitality throughout your entire body. And the good news is that gut repair doesn't have to take months. This 10-day gut program uses high, therapeutic doses of safe, powerful ingredients to transform your gut environment — quickly. **Source:** BEYOND MTHFR — Optimizing Genes, Changing Lives. <https://www.beyondmthfr.com/protocols/10-day-gut-repair/> ---
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Care planGI Restoration Program (28-Day)We share our world with countless microscopic organisms — and our bodies are no exception. Every human being carries trillions of bacteria, fungi, and viruses that together form what scientists call a microbiome, with the largest and most influential community living right in your gut. While certain microorganisms are associated with illness, the vast majority of the ones naturally inhabiting your digestive tract are not only harmless — they are essential. Your gut microbiome plays a starring role in digestion, immune defense, and even the way your brain functions. That's why nurturing a healthy, thriving gut microbiome matters so deeply to your overall well-being. Unfortunately, this delicate internal ecosystem can be thrown off balance — and when it is, the consequences for your health can be significant. According to Martin J. Blaser, MD, who holds the Henry Rutgers Chair of the Human Microbiome and is director of the Center for Advanced Biotechnology and Medicine at Rutgers University in New Brunswick, New Jersey: > *"The link between the microbiome and human health is so pervasive that there are few conditions that are out of the realm of possibility. It really is a frontier.* > > *Not that the microbiome causes everything, but by understanding and manipulating the microbiome, we could at least palliate, or slow down, particular pathologic processes.* > > *For all the major causes of death in the United States — cardiovascular disease, cancer, dementia and neurodegenerative diseases, diabetes, and lung, liver, and kidney diseases — there is ongoing investigation of the microbiome. A greater promise would be to prevent or cure these illnesses."* > > **Source:** <https://www.medscape.com/viewarticle/where-microbiome-revolution-headed-next-2023a1000vz1?ecd=WNL_mdpls_231222_mscpedit_wir_etid6179755&uac=149193PV&spon=17&impID=6179755> ### When the Gut Falls Out of Balance: Understanding Dysbiosis A [2018 study](https://www.ncbi.nlm.nih.gov/pmc/articles/) published in the *International Journal of Environmental Research and Public Health* reveals that this disruption in the gut microbiota is called **dysbiosis**, and the condition is linked to intestinal illnesses like irritable bowel syndrome (IBS), celiac disease, and inflammatory bowel disease (IBD). Moreover, the study shows that dysbiosis can also cause other issues like obesity, metabolic disorder, cardiovascular syndrome, allergies, and asthma. A 2019 study published in *Nutrients* shows that gut microbiota dysbiosis is now also linked to colorectal cancer, diabetes, and even neurological disorders. The study suggests that there are reciprocal interactions between gut microbiota and the brain — popularly known as the **gut-brain axis** — and changes in this interaction due to dysbiosis can possibly trigger the onset of neurological issues. Overall, studies indicate that dysbiosis is a condition that can affect your health and quality of life immensely and should be prevented at all costs. ---
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Care planGI Restoration Program (Comprehensive 5R)## Understanding Leaky Gut Syndrome **One of the most common — and overlooked — root causes of digestive trouble in people with chronic illness is something called leaky gut.** A large number of these patients struggled with colic or recurrent ear infections early in life and, as a result, were treated frequently with antibiotics. While antibiotics can be lifesaving, they also disrupt the delicate balance of microorganisms living in your gut — a process called dysbiosis — which can set the stage for leaky gut. Your gut does far more than digest food and absorb nutrients — it's home to a vast, complex community of microorganisms known as the microbiome. When that community falls out of balance (dysbiosis), it triggers inflammation in the gut lining. That inflammation can make the mucous membranes of your intestines more permeable — or "leaky." Once the gut lining becomes leaky, microorganisms and partially digested food particles start interacting abnormally with your immune system. Your body begins to mistake these food fragments for foreign invaders and mounts an immune attack against them — giving rise to food sensitivities and allergies. **But leaky gut doesn't stop at food reactions — it can also trigger the immune system to attack the brain.** Research has shown that chronic gut-driven inflammation can continuously activate the brain's immune cells, called microglia, which may begin producing antibodies against the brain's own tissue. In this way, leaky gut can also compromise the blood-brain barrier, allowing substances that should never enter the brain to slip through. **Think of your mouth and digestive tract as the body's internal boundary — much like skin is its external one.** The digestive tract begins at the mouth, and even dental health matters here: poor oral hygiene can contribute to widespread infection and inflammation throughout the body. **Remarkably, about 70% of your body's immune cells reside in your gut.** The surface area of your intestines is roughly equivalent to the size of a football field! **This gut-based immune system is known as gut-associated lymphoid tissue, or GALT — and its job is to protect you from harmful microorganisms that enter through food.** **When the gut becomes inflamed, it becomes easier for bacteria, bacterial fragments, and even intact or partially digested proteins to escape through the intestinal wall and enter the bloodstream.** This leakiness feeds a cycle of whole-body (systemic) inflammation. **Gut inflammation also impairs the absorption of the nutrients your body depends on.** Lipopolysaccharides (LPS) are molecules found on the surface of certain bacteria that normally live in your intestines. They provoke a powerful immune response when they enter the bloodstream. **Elevated LPS levels in the blood are a recognized marker of leaky gut syndrome.** > *"Immune System Compensates for 'Leaky Gut' in Inflammatory Bowel Disease Susceptibility"* — New research could clarify how inflammatory bowel diseases (IBD), conditions that include ulcerative colitis and Crohn's disease, are triggered and develop. Scientists at Emory University School of Medicine have shown how the immune system can compensate for a "leaky gut" and prevent disease in mice that are susceptible to intestinal inflammation. These findings could explain why some individuals who are susceptible to developing IBD do or do not get the disease. "Our results suggest that when there is a chronically leaky intestine, defects in the immune system need to be present for the development of IBD," says senior author Charles Parkos, MD, PhD, professor of pathology and laboratory medicine at Emory University School of Medicine. > > **"Breakdown of the intestinal barrier can occur as a result of intestinal infections or stress.** The normal response involves several components of the immune system that help to heal the injury while controlling invading bacteria. When this normal response is defective and there is a leaky barrier, the risk of developing IBD is increased." > > **Reference:** *Immunity.* Published online September 13, 2012. *ScienceDaily*, Sep. 13, 2012. ---
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Care planGlaucomaGlaucoma is a family of eye diseases that silently damage the optic nerve — the critical connection between your eye and your brain — and can lead to permanent vision loss or blindness. The encouraging news is that with early detection and the right treatment, serious vision loss is often preventable. The optic nerve is a remarkable structure made up of more than 1 million individual nerve fibers bundled together. It carries visual information from the retina — the light-sensitive tissue lining the back of your eye — directly to your brain. A healthy, intact optic nerve is the foundation of good vision. --- ## Understanding Glaucoma ### How Open-Angle Glaucoma Damages the Optic Nerve Multiple large studies have confirmed that elevated eye pressure is one of the most significant risk factors for optic nerve damage. At the front of your eye is a space called the anterior chamber, through which a clear, nourishing fluid constantly circulates. This fluid exits the chamber through an open angle formed where the cornea and iris meet, passing through a spongy, mesh-like drainage channel before leaving the eye. In open-angle glaucoma, that drainage angle remains physically open — but the fluid moves through the meshwork far too slowly, like water trying to pass through a clogged drain. As fluid accumulates, pressure inside the eye rises to levels that can injure the optic nerve. This is why keeping your eye pressure well-controlled is such a critical part of managing and preventing glaucoma. Blood pressure is another important piece of the puzzle. Abnormal blood pressure can also contribute to optic nerve damage, so ensuring that your blood pressure is well-matched to your body's needs is equally important. ### Who Is at Risk for Open-Angle Glaucoma? Glaucoma can affect anyone, but certain groups face a significantly higher risk: - African Americans over age 40 - Everyone over age 60, especially Mexican Americans - People with a family history of glaucoma A comprehensive dilated eye exam can uncover additional risk factors, such as elevated eye pressure, an unusually thin cornea, or an atypical optic nerve appearance. For people with certain combinations of these risk factors, prescription eye drops can reduce the chance of developing glaucoma by roughly half. ### Symptoms of Glaucoma One of the most challenging aspects of open-angle glaucoma is that it is a silent disease — at least in the beginning. It causes no pain and no noticeable change in vision in its early stages, and it can affect one or both eyes without any warning signs. Without treatment, glaucoma gradually steals peripheral (side) vision. Over time, people begin to miss objects at the edges of their visual field, creating the sensation of looking through a narrowing tunnel. Eventually, if the disease goes unchecked, even straight-ahead central vision can be lost entirely. ### Other Forms of Glaucoma and How They Are Treated **Open-angle glaucoma** is by far the most common type, but several other distinct forms of the disease deserve attention. In **low-tension or normal-tension glaucoma**, optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people; in others, glaucoma may worsen despite low pressures. A thorough medical history is essential to identify other contributing risk factors, such as low blood pressure, that may be driving low-tension glaucoma. When no additional risk factors are found, the treatment approach mirrors that of standard open-angle glaucoma. **Angle-closure glaucoma** occurs when the drainage angle becomes physically blocked — typically by part of the iris — preventing fluid from escaping the eye altogether. This can trigger a sudden, dramatic spike in eye pressure. > ⚠️ **IMPORTANT NOTE:** Symptoms of angle-closure glaucoma may include severe eye pain, nausea, eye redness, and blurred vision. If you experience these symptoms, seek emergency care immediately — this is a true medical crisis. If your doctor is unavailable, go directly to the nearest hospital or clinic. Without prompt treatment to restore normal fluid flow, permanent blindness can result. In most cases, timely laser surgery and medication can clear the blockage, normalize eye pressure, and preserve vision. In **congenital glaucoma**, children are born with a structural defect in the eye's drainage angle that impairs normal fluid outflow. Affected infants typically show noticeable symptoms, including cloudy eyes, light sensitivity, and excessive tearing. Surgery is generally the preferred treatment, as medications are not reliably effective in very young children and can carry greater risks in infants. When surgery is performed promptly, outcomes are excellent and most affected children go on to develop good vision. **Secondary glaucomas** develop as a complication of another underlying medical condition. For example, neovascular glaucoma is a severe form that can result from poorly controlled diabetes or high blood pressure. Other types may arise in the setting of cataracts, certain eye tumors, or inflammatory eye conditions such as uveitis. Previous eye surgeries or significant eye injuries can also trigger glaucoma. Even steroid medications used to treat eye inflammation or other systemic diseases can provoke glaucoma in susceptible individuals. Two specific eye conditions are known to cause secondary forms of glaucoma: **Pigmentary glaucoma** occurs when pigment from the iris sheds off and blocks the meshwork, slowing fluid drainage. **Pseudoexfoliation glaucoma** occurs when extra material is produced and shed off internal eye structures and blocks the meshwork, again slowing fluid drainage. > 📝 **NOTE:** Certain drugs are known to be potentially harmful to the optic nerve, retina, and other vital structures of the eye. These include: ACTH, allopurinol (gout), anti-coagulants, aspirin, corticosteroids, Diabinese, diuretics, antihistamines, digitalis, indomethacin, streptomycin, sulfur drugs, tetracycline, diazepam, haloperidol, and quinine. ### What Causes Glaucoma? In most cases, the exact cause of glaucoma remains unknown. For reasons that are not yet fully understood, the drainage ducts or other pressure-regulating structures within the eye become damaged or dysfunctional. **Nutritional and biological factors that may contribute to glaucoma include:** - **Inflammation**, often due to the presence of toxic levels of manganese, iron, aluminum, or other metals in and around the eyes. - **Oxidant damage.** Toxic metals, nutrient deficiencies, liver damage, and other causes may contribute. - **Copper toxicity.** Copper imbalance, which is very common, can damage connective tissue such as that in the ducts of the eyes. This may occur because too much biounavailable copper oxidizes vitamin C and may damage the disulfide bonds that give all connective tissue such as collagen its flexibility and strength. - **Liver toxicity.** Liver damage is associated with most eye diseases. In Chinese medicine, the liver meridian passes through the eyes. As a result, disturbance of this meridian affects the eyes, often in subtle but important ways. Cataracts, glaucoma, retinitis pigmentosa, and other diseases of the eyes are often related to liver toxicity, which is extremely common. ---
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Care planGlycemic Index## Understanding the Glycemic Index **The glycemic index tells you how quickly eating a particular carbohydrate causes your blood sugar to rise.** It runs on a scale from 1 (the slowest rise) to 100 (the fastest, which is the score assigned to pure glucose). That said, your real-world blood sugar response also depends on what else you eat at the same meal, along with several other factors. As a general rule, complex carbohydrates tend to have a lower glycemic index than simple carbohydrates — but not always. Fructose, the natural sugar found in fruit, is one notable exception: despite being a simple sugar, it has surprisingly little impact on blood sugar. **Several key factors shape where a food lands on the glycemic index:** - **Processing:** The more a food has been processed, refined, or finely milled, the higher its glycemic index tends to be. - **Type of starch:** Not all starches behave the same way in your body. For instance, the starch in potatoes is broken down and absorbed into your bloodstream relatively quickly, while barley is digested at a much slower pace. - **Fiber content:** Fiber makes foods harder to digest, which slows the release of sugar into your bloodstream — a good thing for keeping blood sugar steady. - **Ripeness of fruit:** The riper a piece of fruit, the more sugar it contains — and the higher its glycemic index. - **Fat or acid content:** Foods higher in fat or acid are digested more slowly, which means their sugars enter your bloodstream more gradually. - **Preparation:** How you cook or prepare a food matters. Cooking and grinding generally raise a food's glycemic index because they break food down into forms your body can digest and absorb more easily. - **Individual differences:** Everyone's body processes food a little differently, which affects how fast carbohydrates are converted to sugar and absorbed. Even how thoroughly you chew your food — and how quickly you swallow — can make a difference. Why does the glycemic index matter? Foods that send blood sugar rising quickly (high glycemic index foods) also trigger a rapid spike in insulin. That insulin surge can then cause blood sugar to dip too low — a state called hypoglycemia — leaving you hungry again soon after eating and more likely to overeat and gain weight over time. Carbohydrates with a low glycemic index, on the other hand, produce a gentler insulin response, helping you feel fuller for longer after meals. Regularly choosing low-glycemic foods is also linked to healthier cholesterol levels and a lower risk of obesity and diabetes — and for people already living with diabetes, a reduced risk of serious complications. **That said, the glycemic index is a useful guide, not a complete rulebook for healthy eating.** Some foods that aren't exactly nutritional superstars — like potato chips or certain candy bars — actually have a lower glycemic index than genuinely wholesome options like brown rice. And some high-glycemic foods are rich in important vitamins and minerals. Think of the glycemic index as one helpful lens among many when making food choices, not the final word. ---
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Care planGlyphosate/Roundup® ToxicityGlyphosate is the active ingredient in many common weed-killer products and holds the distinction of being the most widely used broad-spectrum weed killer in human history. In the U.S. alone, farmers apply more than **200 million pounds** of glyphosate every year. Beyond the farm, glyphosate is an active ingredient in more than **750 approved products** — many of which sit on the shelves of your local supermarket or hardware store and are routinely used by home gardeners. Glyphosate kills weeds by blocking a key enzyme that plants need to grow. It is used primarily in agriculture, but also in forestry and everyday lawn and garden care. A chemically modified form of glyphosate — its sodium salt — is used to regulate plant growth and accelerate the ripening of certain crops. Glyphosate was first approved for use in the U.S. in 1974 and has since become one of the most widely applied herbicides in the country. It is used across agriculture and forestry, in home lawns and gardens, and for weed control in industrial areas. Some products containing glyphosate are even used to manage aquatic plants. Glyphosate is considered a "non-selective" herbicide — meaning it will kill virtually any plant it contacts. It works by blocking the production of certain proteins that plants need to survive, specifically by shutting down an internal process known as the **shikimic acid pathway**. This pathway is essential for plants and certain microorganisms, but not for animals — a distinction that, as you'll see, turns out to matter a great deal for human health. Since 1974, approximately **8.6 billion kilograms** — roughly **18.9 billion pounds** — of glyphosate have been applied to agricultural fields and other land worldwide. Strikingly, up to two-thirds of that total was applied in just the last decade. --- ## Understanding Glyphosate Exposure and Health Risks ### How Are People Exposed to Glyphosate? Glyphosate exposure happens in two main ways: through environmental contamination and through genetically modified (GM) foods. More than 80 percent of GM crops grown worldwide are specifically engineered to withstand being sprayed with large amounts of glyphosate. All non-organic cereals and grains — including wheat, barley, buckwheat, millet, rice, oats, rye, sorghum, wild rice, popcorn, and teff — are harvested using glyphosate. The Environmental Working Group detected glyphosate in every sample tested from popular oat-based cereals and other oat-based foods marketed to children. Glyphosate has also turned up in baby food — and even in some products labeled as organic. There is also a largely hidden use of glyphosate that most people don't know about: it is routinely applied as a pre-harvest drying agent — called a **desiccant** — on non-GMO and even some organic crops. Glyphosate is regularly sprayed in this way on more than 70 different crops, including almonds, apples, dry edible beans, lentils, chickpeas, peas, grapes, rice, and sunflowers. Many farmers also apply it to fields before the growing season begins — including spinach growers and almond producers. Simply put, glyphosate exposure is nearly impossible to avoid. It has even been detected in tap water. People and animals that consume GM glyphosate-tolerant crops may be ingesting surprisingly high levels of glyphosate residues. A recent report from a division of the Centers for Disease Control and Prevention (CDC) found that **more than 80 percent** of urine samples collected from both children and adults across the U.S. contained detectable glyphosate. While consumers have long been told by manufacturers and government regulators that glyphosate is completely safe, the evidence tells a more complicated story. One significant concern is that glyphosate directly disrupts normal human physiology. Notably, glyphosate has actually been patented as an antibiotic — which helps explain why it has been so harmful to the human microbiome, the vast community of trillions of bacteria that play essential roles in maintaining our internal health and balance. --- ### Health Risks Associated with Glyphosate Exposure Exposure to glyphosate is linked to a range of serious health risks, including disrupted gut function, immune disorders, infertility, accelerated aging, and problems with blood sugar regulation. Since genetically modified (GM) foods were introduced in 1996, the percentage of Americans living with three or more chronic illnesses has nearly doubled — climbing from 7 percent to 13 percent. Over the same period, there has been an unprecedented rise in autism, food allergies, digestive disorders, and reproductive problems. GM foods are also believed to be a contributing factor in the growing epidemic of diabetes and obesity. There is another serious concern: glyphosate is now recognized as a likely cancer-causing agent. The International Agency for Research on Cancer (IARC) — a division of the World Health Organization (WHO) and widely regarded as the leading global authority on cancer research — has classified glyphosate as **"probably carcinogenic to humans" (Group 2A)**. Beyond cancer, glyphosate has a number of other troubling effects on the body: - Damages mitochondria, the energy-generating structures inside your cells - Promotes oxidative stress, a key driver of cellular aging and disease - Disrupts normal hormone signaling throughout the body - Acts as an endocrine disruptor, interfering with the body's hormonal system - Binds to essential minerals, contributing to nutritional deficiencies - Impairs the body's natural detoxification processes - Adds to the total chemical burden your body must manage - Damages the tight junctions between cells, compromising the body's natural barriers ### What Are the Signs and Symptoms of Short-Term Glyphosate Exposure? Pure glyphosate on its own has relatively low toxicity, but commercial products almost always contain additional ingredients designed to help the chemical penetrate plants more effectively — and those added ingredients can significantly increase the product's overall toxicity. Products containing glyphosate can irritate the eyes and skin on contact. People who inhale spray mist from glyphosate-containing products often experience irritation in the nose and throat. Swallowing these products can cause excessive salivation, burns in the mouth and throat, nausea, vomiting, and diarrhea. Deaths have been reported in cases of intentional ingestion. ### What Happens to Glyphosate Once It Enters the Environment? Glyphosate binds tightly to soil particles and can persist in the environment for up to 6 months, depending on climate conditions and the type of soil. It is eventually broken down by naturally occurring bacteria in the soil. Because glyphosate binds so tightly to soil, it is unlikely to leach into groundwater. However, research has shown that glyphosate can linger in plant material — in one study, half of the glyphosate present in dead leaves broke down within 8 to 9 days. Another study found that glyphosate could be taken up directly by carrots and lettuce grown in treated soil. ### Does Glyphosate Cause Cancer? Animal and human studies have been reviewed by regulatory agencies in the USA, Canada, Japan, Australia, and the European Union, as well as by the Joint Meeting on Pesticide Residues of the United Nations and World Health Organization (WHO). These agencies examined cancer rates in humans and reviewed laboratory studies in which animals were given high doses of glyphosate. Based on that body of evidence, they concluded that glyphosate is unlikely to cause cancer. **However, a separate panel of scientists working for the International Agency for Research on Cancer of the WHO reviewed a different set of studies and reached the opposite conclusion — that glyphosate is probably carcinogenic.** **Sources:** - <https://www.sciencedirect.com/science/article/abs/pii/S1382668923000911> — *Environmental Toxicology and Pharmacology* June 2023, Volume 100, 104149 - <https://totalhealthmagazine.com/diet-nutrition/chlorella-a-superhero-for-glyphosate-detoxification/> - <https://www.fda.gov/food/pesticides/questions-and-answers-glyphosate> - <https://www.epa.gov/ingredients-used-pesticide-products/glyphosate> - <http://npic.orst.edu/factsheets/glyphogen.html> ---
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Care planGoiterA goiter is an unusual swelling or enlargement of the thyroid gland — the butterfly-shaped gland nestled at the base of your neck, just below your Adam's apple. Goiters are typically painless, but when they grow large enough, they can trigger a nagging cough and make swallowing or even breathing feel like a challenge. Around the world, the leading culprit behind goiters is simply not getting enough iodine in the diet. In the United States, however, iodized salt has largely solved that problem — so here, goiters are more commonly tied to the thyroid producing too much or too little hormone, or to the development of nodules (lumps) within the gland itself. How a goiter is treated depends on how large it is, what symptoms you're experiencing, and what's causing it in the first place. Small goiters that are barely noticeable and not causing any trouble typically don't require any treatment at all. ## Understanding Goiter ### Signs and Symptoms Many goiters cause no symptoms whatsoever. When symptoms do appear, they may include: - A visible swelling at the base of your neck — something you might first notice in the mirror while shaving or applying makeup - A sensation of tightness in your throat - A persistent cough - A hoarse or raspy voice - Difficulty swallowing - Difficulty breathing --- ### What Causes a Goiter? To understand why goiters develop, it helps to first understand what your thyroid does. Your thyroid gland produces two key hormones — thyroxine (T-4) and triiodothyronine (T-3) — that travel through your bloodstream and act as master regulators of your metabolism. They influence how your body burns fats and carbohydrates, help keep your body temperature in check, affect your heart rate, and play a role in protein production. Your thyroid also produces calcitonin, a hormone that helps keep calcium levels in your blood properly balanced. The real command center for all of this, however, lies in your brain — specifically in two structures called the pituitary gland and the hypothalamus. Think of the hypothalamus as your body's internal thermostat. When it senses that thyroid hormone levels need adjusting, it sends a signal to the pituitary gland to release thyroid-stimulating hormone (TSH). The pituitary then releases just the right amount of TSH based on how much T-4 and T-3 are already circulating in your blood — and your thyroid responds accordingly, ramping hormone production up or down. It's worth noting that having a goiter doesn't automatically mean your thyroid isn't working properly. Even an enlarged thyroid can produce perfectly normal amounts of hormones — though it may also produce too much or too little. Several conditions can cause your thyroid to swell. The most common include: - **Iodine deficiency.** Iodine is a building block your thyroid cannot do without — it's essential for producing thyroid hormones, and it's found mainly in seawater and coastal soils. In parts of the developing world where people live far from the coast or at higher elevations, iodine deficiency is common, and the thyroid may enlarge in a futile attempt to capture more iodine from the blood. A diet heavy in certain foods — like cabbage, broccoli, and cauliflower — can make this worse by naturally suppressing thyroid hormone production. In countries where iodine is routinely added to table salt and other foods, dietary iodine deficiency is rarely the reason behind a goiter. - **Graves' disease.** Sometimes, a goiter develops because the thyroid is overproducing hormones — a condition called hyperthyroidism. In Graves' disease, the immune system goes off-script and produces antibodies that mistakenly stimulate the thyroid, causing it to churn out excess thyroxine. This constant overstimulation causes the gland to swell. - **Hashimoto's disease.** Goiters can also arise when the thyroid is underactive — a condition called hypothyroidism. Like Graves' disease, Hashimoto's disease is an autoimmune condition, but it works in the opposite direction: rather than pushing the thyroid to overproduce, it slowly damages the thyroid until it can no longer make enough hormone. When the pituitary detects low hormone levels, it pumps out more TSH in an effort to stimulate the sluggish thyroid — and that persistent stimulation causes the gland to enlarge. - **Multinodular goiter.** In this condition, multiple solid or fluid-filled lumps (called nodules) develop on both sides of the thyroid, causing the gland to become enlarged overall. - **Solitary thyroid nodules.** Here, a single nodule forms in one area of the thyroid. The vast majority of these nodules are benign (noncancerous) and do not progress to cancer. - **Thyroid cancer.** Thyroid cancer is significantly less common than benign thyroid nodules. A fine-needle biopsy of a thyroid nodule is a highly accurate way to determine whether it is cancerous. - **Pregnancy.** A hormone produced during pregnancy — human chorionic gonadotropin (HCG) — can cause the thyroid gland to enlarge slightly. - **Inflammation / Thyroiditis.** Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid. It may also tip the scales toward too much or too little thyroxine production. --- ### Who Is at Risk? Goiters can develop in virtually anyone — they can even be present at birth and can arise at any stage of life. That said, certain factors raise your chances of developing one: - **Low dietary iodine.** People living in iodine-poor regions without access to iodine supplements face the greatest risk. - **Being female.** Women are more prone to thyroid disorders in general, which means they're also more likely to develop goiters. - **Age.** Goiters become more common after age 40. - **Personal or family medical history.** A personal or family history of autoimmune disease raises your risk. - **Pregnancy and menopause.** For reasons that aren't entirely understood, thyroid problems are more likely to surface during pregnancy and menopause. - **Certain medications.** Some drugs — including the heart medication amiodarone (Pacerone, others) and the psychiatric medication lithium (Lithobid, others) — can increase your risk. - **Radiation exposure.** Your risk goes up if you've received radiation therapy to your neck or chest, or if you've been exposed to radiation from a nuclear facility, test, or accident. --- ### Possible Complications Small goiters that don't cause physical discomfort or cosmetic concerns are generally nothing to worry about. Larger goiters, however, can make breathing or swallowing difficult and may cause a chronic cough or hoarseness. When a goiter is caused by an underlying thyroid condition — such as hypothyroidism or hyperthyroidism — it may come packaged with a broader range of symptoms, from persistent fatigue and unexplained weight gain to unintended weight loss, irritability, and difficulty sleeping. --- ### How Is a Goiter Diagnosed? Your doctor may first detect an enlarged thyroid simply by feeling your neck and asking you to swallow during a routine physical exam — and may even be able to feel the presence of nodules at that point. Confirming the diagnosis and understanding the cause, however, typically involves additional steps: - **Thyroid hormone blood test.** Blood tests can measure the levels of hormones produced by both your thyroid and pituitary glands. If your thyroid is underactive, thyroid hormone levels will be low while TSH will be elevated — a sign that your pituitary is working overtime trying to wake the thyroid up. A goiter linked to an overactive thyroid, on the other hand, typically shows high thyroid hormone levels paired with a lower-than-normal TSH. - **Antibody blood test.** Some goiters are driven by the immune system producing abnormal antibodies. A blood test can detect whether these antibodies are present. - **Ultrasound.** A handheld device called a transducer is gently moved across your neck. It emits sound waves that bounce off the structures in your neck and are translated into images on a computer screen, revealing the size of your thyroid and whether it contains nodules too small to feel. - **Thyroid scan.** During this test, a small amount of radioactive isotope is injected into a vein at the inside of your elbow. You then lie on a table with your head tilted back while a specialized camera captures an image of your thyroid on a computer screen. The time required can vary depending on how long the isotope takes to reach the thyroid. While thyroid scans provide detailed information about the gland's structure and size, they are more involved, time-consuming, and costly than a simple ultrasound. - **Biopsy (fine-needle aspiration).** Using ultrasound as a guide, a thin needle is precisely directed into the thyroid to collect a small sample of tissue or fluid for laboratory analysis. --- ### Conventional Treatment Options The right treatment for a goiter depends on how large it is, what symptoms it's causing, and what's driving it. Your doctor may recommend one or more of the following approaches: - **Watchful waiting.** If your goiter is small, not causing any problems, and your thyroid is functioning normally, your doctor may recommend simply monitoring it over time — no treatment needed for now. - **Medications.** For an underactive thyroid (hypothyroidism), thyroid hormone replacement therapy with levothyroxine (Levoxyl, Synthroid, Tirosint) can relieve hypothyroid symptoms and reduce the pituitary's release of TSH, which often leads to a gradual reduction in goiter size. If thyroid inflammation is the culprit, your doctor may suggest aspirin or a corticosteroid to bring it under control. For goiters tied to an overactive thyroid, medications to normalize hormone levels may be prescribed. - **Surgery.** Removing all or part of the thyroid gland (a total or partial thyroidectomy) may be recommended if your goiter is large enough to cause discomfort, breathing difficulties, or trouble swallowing — or in some cases, if a nodular goiter is causing hyperthyroidism. Surgery is also the standard treatment for thyroid cancer. Depending on how much thyroid tissue is removed, you may need to take levothyroxine long-term after surgery. - **Radioactive iodine therapy.** In select cases — particularly when the thyroid is overactive — radioactive iodine may be used. Taken by mouth, it travels through the bloodstream to the thyroid, where it selectively destroys thyroid cells. This shrinks the goiter but may eventually leave the thyroid underactive, requiring ongoing hormone replacement. ---
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Care planGout**Gout is a form of inflammatory arthritis** that has been increasingly common in the US over recent decades. Often called a lifestyle disease, research shows that cases have more than doubled as obesity rates have climbed. It's triggered by uric acid that builds up in the bloodstream and forms sharp crystals inside joints. Flare-ups can be so severe that affected joints turn cherry red and throb with pain that patients often describe as nearly unbearable. **Reference:** *J Rheumatol.* 2018 Apr; 45(4): 574–579. Published online 2017 Dec 15. doi: 10.3899/jrheum.170806. PMCID: PMC5880714. NIHMSID: NIHMS914483. PMID: 29247151. The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-Based Study Over 20 Years. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880714/> Gout is a common, painful form of arthritis that causes joints to become swollen, red, hot, and stiff. It develops when uric acid accumulates in your bloodstream — either because your body produces too much of it, doesn't eliminate enough, or because you regularly eat foods high in purines, such as liver and dried beans. Pseudogout looks and feels very similar to gout and is sometimes mistaken for it, but it's actually caused by calcium phosphate crystals — not uric acid. Gout most often strikes the big toe first, but it can also affect the ankles, heels, knees, wrists, fingers, and elbows. You may have a higher chance of developing gout if you: - Are a man - Have a family member with gout - Drink alcohol Early on, gout attacks typically resolve on their own within a few days. Over time, however, attacks tend to last longer and happen more frequently. The buildup of uric acid can also contribute to kidney stones, and if gout goes untreated, it can cause lasting damage to both joints and kidneys. **Source:** NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases --- ## Understanding Gout ### What Causes Gout? Several risk factors are linked to high uric acid levels and gout. These include: - **Genetics.** A family history of gout is common among those who develop the condition. Estimates suggest that between 20 and 80 percent of people with gout have a relative who also has it. - **Sex and age.** Gout is more common in men than in women, and more common in adults than in children. - **Body weight.** Carrying excess weight raises the risk of high uric acid levels and gout, because more body tissue means more cellular breakdown — which translates to more uric acid being produced. - **Alcohol consumption.** Drinking too much alcohol can raise uric acid levels because alcohol interferes with the body's ability to clear uric acid efficiently. - **Diet.** Regularly eating foods that are high in purines can trigger or worsen gout in some individuals. - **Lead and toxic metal exposure.** In some cases, exposure to lead or other environmental toxins can lead to gout. **A note on Vitamin C deficiency…** A recent study published in *The American Journal of Clinical Nutrition* found that people who took 500 milligrams of vitamin C daily — compared to those who took a placebo — had a 12% lower risk of developing gout. The study followed more than 14,000 male physicians and found that men who were not overweight saw the greatest benefit. (Being overweight is itself a known risk factor for gout.) Participants were asked whether they had ever received a gout diagnosis. Earlier research had already shown that vitamin C could lower urate levels and help break down uric acid crystals in the blood — but this study went a step further by demonstrating that supplementation actually reduced the likelihood of developing gout in the first place. **Reference:** *The American Journal of Clinical Nutrition*, Volume 116, Issue 3, September 2022, Pages 812–819. <https://doi.org/10.1093/ajcn/nqac140>. Effects of vitamin C supplementation on gout risk: results from the Physicians' Health Study II trial. <https://academic.oup.com/ajcn/article-abstract/116/3/812/6586333?redirectedFrom=fulltext&login=false> ### Other Health Conditions That Can Contribute to Gout Reduced kidney function — when the kidneys can no longer adequately filter and remove waste products — is a frequent contributor to gout, particularly in older adults. **Other medical conditions that can drive uric acid levels higher include:** - High blood pressure - Hypothyroidism (an underactive thyroid gland) - Conditions involving rapid cell turnover, such as psoriasis, hemolytic anemia, or certain cancers - Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome — two rare inherited conditions in which the enzyme responsible for regulating uric acid levels is either absent or present in insufficient amounts ### Medications That Can Raise Uric Acid Levels Several medications may increase the risk of developing high uric acid levels and gout. These include: - **Diuretics** (water pills), which are prescribed to reduce fluid retention in conditions like high blood pressure, swelling, and heart disease — and which also reduce the amount of uric acid eliminated through urine - **Salicylate-containing drugs,** such as aspirin - **High-dose Niacin** (also known as nicotinic acid) and high-dose Vitamin A (not the beta-carotene form) - **Cyclosporine,** an immune-suppressing medication used to treat certain autoimmune diseases and to prevent organ rejection after transplantation - **Levodopa,** a medication used to support nerve signaling in the treatment of Parkinson's disease ### Foods High in Purines - Anchovies - Asparagus - Beef kidneys - Brains - Dried beans and peas - Wild game meats - Gravy - Herring - Liver - Mackerel - Mushrooms - Sardines - Scallops - Sweetbreads **The uric acid levels that characterize gout are closely tied to how many purines you consume.** Purines are natural compounds found in a wide variety of foods. When your body breaks them down, uric acid is produced as a byproduct — and eating too many high-purine foods can push those levels into the danger zone, raising the risk of a gout flare. ### Protein Choices and Gout Risk - **Animal Proteins:** Certain animal-based proteins — especially organ meats (like liver and kidneys), red meats (such as beef, lamb, and pork), and specific seafood (including anchovies, sardines, and shellfish) — are particularly rich in purines. Eating these foods regularly can raise uric acid levels and increase the likelihood of gout attacks. **Source:** [Mayo Clinic](https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524) - **Plant-Based Proteins:** Legumes (beans, lentils, peas) and tofu are generally lower in purines and make a smart alternative. Including these foods in your diet helps meet your protein needs without significantly pushing uric acid levels higher. **Source:** [Cleveland Clinic](https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet) - **Dairy Products:** Low-fat dairy options — like skim milk and low-fat yogurt — have been associated with a reduced risk of gout. They deliver protein with very little purine content and may actually offer some protection against gout flares. **Source:** [Mayo Clinic](https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524) ### Practical Dietary Recommendations - **Moderation matters:** Cut back on high-purine animal proteins. When you do eat meat, choose leaner options and keep portions to about 3 to 6 ounces per day. ([Healthline](https://www.healthline.com/health/gout/diet-restrictions)) - **Broaden your protein sources:** Lean into plant-based proteins and low-fat dairy to meet your nutritional needs while keeping uric acid in check. ([Cleveland Clinic](https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet)) - **Stay hydrated:** Drinking enough water each day helps your kidneys flush out uric acid, which can reduce the likelihood of crystal formation in your joints. ([Mayo Clinic](https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524)) By being thoughtful about which proteins you eat and keeping high-purine foods to a minimum, you can take meaningful steps toward managing elevated uric acid levels and reducing your risk of gout flares. ---
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Care planHalitosis**Halitosis — commonly known as bad breath, or fetor oris — is a condition in which an unpleasant odor is detectable on the breath.** Bad breath ranks as the third most common reason people visit the dentist, behind only tooth decay and gum disease, and roughly 20% of the general population experiences it to some degree. Not everyone who thinks they have bad breath actually does. In fact, a significant portion of those who are concerned — anywhere from 5 to 72%, depending on the study — show no measurable problem when evaluated by a professional. Among those who do have genuine halitosis, the odor most often comes from bacteria living below the gum line and coating the back of the tongue. The remaining 10% of cases stem from a wide range of sources, including the nasal passages, sinuses, throat, lungs, esophagus, stomach, or beyond. In rare cases, halitosis can be one sign among many of a serious underlying condition, such as liver failure. However, the vast majority of cases have a minor, correctable cause — and breath quality can often be meaningfully improved with better oral hygiene habits, such as brushing more thoroughly, gently scraping the back of the tongue, and flossing to support gum health. Occasionally, though — particularly when the odor does not originate in the mouth — halitosis can be harder to pin down and successfully treat. Because bad breath carries a social stigma, both real and perceived cases can sometimes fuel social anxiety. ## Understanding Halitosis Two main frameworks exist for classifying halitosis, though neither has been universally adopted. ### The Miyazaki Classification The Miyazaki classification was first introduced in 1999 in a Japanese scientific journal and has since been refined to better reflect North American perspectives, particularly around halitophobia — the fear of having bad breath. This framework divides halitosis into three core categories: genuine halitosis, pseudohalitosis, and halitophobia. While it is considered the most widely used system, critics have noted that it is overly simplified and primarily serves dental practitioners rather than clinicians in other specialties. - Genuine halitosis - A. Physiologic halitosis - B. Pathologic halitosis - Oral - Extra-oral - Pseudohalitosis - Halitophobia ### The Tangerman and Winkel Classification The Tangerman and Winkel classification was introduced in Europe in 2002. This system focuses exclusively on cases of genuine halitosis, which is why some have argued it is less practically useful in a dental setting than the Miyazaki approach. - Intra-oral halitosis - Extra-oral halitosis - A. Blood-borne halitosis - Systemic diseases - Metabolic diseases - Food - Medication - B. Non-blood-borne halitosis - Upper respiratory tract - Lower respiratory tract The same researchers also proposed grouping halitosis by the character of the odor into 3 categories: - **"Sulfurous or fecal"** — caused by volatile sulfur compounds (VSC), most notably methyl mercaptan, hydrogen sulfide, and dimethyl sulfide. - **"Fruity"** — caused by acetone, present in diabetes. - **"Urine-like or ammoniacal"** — caused by ammonia, dimethyl amine, and trimethylamine (TMA), present in trimethylaminuria and uremia. ### A Newer Cause-Based Framework Drawing on the lessons of these earlier classification efforts, a newer cause-based framework has been proposed: - Type 0 (physiologic) - Type 1 (oral) - Type 2 (airway) - Type 3 (gastroesophageal) - Type 4 (blood-borne) - Type 5 (subjective) In any given individual, halitosis may represent a blend of these types in any combination, layered on top of the baseline breath odor that is present in all healthy people. ### What Health Conditions Are Linked to Bad Breath? Persistent bad breath — or a lingering bad taste in the mouth — can be an early warning sign of gum (periodontal) disease. Gum disease develops from plaque buildup on the teeth, which allows bacteria to produce toxins that irritate and inflame the gums. Left untreated, it can eventually damage both the gums and the underlying jawbone. Other dental contributors to bad breath include ill-fitting dental appliances, oral yeast infections, and cavities (dental caries). Dry mouth — medically known as **xerostomia** — is another common culprit. Saliva plays a vital role in keeping the mouth healthy: it moistens tissues, neutralizes the acids produced by plaque, and rinses away dead cells that collect on the tongue, gums, and inner cheeks. When those cells aren't cleared away, they break down and contribute to bad breath. Dry mouth can be a side effect of many medications, problems with the salivary glands, or habitual mouth breathing. A range of other diseases and medical conditions can also contribute to bad breath, including: - Respiratory tract infections such as pneumonia or bronchitis - Chronic sinus infections, postnasal drip - Gastroesophageal infection - Diabetes - Chronic acid reflux, liver or kidney problems - Some cancers, and conditions such as metabolic disorders **References:** - A Current Approach to Halitosis and Oral Malodor — A Mini Review. *Open Dent J*. 2018;12:322–330. Published online 2018 Apr 30. doi: 10.2174/1874210601812010322. PMCID: PMC5944123. PMID: 29760825. - Halitosis: From diagnosis to management. *J Nat Sci Biol Med*. 2013 Jan-Jun;4(1):14–23. doi: 10.4103/0976-9668.107255. PMCID: PMC3633265. PMID: 23633830. ---
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Care planHDL CholesterolYour genes play a meaningful role in how much HDL cholesterol your body makes and how it distributes its various subtypes. While you can't rewrite your genetic code, you *can* influence how your genes express themselves through the choices you make every day — this is the science of your **epigenome**. Think of the epigenome as a master control panel of switches that turn genes "on" or "off" without altering the underlying DNA itself. Your diet, stress levels, sleep habits, and environment all have the power to flip these switches, meaning your daily lifestyle choices carry far more influence over your genetic destiny than most people realize. Here are some of the most effective — and in many cases surprisingly simple — steps you can take to move your HDL numbers in the right direction. ---
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Care planHeadaches / MigrainesThe most common type of headache diagnosed in the United States is not caused by a blood vessel problem — it's caused by muscle tension. In fact, about **70% of all headaches** fall into this category. Common causes include spasms in the small muscles at the base of your skull (the suboccipital muscles) from a neck injury like whiplash, poor posture (such as a computer monitor positioned at the wrong angle), or even sleeping with a pillow that's too thick and bends your neck forward during the night. These headaches typically come on gradually, but they tend to follow a repeating cycle of tension and release. Over time, the muscles and joints of the neck can become locked in abnormal positions, making the pattern harder to break. ### What Does It Feel Like? - Most commonly, the discomfort originates from tension in the muscles at the base of the skull - Rather than throbbing, these headaches feel like a steady, dull ache that can show up in different parts of the head and neck - Pain can appear in seemingly unrelated areas because it is often "referred pain" — discomfort that travels from tight trigger points in the neck and skull muscles to other locations ---
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Care planHealth Appraisal Questionnaire (HAQ) Key
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Care planHealthy Weight ManagementAdapted from *[Inside-Out Health: A Revolutionary Approach to Your Body](https://www.amazon.com/gp/product/1619614499/ref=dbs_a_def_rwt_bibl_vppi_i0)*, by Dr. Robert Silverman. Medical experts broadly agree that obesity — and even just being overweight — plays a major role in driving virtually every degenerative disease we know of. The United States Surgeon General has warned that **failing to address excess weight and obesity *"could wipe out the gains we've made in areas such as heart disease, several forms of cancer, and other chronic health problems."*** Despite how common it is for Americans to attempt weight loss, obesity rates have climbed sharply since the 1980s. In his book, Dr. Robert Silverman makes a striking observation: > *"Americans try all sorts of diets all the time. The weight-loss industry is estimated to take in $64 billion a year in the United States. Despite all that money spent on dieting, today we're heavier than ever. 70 percent of all adults are overweight or obese."* **It's pretty clear that diets don't work. What does? Quality foundational nutrition and therapeutic lifestyle changes.** ---
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Care planHearing LossHearing loss that gradually develops with age — known as presbycusis — is remarkably common. According to the National Institutes of Health, an estimated one-third of Americans between the ages of 65 and 75 and close to one-half of those older than 75 have some degree of hearing loss. Experts believe that genetics and a lifetime of exposure to loud noise are the primary culprits behind age-related hearing loss. Other factors, like a buildup of earwax, can physically block your ears from transmitting sound the way they should. ## Understanding Hearing Loss ### How Hearing Works Hearing happens when sound waves travel into your ear and set off a chain reaction — vibrations are converted into nerve signals that your brain interprets as sound. ### A Quick Tour of Your Ear Your ear is organized into three main regions: the outer ear, the middle ear, and the inner ear. Sound waves enter through the outer ear and cause your eardrum to vibrate. The eardrum, together with three tiny bones of the middle ear — the hammer, anvil, and stirrup — amplify those vibrations and pass them along to the inner ear. There, the vibrations travel through fluid inside the cochlea, a snail-shaped structure that is central to your sense of hearing. Lining the cochlea are thousands of microscopic hair cells that convert those fluid vibrations into electrical signals sent to your brain. Different sounds move these hair cells in different ways, which is how your brain learns to tell one sound apart from another. ### What Causes Hearing Loss For some people, hearing loss is as straightforward as a buildup of earwax that blocks the ear canal and prevents sound from getting through. Earwax blockage can affect people of any age. More often, though, hearing loss stems from damage deep inside the ear. The natural aging process, combined with years of noise exposure, gradually wears down the delicate hair cells and nerve cells inside the cochlea. Once damaged or lost, these cells can no longer send sound signals to the brain efficiently — and hearing loss follows. High-pitched sounds may begin to sound muffled, and it may become increasingly difficult to follow a conversation in a noisy room. Your genetic makeup may make you more or less vulnerable to these changes. Ear infections, abnormal bone growths, or tumors in the outer or middle ear can also impair hearing, as can a ruptured eardrum. ### Risk Factors The following factors can damage or destroy the hair cells and nerve cells inside your inner ear: - **Aging.** A lifetime of sound exposure slowly takes a toll on the delicate cells of your inner ear. - **Heredity.** Your genetic profile can make you more — or less — susceptible to ear damage over time. - **Occupational noises.** Careers that involve sustained loud noise — such as farming, construction, or factory work — can cause lasting damage to your inner ear. - **Recreational noises.** Sudden, explosive sounds from firearms or fireworks can cause immediate and permanent hearing loss. Activities like snowmobiling, motorcycling, or listening to loud music for extended periods also carry real risk. Even personal music players — like MP3 players — can cause lasting hearing loss if the volume is cranked high enough to drown out other loud sounds, like a lawn mower. - **Some medications.** Certain drugs — including the antibiotic gentamicin and some chemotherapy agents — can permanently damage the inner ear. High doses of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs, or loop diuretics may cause temporary hearing effects such as ringing in the ears (tinnitus) or muffled hearing. - **Some illnesses.** Illnesses that trigger a high fever — such as meningitis — can damage the cochlea. **Common Pain Relievers and Hearing Loss Risk in Men** — Men who take aspirin, acetaminophen (Tylenol®), and/or NSAIDs (Advil®, Motrin®, etc.) at least twice a week increase their risk of experiencing hearing loss: - Aspirin — 33% - NSAIDs — 61% - Acetaminophen — 99% **Reference:** Curhan SG, Eavey R, Shargorodsky J, Curhan GC. Analgesic use and the risk of hearing loss in men. *Am J Med*. 2010 Mar;123(3):231–7. ### Prevention The good news: many cases of noise-induced hearing loss are preventable, and there are concrete steps you can take to slow age-related hearing loss as well: - **Protect your ears at work.** Purpose-built earmuffs that resemble headphones can bring most dangerously loud sounds down to a safe level. Foam, pre-formed, or custom-molded earplugs made of plastic or rubber are equally effective at shielding your ears from harmful noise. - **Get your hearing checked regularly.** If you work in a loud environment, routine hearing tests are a smart investment. Early detection gives you the best chance to take action before further damage occurs. - **Be mindful of recreational noise.** Activities like snowmobiling, hunting, and listening to very loud music for extended periods can quietly erode your hearing. Wearing ear protection during these activities — or simply stepping away from the noise for regular breaks — can make a meaningful difference. And when listening to music, turning the volume down is one of the simplest things you can do to protect your hearing long-term. ---
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Care planHemochromatosis**Hemochromatosis** is a condition in which your body accumulates far more iron than it needs — which is why it's often called **"iron overload."** Under normal circumstances, your intestines absorb just enough iron from the foods you eat to keep your body healthy. In hemochromatosis, however, your body soaks up far too much iron and has no effective way to eliminate the surplus. That excess iron gets deposited in your joints and vital organs — including your liver, heart, and pancreas — causing progressive damage. Left untreated, hemochromatosis can lead to organ failure. ### Two Forms: Primary and Secondary **Primary hemochromatosis** is inherited — it runs in families. If you receive one copy of the responsible gene from each parent, your risk of developing this disorder is significantly elevated. **Secondary hemochromatosis** develops as a consequence of other underlying medical conditions, such as: - Certain types of anemia - Liver disease - Receiving frequent blood transfusions People of Northern European descent are at the highest risk for hereditary hemochromatosis. Men are approximately 5 times more likely to develop it than women. ### Recognizing the Symptoms Surprisingly, up to half of all people with hemochromatosis never experience noticeable symptoms. In men, symptoms tend to appear between the ages of 30 and 50. Women often don't show signs until after age 50 or menopause — likely because menstruation and childbirth naturally reduce iron stores throughout their lives. **When symptoms do appear, they can include:** - Joint pain, particularly in the knuckles - Persistent fatigue - Unexplained weight loss - A bronze or grayish tint to the skin - Abdominal pain - Decreased sex drive - Loss of body hair - Heart palpitations - Brain fog or memory difficulties In some cases, the first sign that something is wrong isn't a symptom at all — it's a related complication, such as: - Liver problems, including cirrhosis (scarring of the liver) - Diabetes - Irregular heart rhythm - Arthritis - Erectile dysfunction One important note: if you regularly take high doses of vitamin C or eat a lot of vitamin C-rich foods, you may inadvertently worsen your hemochromatosis. Vitamin C significantly enhances your body's ability to absorb iron from food. ### Who Is Most at Risk? Several factors can raise your likelihood of developing hemochromatosis: - **Genetics:** Inheriting two defective copies of the HFE gene — one from each parent — is the primary driver of hereditary hemochromatosis. (In the gene's name, "H" stands for high, and "FE" is the chemical symbol for iron.) - **Family history:** Having a parent, sibling, or child with hemochromatosis meaningfully increases your own risk. - **Ethnicity:** According to the NHLBI, Caucasian people of Northern European descent have a higher risk of having the HFE gene mutation and of developing hemochromatosis. They note that it is less common in people of African American, Hispanic, Asian, and American Indian descent. - **Sex:** Iron overload can affect both men and women, though it tends to be less severe in women. Because menstruation naturally reduces iron levels through blood loss, women are somewhat protected during their reproductive years. Men may develop symptoms between ages 40–60, while women are more likely to notice them after menopause. ### Getting a Diagnosis Diagnosing hemochromatosis can be challenging, because many of its symptoms overlap with other conditions. Your doctor may recommend testing if: - You are experiencing symptoms. - You have developed one of the complications listed above. - A family member has been diagnosed with the disorder. **Here's how your doctor will work to confirm the diagnosis:** - **Medical and family history.** Your doctor will ask about your health history and whether anyone in your family has had hemochromatosis or related conditions — such as arthritis or liver disease — that might suggest undetected iron overload. - **Physical examination.** Your doctor will examine you thoroughly, listening to your heart and lungs with a stethoscope and gently tapping on various areas of your abdomen to check for organ changes. - **Blood tests.** Two key tests provide important clues: - **Transferrin saturation.** This measures how much iron is bound to transferrin, the protein responsible for carrying iron through your bloodstream. - **Serum ferritin.** This measures the level of ferritin — the protein that stores iron — circulating in your blood. If either test reveals elevated iron levels, your doctor may also order genetic testing to determine whether you carry the gene variants associated with hemochromatosis. - **Liver biopsy.** Your doctor may remove a small tissue sample from your liver to examine under a microscope for signs of damage or scarring. - **MRI.** This non-invasive imaging scan uses powerful magnets and radio waves to create detailed pictures of your internal organs, helping assess iron accumulation without surgery. ### Treatment Options The main treatments for hemochromatosis are therapeutic phlebotomy, iron chelation therapy, dietary modifications, and management of any complications that have developed. **The overarching goals of treatment are to:** - Bring iron levels in your body back to a healthy range - Prevent or slow further organ damage from iron overload - Address any complications that have already developed - Keep your iron levels within a healthy range for the long term **Therapeutic Phlebotomy** is essentially a medically supervised blood draw — and it's the most effective way to remove excess iron from your body. A needle is placed into a vein, and blood flows through a sterile tube into a collection bag. The process closely resembles donating blood, and it can be performed at blood donation centers, hospital outpatient units, or your doctor's office. In the early phase of treatment, approximately 1 pint of blood is removed once or twice per week. Once your iron levels normalize, phlebotomy sessions continue but become less frequent — typically every 2–4 months. As long as treatment continues, which often is for the rest of your life, you'll need frequent blood tests to check your iron levels. **Iron Chelation Therapy** uses medication to bind and remove excess iron from your body. This is an excellent alternative for people who are unable to tolerate routine blood removal. The chelating medication can be administered by injection (at a clinic or doctor's office) or taken as an oral tablet at home — making it a more flexible option for many patients. **Dietary modifications** to reduce iron intake can help manage symptoms and slow disease progression. Helpful changes include: - Avoiding iron supplements in any form, including pills and injections - Avoiding vitamin C supplements, since vitamin C significantly increases iron absorption - Cutting back on iron-rich and iron-fortified foods - Avoiding raw fish and shellfish - Limiting alcohol, which can worsen liver damage **Source:** WebMD Medical Reference — Reviewed by Minesh Khatri, MD on December 21, 2018. <https://www.webmd.com/a-to-z-guides/what-is-hemochromatosis#1> ---
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Care planHemorrhoidsHemorrhoids (also called piles) are swollen, inflamed veins located in and around the anus and lower rectum. They're more common than most people realize, and the good news is that they're very treatable. - Hemorrhoids often develop from repeated straining during bowel movements, or from the extra pressure these veins endure during pregnancy — though there are other causes as well. - They come in two varieties: those that form inside the rectum (internal hemorrhoids) and those that develop just beneath the skin surrounding the anus (external hemorrhoids). - Hemorrhoids are remarkably common. By age 50, roughly half of all adults have experienced the itching, discomfort, and bleeding that can signal their presence. ## Understanding Hemorrhoids Your symptoms will often depend on where the hemorrhoid is located. Internal hemorrhoids sit inside the rectum — you typically can't see or feel them, and they usually cause no discomfort on their own. However, straining or irritation during a bowel movement can damage the hemorrhoid's delicate surface and cause it to bleed. In some cases, straining can push an internal hemorrhoid out through the anal opening — this is called a protruding or prolapsed hemorrhoid, and it can be quite painful and irritating. External hemorrhoids develop beneath the skin around the anus. When aggravated, they can itch or bleed. Occasionally, blood may pool inside an external hemorrhoid and form a clot (called a thrombus), leading to intense pain, swelling, and inflammation. ### Signs and Symptoms of Hemorrhoids **What does it feel like?** Signs and symptoms of hemorrhoids may include: - Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl - Itching or irritation in the anal area - Pain or discomfort - Swelling around the anus - A tender or painful lump near the anus - Accidental leakage of stool ### What Causes Hemorrhoids? The veins around the anus are naturally prone to stretching under pressure — and when that pressure becomes chronic or excessive, they can bulge and swell into hemorrhoids. Common factors that raise pressure in the lower rectum include: - Straining during bowel movements - Sitting on the toilet for prolonged periods - Chronic diarrhea or constipation - Obesity - Pregnancy - Anal intercourse A tendency toward hemorrhoids can also run in families. And as we age, the supportive tissues around the rectal and anal veins naturally weaken and lose elasticity — making hemorrhoids more likely over time. ### Can Hemorrhoids Lead to Bigger Problems? Serious complications from hemorrhoids are uncommon, but they do exist: - **Anemia.** Chronic blood loss from hemorrhoids may cause anemia, in which you don't have enough healthy red blood cells to carry oxygen to your cells, resulting in fatigue and weakness. - **Strangulated hemorrhoid.** If blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," which can cause extreme pain and lead to tissue death (gangrene). ### How Are Hemorrhoids Diagnosed? External hemorrhoids are often visible to your doctor on simple inspection. Diagnosing internal hemorrhoids may require a brief in-office exam using one or more of the following approaches: - **A physical exam of your anal canal and rectum.** During a digital rectal exam (DRE), your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. The exam can give your doctor an indication of what further testing might be appropriate. - **A visual inspection of your anal canal and rectum.** Because internal hemorrhoids are often too soft to be felt in a rectal examination, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope, or sigmoidoscope. These are scopes that allow your doctor to see into your anus and rectum. ### What You Can Do at Home Right Now - **Try an over-the-counter topical treatment.** Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent. You can often relieve the mild pain, swelling, and inflammation of hemorrhoids with home treatments. Often these are the only treatments needed. - **Soak in a warm bath or sitz bath.** Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet. You can get one at most drugstores. - **Keep the area clean and gentle.** Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn't necessary and may aggravate the problem. Gently dry the area with a hair dryer after bathing. - **Skip the dry toilet paper.** To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn't contain perfume or alcohol. - **Use cold therapy.** Apply ice packs or cold compresses on your anus to relieve swelling. ### How to Prevent Hemorrhoids in the First Place - **Load up on high-fiber foods.** Eat more fruits, vegetables, and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids. Add fiber to your diet slowly to avoid problems with gas. The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. - **Stay well hydrated.** Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft. - **Consider a fiber supplement.** Most people don't get enough of the recommended amount of fiber — 20 to 35 grams a day — in their diet. Studies have shown that over-the-counter fiber supplements (such as **[Dynamic Fiber](https://nutridyn.com/dynamic-fiber)**) improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse. - **Don't strain.** Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum. - **Listen to your body's signals.** If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass. - **Move your body regularly.** Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids. - **Don't sit — or stand — for too long.** Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus. **Source:** <http://www.mayoclinic.com/health/hemorrhoids/DS00096> ---
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Care planHepatitisHepatitis is an inflammation of the liver marked by patches — or widespread areas — of dying liver cells. **There are 4 major kinds of hepatitis: type A, type B, type D, and type non-A, non-B.** Hepatitis is caused by a virus, and while types A, B, and D can be told apart by their unique proteins, all four types look and behave similarly in patients. Less common infectious causes of hepatitis include infectious mononucleosis, yellow fever, cytomegalovirus, and leptospirosis. Hepatitis can also develop after exposure to certain toxic substances, including carbon tetrachloride, benzene, tetracyclines, amanita mushrooms, arsenic, phosphorus, and alcohol. ### Hepatitis A Hepatitis A is caused by an enterovirus and spreads through contaminated food and water — what doctors call the fecal-oral route. It is contagious throughout its 2–6 week incubation period, but only briefly once symptoms appear. Outbreaks are common because the virus spreads so easily. In many cases, the illness is so mild that it goes unnoticed, and only blood tests would reveal that someone had been infected. Hepatitis A does not create a long-term carrier state and does not lead to chronic liver disease. Unlike other types of hepatitis, which can affect people of any age, hepatitis A is most common in children and young adults. ### Hepatitis B Hepatitis B has a wide range of presentations — from a silent carrier state to acute hepatitis, chronic hepatitis, severe liver scarring, and even liver cancer. It spreads primarily through blood, most often via shared needles among people who use drugs intravenously; sexual transmission is possible but far less likely. Healthcare workers — particularly surgeons, dentists, dialysis staff, and others with regular blood exposure — face a heightened risk of accidental infection. The incubation period ranges from 4–25 weeks, with an average of about 30 days. ### Hepatitis C Hepatitis C is a bloodborne virus that spreads through direct blood-to-blood contact. Whether it can also be transmitted through semen or saliva remains unclear. Once called "non-A, non-B" hepatitis, it was officially identified in 1989 when a test for antibodies to the virus became available. The most common routes of transmission include blood transfusions received before 1992, intravenous drug use, hemodialysis, tattooing, sharing razors or toothbrushes, body piercing, and cocaine snorting. Sexual intercourse is not a common mode of transmission. ### Hepatitis D Hepatitis D can only infect someone who already carries hepatitis B. ### Signs & Symptoms Hepatitis can range from a mild, flu-like illness to a serious, life-threatening liver condition. It typically progresses through several distinct stages: **Anicteric Phase** (early stage, before jaundice): - Fatigue and general malaise - Fever - Sudden aversion to cigarettes - Abnormal liver function tests **Preicteric Phase** (building toward jaundice): - Fatigue and general malaise - Enlarged, tender liver - Headache - Fever - Occasionally a patient will experience joint pain and hives **Jaundice Phase** (follows 3–10 days later): - Liver remains enlarged and tender, with a smooth edge - Mild splenomegaly is present in 15–20% of patients - Dark urine and yellowing of the skin and whites of the eyes (jaundice); jaundice worsens for 1–2 weeks and then gradually disappears during the 2–4 week recovery period; interestingly, when jaundice appears, most patients begin to feel better as the body-wide symptoms ease ### Lab Findings - AST/SGOT: 1000–3000 units (does not correlate with disease severity) - ALT/SGPT: 1000–3000 units (does not correlate with disease severity) - (+) urinary bilirubin - Differential: atypical lymphocytes - WBCs: low normal - (+) serum bilirubin (usually direct) ---
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Care planHerpes Simplex Virus (Type 1 & Type 2)Herpes is a common viral infection caused by the **herpes simplex virus (HSV)**. Depending on the type of virus involved, HSV can cause either oral herpes (cold sores) or genital herpes. **Herpes simplex virus type 1 (HSV-1) is the strain most commonly responsible for oral herpes** and spreads through contact with sores or saliva. In some cases, oral sex can transmit the virus to the genitals. **Herpes simplex virus type 2 (HSV-2) is the strain most commonly responsible for genital herpes.** It spreads through sexual contact — and importantly, it can be transmitted even when no visible sores are present. Oral herpes typically causes cold sores around the mouth or face, while genital herpes affects the genitals, buttocks, or anal area. Genital herpes is considered a sexually transmitted disease (STD). In some cases, herpes can also affect the eyes, skin, or other parts of the body. The virus can be particularly serious in newborns or in people with weakened immune systems. HSV spreads through direct contact. Some people never develop symptoms, while others develop sores near the site of infection. These sores typically progress into blisters that become itchy and painful before eventually healing. Most people experience several outbreaks per year, though outbreaks tend to become less frequent over time. ### Cold Sores | Fever Blisters Cold sores are a type of skin eruption caused by a herpes virus, characterized by clusters of small, fluid-filled blisters. The term "herpes" on its own may refer to either herpes simplex or herpes zoster. **The cold sores most people are familiar with are caused by HSV-1, which spreads primarily through oral secretions.** They most often appear around the lips and nose, though sometimes they arise without any preceding fever or illness. The blisters are self-limited, meaning they resolve on their own. **Herpes simplex infections — whether caused by HSV-1 or HSV-2 — typically produce one or more small, fluid-filled blisters surrounded by reddened skin, appearing either on the skin or mucous membranes.** These infections may occur as a first-time (primary) infection or as a recurrence triggered by reactivation of a dormant virus already in the body. **HSV-1 most commonly causes sores above the waist, while HSV-2 lesions tend to appear on or around the genitals.** Known triggers include fever, cold temperatures, ultraviolet light exposure, sunburn, skin or mucous membrane irritation, emotional stress, and nerve injury. A form known as traumatic herpes occurs when the herpes simplex virus infects skin that has already been injured, often resulting in sores at the site of trauma along with swollen nearby lymph nodes and symptoms like fever and fatigue. This type of infection has been seen in contact sports like wrestling, transmitted through mats or close physical contact. The good news: there are steps you can take to reduce inflammation, irritation, and other symptoms through a combination of home remedies, lifestyle adjustments, and targeted nutritional supplements. ---
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Care planHerpes ZosterShingles — formally called herpes zoster — is a painful condition caused by the reactivation of the varicella-zoster virus. It targets the nerve roots of the spinal cord, triggering a distinctive, blistering rash and often intense nerve pain that follows the path of the affected nerves along the skin. Shingles is caused by the varicella-zoster virus — the very same virus responsible for chickenpox. After a bout of chickenpox, the virus doesn't disappear; it quietly takes up residence in your nervous system. For years, sometimes decades, it causes no trouble. But as we age and our immune system naturally loses some of its edge, the virus can stir back to life — this time as shingles. Importantly, you cannot "catch" shingles from someone who has it. Shingles often announces itself with burning, shooting pain, or tingling and itching — typically on one side of the body or face — before any rash appears. The pain can range from mild to quite severe. Within days, fluid-filled blisters develop and may persist for 1 to 14 days. When shingles affects the face, it can occasionally impact vision or hearing. Perhaps most frustrating of all, the nerve pain can linger for weeks, months, or even years after the blisters are long gone — a condition called postherpetic neuralgia. **Source:** *NIH: National Institute of Allergy and Infectious Diseases* ---
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Care planHiatal HerniaA hiatal hernia occurs when the upper portion of your stomach pushes upward through a small opening in the diaphragm — the dome-shaped muscle that separates your chest from your abdomen. Under normal circumstances, the diaphragm acts as a natural barrier, helping to keep stomach acid where it belongs. When a hiatal hernia is present, that barrier is compromised, making it easier for acid to escape upward into the esophagus — a process known as gastroesophageal reflux disease (GERD). GERD can produce a range of uncomfortable symptoms, including: - Heartburn - Difficulty swallowing - A persistent dry cough - Bad breath Hiatal hernias are surprisingly common — particularly in adults over age 50. For many people, symptoms can be meaningfully improved through straightforward lifestyle changes: eating smaller meals, steering clear of trigger foods, quitting smoking, limiting alcohol, and maintaining a healthy weight. ---
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Care planHigh Coronary Calcium ScoreA coronary calcium scan is a specialized CT (computed tomography) scan that takes detailed pictures of your heart, specifically looking for calcium deposits in the arteries that feed it. When calcium builds up inside these arteries, it can narrow them and restrict blood flow to the heart — a process that can begin silently, long before you feel any symptoms. Catching this early is exactly what a coronary calcium scan is designed to do. Your scan results provide valuable information about your personal risk for heart attack or stroke — and can help guide decisions about whether to start, adjust, or continue treatment for coronary artery disease. You may also see this test referred to by other names: - Coronary artery calcium (CAC) test - Coronary calcium CT scan - Heart CT calcium scan ### Why Would You Need This Test? A coronary calcium scan checks for calcium buildup in the arteries that supply blood to your heart — and can help detect early coronary artery disease before it causes problems. Coronary artery disease is one of the most common heart conditions in the world. It develops when calcium, fats, and other substances gradually accumulate inside your heart's arteries, forming what's called plaque. This process unfolds slowly over many years — often with no warning signs at all. The scan uses a series of X-rays to capture images that can detect whether calcium-containing plaque is present in your arteries. Your doctor may recommend this test if: - You have a strong family history of early coronary artery disease - Your risk for heart attacks is intermediate, not low or high - Your level of risk of heart attacks is uncertain A coronary calcium scan may help: - Understand your risk of heart disease - Plan treatment if you have a low to moderate risk of heart disease, or if your heart disease risk isn't clear A coronary calcium scan is not routinely recommended as a general screening tool for people already known to be at high risk for heart attacks. It's also generally not needed if you've already had a heart attack, a coronary stent, or bypass surgery — since other tests performed during those events already provide detailed information about your heart's arteries. Talk with your healthcare team to find out whether a coronary calcium scan makes sense for you. **Source:** <https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686#:~:text=A%20score%20of%20100%20to,a%20higher%20heart%20attack%20risk.> ---
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Care planHigh Cortisol LevelsCortisol is an essential hormone with many vital jobs — chief among them, helping your body handle stress. But here's the catch: unlike most hormones that decline as we age, cortisol tends to rise over time, and that upward creep can quietly cause serious harm. Elevated cortisol has been linked to depression, Alzheimer's disease, and a range of other health problems. The good news? Emerging research on natural nutrients — including phosphatidylserine, DHEA, and ginkgo biloba — is giving us real, evidence-based tools to keep cortisol in a healthy range and protect our long-term wellbeing. Declining hormones are one of the hallmarks of growing older. Levels of DHEA, pregnenolone, and testosterone all fall significantly with age, and those shifts can have real consequences for how we feel and function. But cortisol breaks from this pattern in a troubling way. Rather than declining, cortisol — a hormone released in response to stress — tends to climb as we get older. While cortisol is genuinely necessary for survival, too much of it over time can erode mental sharpness, fuel depression, and cause the body to break down lean muscle. In extreme cases, as seen in Cushing's syndrome (a condition of severe cortisol overproduction), the effects include excess body fat, weakened bones, and profound muscle loss. Keeping cortisol within a healthy range is therefore critically important — and fortunately, phosphatidylserine, DHEA, and ginkgo biloba have each been shown to help do exactly that. --- ## Understanding Cortisol ### What Cortisol Actually Does in Your Body Cortisol is one of several hormones that work together within a finely tuned regulatory system called the **hypothalamic-pituitary-adrenal (HPA) axis**. This self-regulating network ties together the hormonal, nervous, and immune systems, continuously adjusting to both internal changes and outside pressures. It's what allows the body to adapt to a wide range of challenges — from fighting an infection to meeting a deadline. When this system malfunctions or is pushed too hard, the body bears the cost in the form of hormonal, neurological, and immune dysregulation. Here's how the stress response unfolds: when you experience stress, a brain region called the hypothalamus sends a chemical signal — corticotropin-releasing hormone — to the pituitary gland via a specialized blood vessel system. The pituitary then releases a hormone called adrenocorticotropin, or ACTH, which travels to the outer layer of the adrenal glands (sitting just above your kidneys) and triggers the production of cortisol. When ACTH surges, so does cortisol — along with related hormones called glucocorticoids. Cortisol, also known as hydrocortisone, accounts for about **95%** of total glucocorticoid activity in the body. It does a lot: it mobilizes stored fats to use as fuel, preserves blood sugar for the brain, breaks down muscle protein to supply energy and raw materials for repair, and converts fat and protein into glucose when needed. It also acts as a counterbalance to insulin and, on the non-metabolic side, helps cool inflammation, boosts blood flow, and sharpens mental focus under pressure. Cortisol's short-lived anti-inflammatory power is so potent that it was used as a treatment for arthritis when it was first introduced as a drug in the 1950s. But its downsides became clear quickly — prolonged use suppresses the immune system and causes serious complications. Once heralded as a wonder drug, cortisol-based medications are now reserved for situations where other options have failed, and even then, only for brief periods. > *"Clearly, cortisol is a double-edged sword. We cannot live without it, nor would we want to, as it helps the body adapt to stressful situations, such as illness or a deadline at work. Yet, chronic, ongoing stress results in chronic markedly elevated cortisol levels, which result in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to down-regulate inflammatory response."* Glucocorticoids touch nearly every cell, molecule, and physiological system in the human body. They play central roles in growth, reproduction, metabolism, immune and inflammatory responses, brain function, and cardiovascular health. This helps explain why chronically high cortisol is associated with so many conditions that become more common as we age: high blood pressure, poor wound healing, bone loss, muscle wasting, thinning skin, increased belly fat, insulin resistance, disrupted sleep, and depression. ### Warning Signs: Symptoms of High Cortisol / Glucocorticoid Receptor Resistance (GCR) - Feeling wired but exhausted - High blood pressure - Elevated blood sugar (hyperglycemia) - Worsening memory and concentration - Difficulty sleeping (insomnia) - Decreased sex drive - Erectile dysfunction - Weight gain and obesity - Weakened immune system ### Warning Signs: Symptoms of Adrenal Maladaptation Syndrome (Low Cortisol) - Fatigue - Worsening memory and concentration - Difficulty sleeping (insomnia) - Cravings for sugar and salt - Decreased sex drive - Low or depressed mood - Weight gain - Bone and muscle loss - Anxiety - Irritability **References:** - Ferrari E, Cravello L, Muzzoni B, et al. Age-related changes of the hypothalamic-pituitary-adrenal axis: pathophysiological correlates. *Euo J Endocrin*. 2001 Apr;144(4):319–29. - Wilmore J, Costill D. *Physiology of Sport and Exercise*. Champaign, IL: Human Kinetics; 1999. - Elmlinger MW, Dengler T, Weinstock C, Keuhnel W. Endocrine alterations in the aging male. *Clin Chem Lab Med*. 2003 Jul;41(7):934–41. - Sher L. Daily hassles, cortisol, and the pathogenesis of depression. *Med Hypotheses*. 2004;62(2):198–202. - Gold PW, Drevets WC, Charney DS. New insights into the role of cortisol and the glucocorticoid receptor in severe depression. *Biol Psychiatry*. 2002 Sep 1;52(5):381–5. - Pomara N, Greenberg WM, Branford MD, Doraiswamy PM. Therapeutic implications of HPA axis abnormalities in Alzheimer's disease: review and update. *Psychopharmacol Bull*. 2003;37(2):120–34. - *Proc Natl Acad Sci USA*. 2012 Apr 17;109(16):5995–9. PMID: 22474371. ---
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Care planHigh Female Testosterone LevelsTestosterone is often thought of as a "male hormone," but women's ovaries naturally produce it too — just in smaller amounts. Working alongside estrogen (the primary female sex hormone), testosterone plays an important role in maintaining a woman's reproductive tissues, bone strength, and overall wellbeing. According to the Mayo Clinic, the normal testosterone range for females is: | **Age (in years)** | **Testosterone Range (nanograms per deciliter)** | |---|---| | 10–11 | < 7–44 | | 12–16 | < 7–75 | | 17–18 | 20–75 | | 19+ | 8–60 | For reference, the normal range in males is considerably higher, and also varies with age: | **Age (in years)** | **Testosterone Range (nanograms per deciliter)** | |---|---| | 10–11 | < 7–130 | | 12–13 | < 7–800 | | 14 | < 7–1,200 | | 15–16 | 100–1,200 | | 17–18 | 300–1,200 | | 19+ | 240–950 | When testosterone falls out of its normal range in women, the resulting imbalance can take a real toll on both health and sex drive. ---
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Care planHigh-Sensitivity C-Reactive Protein (Hs-CRP)C-reactive protein (CRP) is a simple blood test that measures the level of a protein called C-reactive protein circulating in your bloodstream. Think of it as a thermometer for inflammation — the higher the reading, the more inflammation is present throughout your body. High-sensitivity CRP (hs-CRP) — sometimes called "Cardio-CRP" — is a more precise version of this test, fine-tuned to detect low-grade inflammation that quietly damages your arteries over time. This kind of chronic, smoldering inflammation is a key driver of atherosclerosis: it injures the artery wall, encourages the buildup of plaque, and raises your risk of dangerous blockages and blood clots. --- ## Understanding CRP and Your Heart Risk We spend a lot of time worrying about cholesterol — but did you know that another blood test may actually be an even stronger predictor of your risk of dying from a heart attack or stroke? The *American Heart Association* and *U.S. Centers for Disease Control and Prevention* have defined hs-CRP risk groups as follows: - **Low risk:** less than 1.0 mg/L - **Average risk:** 1.0 to 3.0 mg/L - **High risk:** above 3.0 mg/L Elevated hs-CRP has become one more justification doctors use to prescribe statin medications — even when cholesterol levels are perfectly normal. That's because statins don't just lower cholesterol; they also act like a powerful anti-inflammatory, quieting the fire in your arteries. Some estimates suggest that if we treated every American adult with an hs-CRP over 2.0, an additional 30–40 million people would be candidates for a statin. **But before accepting the potential side effects that come with statin drugs, it's worth knowing that there are many proven, natural strategies to bring your hs-CRP back into a healthy range.** Here are some of them. ---
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Care planHistamine Intolerance (HIT)Could certain foods be behind your troublesome symptoms? Beyond allergies and food sensitivities, histamine intolerance may be another hidden culprit driving your adverse reactions to food. Yet histamine intolerance remains widely misunderstood — and notoriously difficult to pin down with a diagnosis. ## Understanding Histamine Intolerance Histamine is a chemical messenger with a surprising number of jobs in your body. It occurs naturally in certain foods and is perhaps best known for its dramatic role in allergic and inflammatory reactions. But histamines are also produced by your own immune cells and gut bacteria — and they are genuinely fascinating. Here's the first surprise: histamines function primarily as neurotransmitters. That's right — like serotonin or dopamine, histamine is a brain chemical. In fact, antihistamines are sometimes used to treat anxiety! There are four types of histamines that we know of: - **H1 histamine** is known for its role in hives, allergies, and the sleep/wake cycle. (If an H1-blocking antihistamine ever made you drowsy, now you know why!) - **H2 histamine** triggers the release of hydrochloric acid in the stomach. (Pepcid is actually an H2-blocking antihistamine.) - **H3 histamine** behaves more like a classic neurotransmitter and is thought to be involved in OCD, sleep disorders, and ADHD. - **H4 histamine** plays a role in hives and asthma. Histamines released by mast cells are broken down — or degraded — in the nervous system and the gut. This breakdown relies on certain bacteria and two specific enzymes. The most important enzyme your body uses to clear histamine is called diamine oxidase, or DAO. So what exactly is histamine intolerance? Despite how the name sounds, it's not really about being "intolerant" of histamine itself. Rather, histamine intolerance develops when histamine accumulates in your body faster than your body can break it down. **When your body struggles to clear histamines efficiently, this is called Histamine Intolerance, or HIT.** Histamine Intolerance (HIT) is more common than most people realize. It occurs when someone cannot produce one or both of the enzymes needed to break down histamine — or when those enzymes are blocked from doing their job. For most people, circulating histamine is kept in check by the DAO enzyme. However, a small percentage of people have a DAO deficiency, meaning histamine is likely to accumulate in the body — especially after eating one or two histamine-rich meals. People with histamine intolerance often notice immune-related reactions on the skin, including rosacea (flushing and redness), acne, and eczema. These symptoms may be ongoing or may come and go as sporadic flare-ups. Diagnosing histamine intolerance through lab tests alone is genuinely challenging, because DAO production is influenced by so many other factors in the body. The most reliable way to determine whether you are truly reacting to histamines in food is through an elimination diet — typically four weeks without high-histamine foods, followed by a structured reintroduction phase. ---
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Care planHIV | AIDS**If you're living with HIV, nutrition is one of the most powerful tools at your disposal — and here's why it deserves your full attention.** HIV affects your body in multiple ways, both from the virus itself and from the medications used to treat it. You may experience significant weight loss, recurrent infections, or persistent diarrhea. A condition called **lipodystrophy** — sometimes called fat redistribution syndrome — can also change your body shape and raise your cholesterol levels. The good news: improving what you eat can meaningfully improve how you feel and how well your body functions. ## Understanding Nutrition and HIV ### Why What You Eat Matters When You Have HIV/AIDS Good nutrition offers real, tangible benefits for people living with HIV. A well-nourished body can: - Improve your overall quality of life by giving your body the nutrients it needs to thrive. - Keep your immune system as strong as possible, helping you fight off illness more effectively. - Help manage HIV-related symptoms and complications. - Process your medications more efficiently and help ease their side effects. ### The Building Blocks of Healthy Eating with HIV The same foundational principles of healthy eating that benefit everyone apply to you as well — and they're especially important when you're living with HIV. These principles include: - Building your meals around vegetables, fruits, whole grains, and legumes - Choosing lean, low-fat protein sources - Cutting back on sweets, soft drinks, and foods with added sugar - Making sure every meal and snack includes a mix of protein, carbohydrates, and a little healthy fat **Here's a closer look at each key nutrient to help you build a healthier eating plan.** - **Calories** are the units of energy your body runs on — think of them as fuel. To preserve your lean muscle mass, you may need to take in more calories than you think. Here's a helpful guide: - Consume 17 calories per pound of your body weight if you've been maintaining your weight. - Consume 20 calories per pound if you have an opportunistic infection. - Consume 25 calories per pound if you are losing weight. - **Protein** is the raw material your body uses to build and repair muscles, organs, and a resilient immune system. Here's how to make sure you're getting enough of the right kinds: - Aim for 100–150 grams a day, if you are an HIV-positive man. - Aim for 80–100 grams a day, if you are an HIV-positive woman. - If you have kidney disease, don't get more than 15%–20% of your calories from protein; too much can put stress on your kidneys. - Choose extra-lean pork or beef, skinless chicken breast, fish, and low-fat dairy products. - To sneak in extra protein, spread nut butter on fruit, vegetables, or toast; stir cheese into sauces, soups, potatoes, or steamed vegetables; or toss canned tuna into salads or casseroles. - **Carbohydrates** are your body's primary source of energy. Here's how to choose the ones that work hardest for you: - Eat five to six servings (about 3 cups) of fruits and vegetables each day. - Choose produce with a variety of colors to get the widest range of nutrients. - Choose legumes and whole grains, such as brown rice and quinoa. If you do not have a gluten sensitivity, whole-wheat flour, oats, and barley may be ok. If you do, stick with brown rice, quinoa, and potato as your starch sources. If you are diabetic, pre-diabetic, or have insulin resistance, then most of your carbohydrates should come from vegetables. - Limit simple sugars, such as candy, cake, cookies, or ice cream. - **Fat** is a concentrated source of energy — and the right kinds support your heart and brain. Here's how to strike the right balance: - Get 30% of your daily calories from fat. - Get 10% or more of your daily calories from monounsaturated fats. Examples: nuts, seeds, avocado, fish, and canola and olive oils. - Get less than 10% of your daily calories from polyunsaturated fats. Examples: corn, sunflower, soybean, and safflower oil. - Get less than 7% of your daily calories from saturated fats. Examples: fatty meat, poultry with skin, butter, whole-milk dairy foods, and coconut and palm oils. - **Vitamins and minerals** are the body's behind-the-scenes regulators — they keep your internal processes running smoothly. People living with HIV have an especially high need for these nutrients, as the body works harder to repair and rebuild damaged cells. Focus on foods rich in the following immune-supportive vitamins and minerals: - Vitamin A and beta-carotene: dark green, yellow, orange, or red vegetables and fruit; liver; whole eggs; milk - B vitamins: meat, fish, chicken, grains, nuts, white beans, avocados, broccoli, and green leafy vegetables - Vitamin C: citrus fruits - Vitamin E: green leafy vegetables, peanuts, and vegetable oils - Selenium: whole grains, nuts, poultry, fish, eggs, and peanut butter - Zinc: meat, poultry, fish, beans, peanuts, and milk and other dairy products Because it can be difficult to get sufficient amounts of every nutrient from food alone, your healthcare provider may recommend a multivitamin and mineral supplement. Always talk with your doctor about what you're taking — more isn't always better. And if you're not regularly eating at least three servings of high-calcium foods (such as green leafy vegetables or dairy) each day, a calcium supplement may also be worth discussing. ---
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Care planHives (Urticaria) and Angioedema**Hives — also known as urticaria** — is a skin reaction that causes raised, red, itchy welts (wheals or swellings) ranging in size from small spots to large blotches several inches across. Individual welts appear and fade as the reaction runs its course. **Angioedema** is a reaction similar to hives, but it goes deeper — affecting the lower layers of skin, the tissues beneath the skin, and the lining of the throat and intestines. Angioedema most often appears around the eyes, cheeks, or lips, but can also develop on the hands or feet, the genitals, or even inside the throat or bowel. Angioedema and hives can occur on their own or together at the same time. In most cases, hives and angioedema are harmless and don't leave any lasting marks — even without treatment. The most common treatment for both conditions is antihistamine medication. However, severe angioedema can be life-threatening if swelling of the throat or tongue blocks the airway and leads to loss of consciousness. --- ## Understanding Hives and Angioedema ### What Hives Look and Feel Like - Raised red or white welts (wheals or swellings) of various sizes that can cover large areas of skin - Welts that fade while new ones appear elsewhere, making it seem as if the hives are "moving" across your body - Itching, which can sometimes be intense - Rarely, a burning or stinging sensation in the affected area - Hives can be either short-term or long-lasting: acute hives last anywhere from less than one day up to six weeks; chronic hives last more than six weeks — sometimes for months or even years ### What Angioedema Looks and Feels Like - Large, thick, firm welts - Noticeable swelling of the skin - Pain or warmth in the affected areas - Difficulty breathing or swallowing, in severe cases ### What Causes Hives and Angioedema? Hives and angioedema occur when certain triggers cause specialized cells in the skin (called mast cells) to release histamine and other chemicals into the bloodstream, setting off a skin or tissue reaction. Sometimes it's impossible to pinpoint the exact cause — especially when hives or angioedema become chronic or keep coming back. **Allergic reactions are one of the most common triggers of acute hives and angioedema.** Common allergens include: - **Foods.** Many foods can trigger reactions in people with sensitivities. Shellfish, fish, peanuts, tree nuts, eggs, and milk are among the most frequent culprits. - **Medications.** Almost any medication can cause hives or angioedema. Common offenders include penicillin, aspirin, ibuprofen (Advil®, Motrin®, others), naproxen (Aleve®, others), and blood pressure medications. - **Other allergens.** Additional substances that can trigger hives and angioedema include pollen, animal dander, latex, and insect stings. **Other triggers include:** - **Environmental factors.** In some people, environmental factors can prompt the release of histamine. Examples include heat, cold, sunlight, water, pressure on the skin, emotional stress, and exercise. - **Dermatographia (also known as dermographia).** The name of this condition literally means "skin writing." When the skin is stroked or scratched, it responds by forming raised red lines in the exact pattern of the pressure applied. - Hives and angioedema can also occur in response to blood transfusions; immune system disorders such as lupus; certain cancers such as lymphoma; some thyroid conditions; and infections caused by bacteria or viruses such as hepatitis, HIV, cytomegalovirus, or Epstein-Barr virus. - **Hereditary angioedema** is a rare, inherited (genetic) form of the condition. It is linked to low levels or abnormal functioning of certain blood proteins (called C1 inhibitors) that help regulate how your immune system works. ### How to Help Prevent Hives and Angioedema To reduce your chances of experiencing hives or angioedema, consider the following steps: - **Avoid known triggers.** These may include certain foods or medications, or situations — like extreme temperatures — that have set off allergic reactions in the past. - **Keep a diary.** If you suspect foods are playing a role, keep a food diary. Be aware that certain ingredients may appear under less familiar names on product labels. ### What You Can Do at Home If you're dealing with mild hives or angioedema, these practical tips may help ease your symptoms: - Try to identify and steer clear of substances that irritate your skin or trigger an allergic reaction — these can include foods, medications, pollen, pet dander, latex, and insect stings. It's also worth ruling out food and/or chemical sensitivities associated with chronic urticaria/hives. (*Lancet* 2:41-2, 1985; *Lancet* 2:907-909, 1986; *Lancet* 2:1157-58, 1986) - Try an over-the-counter antihistamine. A nonprescription oral antihistamine, such as loratadine (Claritin®), cetirizine (Zyrtec®), or diphenhydramine (Benadryl®, others), may help relieve itching. - Apply cool, wet compresses to the affected area. Covering the skin with bandages or dressings can also help soothe irritation and discourage scratching. - Take a comfortably cool bath. To help relieve itching, add baking soda, uncooked oatmeal, or colloidal oatmeal — a finely ground oatmeal made for bathing (Aveeno®, others) — to the bath water. - Wear loose, smooth-textured cotton clothing. Avoid fabrics that are rough, tight, scratchy, or made from wool, as these can aggravate irritated skin. ---
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Care planHomocysteine (High)First identified by Kilmer McCully, M.D., as a major risk factor for vascular disease, **homocysteine** is a naturally occurring amino acid — a building block of protein — that normally circulates at low levels in your blood. When homocysteine accumulates to excess, it can damage blood vessels and has been linked to early stroke, hardening of the arteries (atherosclerosis), and coronary heart disease. It has also been associated with high blood pressure, rheumatoid arthritis, Alzheimer's disease, and depression. > *"An estimated 10–20% of all cardiovascular disease is caused by excessive plasma homocysteine concentrations."* > > — Kilmer McCully, M.D. --- ## Understanding Elevated Homocysteine ### What Is Homocysteine, and Why Does It Matter for Heart Health? Homocysteine is an amino acid that naturally circulates in your blood. When levels get too high, it raises your risk of coronary heart disease, stroke, and peripheral vascular disease — a condition where fatty deposits build up in the arteries of your legs and feet. Research suggests that excess homocysteine may fuel atherosclerosis (fatty buildup in blood vessels) by injuring the delicate inner lining of your arteries and making blood clots more likely to form. ### What Drives Homocysteine Levels Too High? Your body naturally converts homocysteine into two harmless amino acids — methionine and cysteine — with the help of folic acid, vitamin B12, and vitamin B6. This conversion depends on a finely tuned chain of steps, each powered by specialized proteins called enzymes. When your body doesn't have enough of these B vitamins, or when the enzymes involved aren't working properly, this conversion slows down — and homocysteine starts to build up in your blood to potentially harmful levels. ### Can High Homocysteine Run in Families? Yes — elevated homocysteine can have both genetic and lifestyle-related causes, ranging from mild to severe. At the severe end of the spectrum is a rare inherited condition called **homocystinuria**, in which a critical enzyme in the homocysteine breakdown pathway is missing or severely deficient. This causes homocysteine to reach dangerously high levels, and those affected may experience developmental delays, thinning bones (osteoporosis), vision problems, dangerous blood clots, and aggressive hardening of the arteries. This condition is typically diagnosed in childhood. Far more common are milder genetic variations that modestly reduce enzyme efficiency, causing a more subtle rise in homocysteine levels — a condition called **hyperhomocysteinemia**. These variations are widespread in the general population and are an important, often overlooked contributor to cardiovascular risk. ### How Do Folic Acid and B Vitamins Help Keep Homocysteine in Check? Folic acid and other B vitamins are your body's primary tools for breaking down homocysteine. Blood levels of homocysteine are strongly shaped by both what you eat and your genetics. Among dietary factors, folic acid, vitamins B-6 and B-12, and trimethylglycine/betaine (TMG) have the greatest influence. Multiple studies have shown that higher blood levels of B vitamins are associated with lower homocysteine levels — and that low folate levels are linked to a higher risk of fatal heart disease and stroke. Researchers are actively working to define exactly how much folic acid, B-6, and B-12 are needed to meaningfully lower homocysteine. In the meantime, testing homocysteine levels may be especially valuable for people with a personal or family history of heart disease who don't have the more typical risk factors — such as smoking, high cholesterol, high blood pressure, physical inactivity, obesity, or diabetes. The evidence is clear: people at elevated risk should make a conscious effort to get adequate folic acid and vitamins B-6 and B-12 through their diet — especially by eating fruits and dark, leafy green vegetables every day. ### Homocysteine Levels in the U.S. Population — Where Do You Stand? - Normal range: 4–17 micromoles/L of blood - Desirable level: 4–8 micromoles/L of blood - Low risk: < 12 micromoles/L of blood - Medium risk: 12–17 micromoles/L of blood - High risk: > 17 micromoles/L of blood (21% of population: > 16.8 HIGH RISK) **Reference:** Rimm et al., *JAMA.* 1998 Feb 4;279(5):359–64. ### What Causes Homocysteine to Rise? - Inadequate dietary folate, B12, B6, choline, or betaine (TMG) - High protein intake — methionine loading - Age — homocysteine increases with advancing age - Enzyme defects: cystathionine synthase, methyltetrahydrofolate homocysteine methyltransferase, methylenetetrahydrofolate reductase (12% homozygous in the U.K.) - Gastrointestinal disorders that reduce B12 uptake - Gastric acid inhibitors (e.g., Tagamet) that reduce availability of intrinsic factor - Renal disease ### Who Is Most at Risk for High Homocysteine? - Low fruit and vegetable diet - High protein intake - Age (over 50) - Enzyme defects (approximately 12% of population) - Hypochlorhydria - Ulcer - Use of antacids / gastric acid inhibitors - Postmenopausal - Elderly and institutionalized - High stress - Smoking - Renal disease - Hypothyroidism - Family history or personal history of: atherosclerosis, peripheral artery disease, cerebral vascular disease, Alzheimer's disease, diabetes, or high homocysteine ---
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Care planHot FlashesWhile menopause is a natural chapter in every woman's life, you have more power over your symptoms than you might think. How often hot flashes strike — and how intense they feel — can be shaped by the everyday choices you make: what you eat and drink, what you wear, and how you handle stress. These lifestyle factors can either ease your symptoms or make them worse. That's why any truly effective approach to menopause relief goes beyond medication and includes practical, empowering changes to the parts of your life you can actually control. **Here are some practical strategies to help you manage hot flashes and other common menopausal symptoms — including mood swings, low mood, and trouble sleeping.** ---
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Care planHuman Growth Hormone (hGH) ProductionSimple lifestyle changes — like cutting back on sugar, moving your body regularly, and adding targeted supplements — may naturally help your body produce more human growth hormone. Human growth hormone (hGH) is a vital hormone made by your pituitary gland — a pea-sized structure nestled at the base of your brain. Also called growth hormone (GH), it's best known for driving growth in children, but its role doesn't stop there. Throughout life, hGH helps regulate your metabolism, supports muscle development, and helps maintain a lean, healthy body composition. When hGH levels fall below normal, you may notice a decline in your quality of life, a greater susceptibility to illness, and a tendency to accumulate body fat. That said, it's important to know that using growth hormone replacement therapy simply to counter the normal physical changes that come with aging is not recommended, as it may raise the risk of certain cancers and other serious conditions. If you think your growth hormone levels might be low, a doctor can evaluate you using specific tests — including the insulin tolerance test, the GHRH-arginine stimulation test, or the glucagon stimulation test — to determine whether a true deficiency exists. While growth hormone deficiency — which is often rooted in genetic conditions or other underlying health issues — requires medical treatment, adopting evidence-informed changes to your diet and daily habits, under the guidance of a qualified healthcare provider, may help keep your hGH levels in a healthy range. ---
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Care planHuman Papillomavirus (HPV) InfectionHPV (human papillomavirus) is a viral infection that can cause growths on the skin or mucous membranes — most commonly recognized as warts. With over 100 known varieties, HPV is one of the most widespread infections in the world. Some strains cause warts; others are linked to certain cancers. Most HPV infections clear on their own and never develop into cancer. However, certain strains of genital HPV can lead to cervical cancer — a cancer affecting the lower portion of the uterus where it connects to the vagina. HPV has also been linked to cancers of the anus, penis, vagina, vulva, and throat (oropharynx). HPV spreads most often through sexual activity or skin-to-skin contact. Fortunately, vaccines are available that protect against the strains most responsible for genital warts and cervical cancer. ## Understanding HPV ### Recognizing the Signs In most cases, your immune system clears an HPV infection before warts ever develop. When warts do appear, their look and feel depend on which strain of HPV is involved: - **Genital warts.** These may show up as flat patches, small cauliflower-like clusters, or tiny stem-like projections. In women, they most often appear on the vulva, but can also occur near the anus, on the cervix, or inside the vagina. In men, they tend to appear on the penis, scrotum, or around the anus. Genital warts rarely cause significant discomfort or pain, though they may itch or feel sensitive. - **Common warts.** These appear as rough, raised bumps and most often show up on the hands and fingers. While usually harmless, they can be unsightly and occasionally painful, and may bleed if injured. - **Plantar warts.** These are hard, grainy growths that typically develop on the heels or balls of your feet and can cause discomfort when walking. - **Flat warts.** These are slightly raised, flat-topped lesions that can appear almost anywhere on the body. Children tend to get them on the face; men often get them in the beard area; women tend to develop them on the legs. ### HPV and Cervical Cancer: What You Need to Know Nearly all cervical cancers are caused by HPV, yet cervical cancer can take 20 years or more to develop after an initial infection. To make things more complicated, neither the HPV infection itself nor early-stage cervical cancer typically causes any noticeable symptoms. This is why vaccination is your strongest defense — and why regular screening is so critical. Since early cervical cancer is essentially silent, routine screening tests are essential for catching precancerous changes before they progress. Current guidelines recommend that women ages 21 to 29 have a Pap test every three years. Women ages 30 to 65 should continue with a Pap test every three years, or every five years if they also receive an HPV DNA test at the same time. Women over 65 may stop routine testing if they have had three consecutive normal Pap tests, or two combined HPV DNA and Pap tests with no abnormal results. ### How HPV Spreads HPV enters the body through a cut, abrasion, or tiny tear in the skin and is transmitted primarily through direct skin-to-skin contact. Genital HPV infections are typically acquired through vaginal intercourse, anal sex, or other skin-to-skin contact in the genital area. Some HPV infections that produce lesions in the mouth or upper airway are contracted through oral sex. If you are pregnant and have an active HPV infection with genital warts, there is a small chance your baby could contract the virus during delivery — and in rare cases, it may cause a noncancerous growth in the baby's voice box (larynx). Warts are contagious. They can spread through direct contact with a wart or by touching a surface that has been in contact with one. ### Who Is at Greater Risk? HPV is extremely common, and virtually anyone who is sexually active is at some degree of risk. Specific factors that increase that risk include: - **Number of sexual partners.** The more sexual partners you have, the greater your likelihood of contracting a genital HPV infection. Having a partner who has had multiple sexual partners also raises your risk. - **Age.** Common warts occur most often in children. Genital warts are most prevalent in adolescents and young adults. - **A weakened immune system.** People with compromised immune systems — whether from HIV/AIDS or from immunosuppressive medications used after organ transplants — face a higher risk of HPV infection. - **Damaged or broken skin.** Areas of skin that have been cut or punctured are more susceptible to developing common warts. - **Exposure through contact.** Touching someone's warts, or coming into contact with surfaces exposed to HPV — such as in public showers or swimming pools — without adequate protection may raise your risk. ### Possible Complications - Lesions in the mouth and upper airway. Some HPV infections cause lesions on the tongue, tonsils, soft palate, or within the larynx and nasal passages. - Cancer. Certain strains of HPV are capable of causing cervical cancer and may also contribute to cancers of the genitals, anus, mouth, and upper respiratory tract. ### Reducing Your Risk **Common warts** Completely preventing HPV infections that cause common warts is difficult, but you can limit their spread. Avoid picking at existing warts and refrain from biting your nails, as these habits can facilitate the spread of the virus to new areas. **Plantar warts** To lower your risk of picking up the HPV strains that cause plantar warts, make a habit of wearing shoes or sandals in public pool areas and locker rooms. **Genital warts** You can meaningfully reduce your risk of developing genital warts and other HPV-related genital lesions by: - Being in a mutually monogamous sexual relationship - Reducing your number of sex partners - Using a latex condom, which can reduce your risk of HPV transmission ### Getting a Diagnosis Your doctor may be able to identify an HPV infection simply by examining visible warts. If genital warts are not visible, one or more of the following tests may be recommended: - **Vinegar (acetic acid) solution test.** When a vinegar solution is applied to HPV-infected genital tissue, the affected areas turn white — making it easier to identify flat lesions that might otherwise be difficult to see. - **Pap test.** Your doctor collects a sample of cells from your cervix or vagina to send for laboratory analysis. Pap tests can reveal abnormalities that can lead to cancer. - **DNA test.** This test, conducted on cells from your cervix, can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers. It's recommended for women 30 and older in addition to the Pap test. ### Treatment Options Warts often resolve on their own — especially in children — without any intervention. That said, there is no cure for the HPV virus itself, meaning warts can return in the same location or appear elsewhere. **Medications** Wart-targeting medications are typically applied directly to the affected area and often require multiple treatments before they are fully effective. Common options include: - **Salicylic acid.** Available over the counter, salicylic acid works by gradually dissolving the layers of a wart. It is intended for use on common warts and may cause skin irritation; it should not be used on the face. - **Imiquimod.** This prescription cream works by boosting your immune system's ability to fight HPV. Common side effects include redness and swelling at the application site. - **Podofilox.** Another topical prescription option, podofilox works by breaking down genital wart tissue. It may cause burning and itching where applied. - **Trichloroacetic acid.** This chemical treatment burns off warts on the palms, soles of the feet, and genitals, and may cause localized irritation. **Procedures for Wart Removal** If medications are not effective, your doctor may recommend removing warts through one of these methods: - Freezing with liquid nitrogen (cryotherapy) - Burning with an electrical current (electrocautery) - Surgical removal - Laser surgery **Treating HPV-Related Cervical Changes** If your HPV or Pap test results are abnormal, your gynecologist will likely perform a procedure called a colposcopy. Using a specialized magnifying instrument called a colposcope, your doctor will take a close look at your cervix and collect small tissue samples (a biopsy) from any areas that appear abnormal. Precancerous lesions on the cervix need to be removed. Several approaches are available, including freezing (cryosurgery), laser treatment, surgical removal, loop electrosurgical excision procedure (LEEP), and cold knife conization. LEEP uses a thin, electrically charged wire loop to remove a thin layer of cervical tissue, while cold knife conization is a surgical procedure that removes a cone-shaped piece of the cervix. **References:** 1. Jameson JL, et al., eds. Human papillomavirus infections. In: *Harrison's Principles of Internal Medicine*. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2018. <https://accessmedicine.mhmedical.com> 2. Bennett JE, et al., eds. Papillomaviruses. In: *Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases*. 8th ed. Philadelphia, Pa.: Elsevier; 2015. <https://www.clinicalkey.com> 3. Warts. *American Academy of Dermatology*. <https://www.aad.org/public/diseases/contagious-skin-diseases/warts> 4. AskMayoExpert. Human papillomavirus (HPV) vaccination. Rochester, Minn.: *Mayo Foundation for Medical Education and Research*; 2018. 5. Human papillomavirus (HPV) questions and answers. Centers for Disease Control and Prevention. <https://www.cdc.gov/hpv/parents/questions-answers.html> 6. AskMayoExpert. Anogenital warts. Rochester, Minn.: *Mayo Foundation for Medical Education and Research*; 2018. 7. Human papillomavirus (HPV) and cervical cancer. *World Health Organization.* <https://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer> 8. Palefsky JM. Human papillomavirus infections: Epidemiology and disease associations. <https://www.uptodate.com/contents/search> 9. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. U.S. Food and Drug Administration. <https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm622715.htm> 10. Frequently asked questions. Gynecological problems FAQ 187. Abnormal cervical cancer screening test results. *American College of Obstetricians and Gynecologists*. <https://www.acog.org/Patients/FAQs/Abnormal-Cervical-Cancer-Screening-Test-Results> 11. Meites E, et al. Human papillomavirus vaccination for adults: Updated recommendations of the Advisory Committee on Immunization Practices. *MMWR Morbidity and Mortality Weekly Report*. 2019; doi:10.15585/mmwr.mm6832a3. **Source:** <https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596> ---
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Care planHuntington’s DiseaseHuntington's disease (HD) is an inherited condition in which nerve cells in the brain progressively break down and die. This degeneration has a wide-reaching impact on a person's ability to function — typically affecting movement, thinking (cognition), and mental health. Most people begin noticing signs of Huntington's disease in their 30s or 40s, though the disease can appear earlier or later in life. When Huntington's disease appears before age 20, it is called juvenile Huntington's disease. In younger patients, symptoms may look somewhat different and tend to progress more quickly. While medications can help manage symptoms, no current treatment can stop or reverse the physical, mental, and behavioral decline that Huntington's disease causes over time. ## Understanding Huntington's Disease Huntington's disease typically causes a broad range of movement, cognitive, and psychiatric symptoms. Which symptoms appear first — and which become most disabling — varies widely from person to person. ### Movement Symptoms HD can affect both involuntary and voluntary movement, including: - Involuntary jerking or writhing movements (chorea) - Muscle stiffness or abnormal sustained muscle contractions (dystonia) - Slow or abnormal eye movements - Problems with walking, posture, and balance - Difficulty speaking clearly or swallowing Importantly, it is often the loss of deliberate, controlled movement — not the involuntary movements — that most affects a person's ability to work, carry out daily tasks, communicate, and stay independent. ### Cognitive Symptoms HD can also impair thinking and mental processing. Common cognitive changes include: - Difficulty organizing, prioritizing, or staying focused on tasks - Getting "stuck" on a thought, behavior, or action and having trouble moving on (perseveration) - Poor impulse control, which may lead to emotional outbursts, impulsive decisions, or changes in sexual behavior - Limited awareness of one's own behaviors or abilities - Slowed thinking or difficulty finding the right words - Trouble learning and retaining new information ### Mental Health Symptoms Depression is the most common psychiatric condition seen in Huntington's disease — and importantly, it is not simply a reaction to receiving a difficult diagnosis. Rather, it appears to stem from actual changes in brain structure and function caused by the disease itself. Signs may include: - Feelings of irritability, sadness, or emotional numbness (apathy) - Withdrawing from friends, family, and social activities - Insomnia - Fatigue and loss of energy - Frequent thoughts of death, dying, or suicide Other psychiatric conditions that may occur alongside HD include: - Obsessive-compulsive disorder — a condition marked by recurrent, intrusive thoughts and repetitive behaviors - Mania, which can cause elevated mood, overactivity, impulsive behavior, and inflated self-esteem - Bipolar disorder — a condition with alternating episodes of depression and mania In addition to the above symptoms, weight loss is common in people with Huntington's disease — and tends to worsen as the disease progresses. ### Symptoms of Juvenile Huntington's Disease In children and adolescents, HD may look and progress differently than it does in adults. Early signs often include: **Changes in Behavior** - Loss of previously learned academic or physical skills - Rapid, significant drop in overall school performance - Behavioral problems **Changes in Physical Function** - Contracted and rigid muscles that affect gait (especially in young children) - Changes in fine motor skills that might be noticeable in skills such as handwriting - Tremors or slight involuntary movements - Seizures ### When Should You See a Doctor? If you notice changes in your movements, emotional state, or mental ability — especially with a known family history of HD — it's important to see your doctor promptly. Many of these signs and symptoms can have other causes, and a thorough evaluation is the first step toward answers and appropriate care. ### What Causes Huntington's Disease? HD is caused by an inherited defect in a single gene. It follows what is called an autosomal dominant pattern of inheritance, meaning that inheriting just one copy of the faulty gene is enough to cause the disease. Each person inherits two copies of most genes — one from each parent. If a parent carries the defective HD gene, there is a 50 percent chance with each pregnancy that the child will inherit it. This applies equally to every child in the family. ### How Does Huntington's Disease Progress Over Time? After symptoms begin, a person's abilities gradually decline over time. The speed of progression varies, but the time from symptom onset to death is typically about 10 to 30 years. In juvenile HD, the course is usually shorter — often within 10 years of symptom onset. Depression associated with HD can raise the risk of suicide. Research suggests this risk may be highest before a formal diagnosis is made and during the middle stages of the disease, when a person begins losing independence. As the disease advances, a person will eventually need help with all activities of daily living. In the later stages, they will likely be confined to bed and unable to speak — but they can generally still understand language and recognize the people they love. **The most common causes of death in HD include:** - Pneumonia or other infections - Injuries related to falls - Complications related to the inability to swallow ### Can Huntington's Disease Be Prevented? People with a known family history of HD often face difficult questions about whether they might pass the gene to their children. Genetic testing and family planning options are available and worth discussing with a specialist. For those at risk who are considering genetic testing, meeting with a genetic counselor first can be invaluable. A genetic counselor can walk you through what a positive result would mean — namely, that you will develop HD — and help you think through your options for having children, including prenatal genetic testing or in vitro fertilization (IVF) using donor sperm or eggs. Another option is IVF with preimplantation genetic diagnosis (PGD). In this approach, eggs are retrieved from the ovaries and fertilized with the father's sperm in a laboratory setting. The resulting embryos are tested for the HD gene, and only those that test negative are transferred to the mother's uterus. **Source:** <https://www.mayoclinic.org/diseases-conditions/huntingtons-disease/symptoms-causes/syc-20356117> ---
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Care planHyperemesis GravidarumNausea during pregnancy — commonly called morning sickness — is something most women experience at some point. While it can feel miserable in the moment, it's generally not dangerous and tends to resolve on its own by around 12 weeks. **Hyperemesis gravidarum (HG)** is a far more serious condition — an extreme version of morning sickness marked by severe, relentless nausea and vomiting throughout pregnancy. --- ## Understanding Morning Sickness and Hyperemesis Gravidarum ### Morning Sickness vs. Hyperemesis Gravidarum: What's the Difference? Though they may sound similar, morning sickness and HG are two very distinct conditions — with different risks, complications, and impacts on your daily life. Telling them apart matters, because the right treatment depends on knowing which one you're dealing with. **Morning sickness** typically means nausea, sometimes paired with vomiting — both of which usually fade by 12 to 14 weeks. The vomiting, while unpleasant, doesn't lead to serious dehydration. Symptoms generally begin in the first month of pregnancy and resolve by the third or fourth month. You may feel tired and notice a slight dip in your appetite, and some daily activities may feel harder than usual — but most women can still manage their routines. **Hyperemesis gravidarum** is a different story. It involves nausea that simply doesn't let up, along with vomiting so severe that you can't keep any food or fluids down — leading to dangerous dehydration. Symptoms typically appear within the first six weeks of pregnancy. Unlike morning sickness, the nausea rarely eases on its own. HG can be completely debilitating, with fatigue that drags on for weeks or even months. According to the HER Foundation, women with HG may lose their appetite entirely and find themselves unable to work or carry out even basic daily activities. Left unmanaged, HG can lead to dehydration and inadequate weight gain during pregnancy. While there's no proven way to prevent either condition, there are effective ways to manage the symptoms and protect your health. **A side-by-side look — morning sickness vs. hyperemesis gravidarum:** | **Morning Sickness** | **Hyperemesis Gravidarum** | |---|---| | Nausea sometimes accompanied by vomiting | Nausea accompanied by severe vomiting | | Nausea that subsides at 12 weeks or soon after | Nausea that does not subside | | Vomiting that does not cause severe dehydration | Vomiting that causes severe dehydration | | Vomiting that allows you to keep some food down | Vomiting that does not allow you to keep any food down | ### What Does Hyperemesis Gravidarum Actually Feel Like? HG usually begins in the first trimester. The good news: fewer than half of women with HG experience symptoms throughout their entire pregnancy, according to the HER Foundation. **The most common signs of HG include:** - Nearly constant nausea that doesn't let up - Complete loss of appetite - Vomiting more than three or four times per day - Becoming dehydrated - Feeling light-headed or dizzy - Losing more than 10 pounds or 5 percent of your body weight due to nausea or vomiting ### What Causes Hyperemesis Gravidarum? Some degree of nausea and vomiting is nearly universal in pregnancy. And despite being called "morning" sickness, these symptoms can strike at any hour of the day or night. Both morning sickness and HG appear to be connected to human chorionic gonadotropin (hCG) — a hormone produced by the placenta during pregnancy. Your body ramps up production of hCG very quickly in early pregnancy, and levels can continue climbing throughout the months that follow. ### Who Is Most Likely to Develop Hyperemesis Gravidarum? Certain factors may raise your risk of developing HG, including: - A family history of HG - Carrying more than one baby - Being overweight - Being pregnant for the first time A condition called trophoblastic disease — which involves abnormal cell growth inside the uterus — can also trigger HG. ### How Is Hyperemesis Gravidarum Diagnosed? Your doctor will begin by reviewing your medical history and symptoms. In most cases, a standard physical exam is sufficient to make the diagnosis. Your doctor will look for telltale signs of HG, such as low blood pressure or a rapid pulse. Blood and urine tests may be ordered to check for dehydration. Additional tests may also be recommended to rule out gastrointestinal conditions as the source of your nausea or vomiting. An ultrasound may be needed to check whether you're carrying twins or to identify any other concerns. This painless test uses sound waves to create a picture of what's happening inside your body. ### How Is Hyperemesis Gravidarum Treated? Treatment is tailored to how severe your symptoms are. For milder cases, your doctor may suggest natural remedies like vitamin B-6 or ginger. Eating smaller, more frequent meals and sticking to dry foods like crackers can also help. Staying well hydrated by drinking plenty of fluids is essential. In more severe cases, hospitalization may be necessary. When you can't keep anything down due to persistent nausea or vomiting, fluids and nutrients may need to be delivered directly through an IV. When vomiting poses a risk to you or your baby, medication becomes necessary. The most commonly used anti-nausea medications are promethazine and meclizine, both of which can be given via IV or suppository. While taking medication during pregnancy carries some potential risks to the baby, severe maternal dehydration from untreated HG is an even greater concern. Always talk with your doctor about the risks and benefits of any treatment option. ### What Can You Expect in the Long Run? Here's the reassuring news: HG symptoms resolve after delivery. That said, postpartum recovery may take a bit longer for women who experienced HG during pregnancy. Don't go through this alone. Talk openly with your doctor, seek out educational resources, and connect with support groups to help you and your loved ones navigate HG. Communicating honestly with both your medical team and your personal support network makes a real difference. **Sources:** - <https://www.healthline.com/health/hyperemesis-gravidarum#outlook> - <https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/hyperemesis-gravidarum-880/> **References:** - About hyperemesis gravidarum. (2013). <helpher.org/hyperemesis-gravidarum/> - hCG levels. (2017). <pregnancybirthbaby.org.au/hcg-levels> - Hyperemesis gravidarum (severe nausea and vomiting during pregnancy). (2016). <my.clevelandclinic.org/health/diseases_conditions/hic_Am_I_Pregnant/hic_Premature_Labor/hic_Hyperemesis_Gravidarum_Severe_Nausea_and_Vomiting_During_Pregnancy> - Severe morning sickness (hyperemesis gravidarum). (2014). <kidshealth.org/en/parents/hyperemesis-gravidarum.html> ### A Silver Lining: Nausea May Actually Be a Good Sign Nausea alone or with vomiting was associated with a 50% to 75% reduction in the risk for pregnancy loss, according to a secondary analysis of a prospective preconception cohort study. > *"The findings may provide reassurance to women experiencing these difficult symptoms in pregnancy,"* writes Stefanie N. Hinkle, PhD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, and colleagues. > > **Reference:** *JAMA Internal Medicine*, published online September 26, 2016. ---
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Care planHyperhidrosis**Hyperhidrosis** is a medical condition in which the body sweats far more than it needs to — often with no connection to heat or physical activity. The sweating can be intense enough to soak through clothing or drip from your hands. Beyond the physical discomfort, excessive sweating can take a real toll on your confidence and daily life, leading to social anxiety and embarrassment. Hyperhidrosis most commonly affects the armpits, hands (palms), and feet. At its root, the problem lies with overactive sweat glands that signal the body to produce far more sweat than is necessary. There are two basic types of excessive sweating: ### Localized Sweating: Primary Focal Hyperhidrosis The most common form of excessive sweating is called primary focal hyperhidrosis. It affects approximately 1% to 3% of people and typically begins during childhood or adolescence. **Primary focal hyperhidrosis does not cause illness.** Put simply, the body just sweats too much. While it is a recognized medical condition, it is not a sign of an underlying disease or a medication side effect. People who have it are otherwise in good health. The symptoms of primary focal hyperhidrosis are fairly characteristic. It's called "focal" or "localized" because it targets specific areas of the body — such as the underarms, groin, head, face, hands, or feet. The sweating also tends to be symmetrical, meaning it affects both sides of the body equally. **Why does it happen?** The honest answer is that experts aren't entirely sure, but primary focal hyperhidrosis appears to stem from a minor glitch in the nervous system. There is also some evidence suggesting it may run in families. While primary focal hyperhidrosis is not medically dangerous, it can significantly affect your quality of life. "Primary focal hyperhidrosis can really interfere with your quality of life," Glaser says. For some people, excessive sweating is merely an inconvenience. For others, the embarrassment becomes severe enough to limit their social interactions and professional life in meaningful and harmful ways. ### Generalized Sweating: Secondary General Hyperhidrosis This less common form of hyperhidrosis causes sweating across the entire body — not just the hands or feet. Secondary general hyperhidrosis is also more medically significant. It's called "secondary" because it is driven by an underlying cause, such as another health condition. One telling sign of secondary hyperhidrosis is excessive, generalized sweating at night. **What can trigger secondary general hyperhidrosis?** There are many possible causes, spanning a range of medical conditions and diseases. They include: - Menopause - Pregnancy - Thyroid problems - Diabetes - Alcoholism - Infectious diseases like tuberculosis - Parkinson's disease - Rheumatoid arthritis - Stroke - Heart failure - Cancers like leukemia and lymphoma ### What About Anxiety? People who are anxious — or who have a diagnosed anxiety disorder — may sweat more than others. However, experts are clear that anxiety-related sweating is not the same thing as hyperhidrosis. In some people, though, both conditions can be present at the same time. ### Medications That Can Also Cause Generalized Excessive Sweating Include: - Some psychiatric drugs - Some blood pressure medications - Some medicines for dry mouth - Some antibiotics - Some supplements ### Conventional Treatments for Excessive Sweating: - **Antiperspirants.** Specially formulated over-the-counter or prescription sprays, lotions, and roll-ons can help keep symptoms under control. - **Iontophoresis.** This treatment uses gentle, low-level electrical impulses to temporarily dial down the activity of the sweat glands. - **Medications.** Certain drugs can prevent the sweat glands from becoming overactive. - **Botox.** Botox injections can temporarily block the nerve signals that trigger excessive sweating. This treatment is FDA-approved for excessive underarm sweating. - **Surgery.** One surgical option involves severing a nerve in the chest that triggers excessive sweating. Another approach is to surgically remove some of the sweat glands directly. ### When to See a Doctor About Excessive Sweating: - **Night sweats:** if you are waking up drenched or finding your pillowcase and sheets damp in the morning. - **Generalized sweating:** if you are sweating all over your body, rather than only from typical areas like the head, face, underarms, groin, hands, or feet. - **Asymmetrical sweating:** if the sweating is occurring on only one side of your body — for example, only one armpit. - **Sudden changes:** if your sweating has abruptly worsened without a clear explanation. - **Late onset:** if excessive sweating first appears in middle age or later. The more common primary focal hyperhidrosis typically begins in teenagers and young adults. - **Sweating after a medication change:** if your excessive sweating began shortly after starting a new drug. - **Sweating accompanied by other symptoms,** such as fatigue, insomnia, increased thirst, increased urination, or persistent cough. **Source:** <https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/symptoms-causes/syc-20367152> ---
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Care planHypertensionBlood pressure consistently higher than 140/90 mm Hg. > ⚠️ **IMPORTANT NOTE:** A **Hypertensive Crisis** (>150 mm Hg), or any blood pressure elevation accompanied by symptoms such as headache, vision changes, or unusual drowsiness, requires immediate emergency care. High blood pressure — or hypertension — is one of the most common health conditions in the world. It develops when the force of blood pushing against your artery walls remains persistently elevated, silently setting the stage for serious problems like heart disease. Think of your blood pressure as the result of two forces working together: how hard your heart is pumping, and how much resistance your arteries are putting up. The harder your heart works and the narrower your arteries, the higher your blood pressure climbs. What makes hypertension particularly dangerous is that it can go undetected for years — no pain, no warning signs — all while quietly damaging your blood vessels and heart. Left uncontrolled, it dramatically raises your risk of heart attack and stroke. ## Understanding High Blood Pressure ### Recognizing the Signs (or Lack Thereof) Here's the unsettling truth about high blood pressure: most people have absolutely no idea they have it. Even when readings reach dangerously high levels, there are often no symptoms at all. Some people do experience headaches, shortness of breath, or nosebleeds — but these are not reliable warning signs. They tend to show up only when blood pressure has reached a severe or life-threatening stage. The good news? High blood pressure is easy to detect with a simple measurement. And once you know you have it, you and your practitioner can take meaningful steps to bring it under control — before it causes lasting damage. ### Understanding Your Top Number: Systolic Blood Pressure Every time your heart beats, it contracts and sends a surge of blood through your arteries to the rest of your body. The pressure generated by that surge is your **systolic blood pressure** — the first, or top, number in your reading. Here's what your systolic number is telling you: - **Normal:** Below 120 - **Elevated:** 120–129 - **Stage 1 hypertension:** 130–139 - **Stage 2 hypertension:** 140 or more - **Hypertensive crisis:** 180 or more. Call 911. ### Understanding Your Bottom Number: Diastolic Blood Pressure Between heartbeats, your heart relaxes and refills with blood — and the pressure in your arteries during that resting phase is your **diastolic blood pressure**, the second, or bottom, number in your reading. Here's what your diastolic number means: - **Normal:** Lower than 80 - **Stage 1 hypertension:** 80–89 - **Stage 2 hypertension:** 90 or more - **Hypertensive crisis:** 120 or more. Call 911. Keep in mind: even if your bottom number is normal (lower than 80), a systolic reading between 120–129 still puts you in the "elevated" category — and warrants attention. ### What Causes High Blood Pressure? There are two distinct types of high blood pressure, each with a different origin story. **Primary (essential) hypertension** In most adults, no single cause can be identified. This form — called primary or essential hypertension — tends to develop slowly and silently over many years, the result of a combination of genetics, lifestyle, and aging. **Secondary hypertension** In some people, high blood pressure is driven by an identifiable underlying condition. This type — called secondary hypertension — tends to appear more suddenly and push blood pressure even higher than primary hypertension does. Conditions and medications that can trigger secondary hypertension include: - Obstructive sleep apnea - Kidney problems - Adrenal gland tumors - Thyroid problems - Certain defects you're born with (congenital) in blood vessels - Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs* - Illegal drugs, such as cocaine and amphetamines **\*A critical note about prescription medications: Nearly one out of five American adults with hypertension is taking a prescription drug known to raise blood pressure,** according to an analysis of more than 27,000 participants from the National Health and Nutrition Examination Survey (NHANES, 2021). Among adults with hypertension in this group, 18.5% were using a blood pressure-raising prescription drug. The most commonly used category was antidepressants (8.7%), followed by nonsteroidal anti-inflammatory drugs or NSAIDs (6.5%), steroids (1.9%), estrogens (1.7%), and several other agents each used by fewer than 1% of participants — as reported by John Vitarello, MD, at the annual scientific sessions of the American College of Cardiology. **Chemical substances and medicines that can cause high blood pressure include:** - Acetaminophen - Alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine - Angiogenesis inhibitors (including tyrosine kinase inhibitors and monoclonal antibodies) - Antidepressants (including venlafaxine, bupropion, and desipramine) **Source:** <https://medlineplus.gov/ency/article/000155.htm> ### Who Is Most at Risk? High blood pressure doesn't discriminate, but certain factors make it more likely to develop: - **Age.** The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65. - **Race.** High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, are also more common in people of African heritage. - **Family history.** High blood pressure tends to run in families. - **Being overweight or obese.** The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls. - **Not being physically active.** People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. - **Using tobacco.** Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk. - **Too much salt (sodium) in your diet.** Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure. - **Too little potassium in your diet.** Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood. - **Drinking too much alcohol.** Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. - **Stress.** High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco, or drinking alcohol, you may only increase problems with high blood pressure. - **Certain chronic conditions.** Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes, and sleep apnea. - Sometimes **pregnancy** contributes to high blood pressure, as well. Although high blood pressure is most common in adults, children are not immune. For some kids, it stems from underlying heart or kidney problems. But for a growing number, it's driven by lifestyle: poor diet, excess weight, and too little physical activity. ### The Surprising Role of Carbon Dioxide (CO2) in Blood Pressure Carbon dioxide (CO2) does far more than just leave your body when you exhale. It actually plays an active role in energy production — improving how efficiently oxygen is delivered into your cells — and helps protect against a damaging process called lipid peroxidation. Think of CO2 and lactate as opposing forces. Lactate is produced when your body breaks down glucose without oxygen — an inefficient backup process. Where lactate causes harm, CO2 provides protection. Elevated lactate is a recurring theme in conditions like diabetes, Alzheimer's disease, heart failure, shock, and general aging. It fans the flames of inflammation and undermines the energy-producing structures inside your cells (mitochondria). On the flip side, low CO2 levels have been linked to epileptic seizures, muscle spasms, inflammation, hypothyroidism, stroke, and clotting disorders. Interestingly, all of these problems — whether driven by excess lactate or insufficient CO2 — may respond to CO2-based therapies. These include CO2 baths (where carbon dioxide is pumped into the tub, creating an effect similar to bathing in naturally carbonated mineral water) or incorporating CO2 into standard hyperbaric oxygen treatments. Simpler, everyday ways to gently raise your body's CO2 levels include breathing into a paper bag, ensuring adequate calcium intake, and using salt, baking soda, or carbonated beverages in moderation. **A Simple Biohack to Naturally Boost CO2** According to Forbes Health, biohacking is "a term used to describe various tips and tricks for enhancing the body's ability to function at peak performance — and maybe even extend one's lifespan." **One surprisingly simple biohack for raising CO2 — mimicking the effect of being at higher altitude — is to breathe slowly into a paper lunch bag for a minute or two.** Choose a bag that isn't too small or too large (an ideal size is 6 inches by 15 inches, or 15 centimeters by 38 centimeters). Cover both your mouth and nose and breathe gently until you feel more settled. Each time you exhale, you release carbon dioxide. By rebreathing the air inside the bag, you gradually raise your body's CO2 level. According to Dr. Ray Peat, practicing this technique a few times a day has been shown to bring blood pressure down by as much as 30 points — and keep it there after just a few days of consistent practice. **Sources and References:** 1. [Umzu. Who Is Ray Peat?](https://www.umzu.com/articles/who-is-ray-peat) 2. [Conscious Breathing Carbon Dioxide, Physiology](https://www.consciousbreathing.com/science/yandell-henderson-carbon-dioxide/) 3. [Ray Peat, Mitochondria and Mortality](https://raypeat.com/articles/articles/mitochondria-mortality.shtml) 4. [Skool.com Ray Peat Simplified](https://www.skool.com/righteousness/mitochondria-and-mortality-simplified-ray-peat) 5. [Functional Performance Systems CO2 v. Lactic Acid](https://www.functionalps.com/blog/2012/11/06/comparison-carbon-dioxide-v-lactic-acid/) 6. [Ray Peat, Protective CO2 and Aging](https://raypeat.com/articles/articles/co2.shtml) 7. [StatPearls Biochemistry, Electron Transport Chain](https://www.ncbi.nlm.nih.gov/books/NBK526105/) 8. [Ray Peat, Mitochondria and Mortality](https://raypeat.com/articles/articles/mitochondria-mortality.shtml) 9. [Ray Peat Forum May 29, 2017](https://raypeatforum.com/community/threads/carbon-dioxide-carbs-vs-fat-oxidation.17568/) 10. [Toxicological Research March 2011; 27(1): 1–6](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834518/#:~:text=Lipid%20peroxidation%20is%20a%20free,products%20formed%20during%20the%20process) 11. [Science Direct Lipid Peroxide](https://www.sciencedirect.com/topics/medicine-and-dentistry/lipid-peroxide) 12. [Toxicological Research March 2011; 27(1): 1–6](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834518/#:~:text=Lipid%20peroxidation%20is%20a%20free,products%20formed%20during%20the%20process) 13. [Stroke October 1, 1999; 30: 2033–2037](https://www.ahajournals.org/doi/10.1161/01.str.30.10.2033) 14. [Conscious Breathing Carbon Dioxide](https://www.consciousbreathing.com/science/yandell-henderson-carbon-dioxide/) 15. [Geoengineering Watch](https://www.geoengineeringwatch.org/) 16. [Patreon Adapt2030](https://www.patreon.com/adapt2030) 17. [YouTube Adapt2030](https://www.youtube.com/user/MyanmarLiving) ### Why Uncontrolled Blood Pressure Is So Dangerous When blood pressure remains high over time, it places relentless strain on your artery walls — and that strain takes a toll on nearly every organ in your body. The higher the pressure and the longer it goes unaddressed, the greater the damage. Uncontrolled high blood pressure can lead to: - **Heart attack or stroke.** High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke, or other complications. - **Aneurysm.** Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. - **Heart failure.** To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure. - **Weakened and narrowed blood vessels in your kidneys.** This can prevent these organs from functioning normally. - **Thickened, narrowed, or torn blood vessels in the eyes.** This can result in vision loss. - **Metabolic syndrome.** This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure; and high insulin levels. These conditions make you more likely to develop diabetes, heart disease, and stroke. - **Trouble with memory or understanding.** Uncontrolled high blood pressure may also affect your ability to think, remember, and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure. - **Dementia.** Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia. Managing hypertension is genuinely complex. The medications most commonly prescribed — including beta-blockers, diuretics, and others — can carry meaningful side effects. That's why researchers and clinicians have increasingly turned their attention to nutrition as both a complement and, in some cases, an alternative. *"High intakes of potassium, polyunsaturated fatty acids, and protein, along with exercise and possibly vitamin D, may reduce blood pressure. Less-conclusive studies suggest that amino acids, tea, green coffee bean extract, dark chocolate, and foods high in nitrates may reduce blood pressure. Short-term studies indicate that specialized diets may prevent or ameliorate mild hypertension; most notable are the Dietary Approaches to Stop Hypertension (DASH) diet, which is high in fruits, vegetables, and low-fat dairy products, and the DASH low-sodium diet."* A four-year study published in *JAMA* put it plainly: ***"Study findings demonstrated that nutritional therapy may substitute for drugs in a sizable proportion of hypertensives or, if drugs are still needed, can lessen some unwanted biochemical effects of drug treatment."*** This is why identifying a nutritional approach — one without the side effects of medication — is so worth pursuing. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410> - <https://www.webmd.com/hypertension-high-blood-pressure/guide/diastolic-and-systolic-blood-pressure-know-your-numbers#1> - *Annu Rev Nutr*. 2010 Aug 21;30:365–401. doi: 10.1146/annurev-nutr-010510-103954. The effect of nutrition on blood pressure. *JAMA* March 20, 1987 - Vol. 257. Nutritional Therapy for High Blood Pressure. ---
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Care planHypertriglyceridemia**High Triglycerides (Hypertriglyceridemia)**, a condition in which fat levels in the blood are too high, is one of the most common metabolic disorders in the United States. **It is frequently caused or worsened by poorly controlled diabetes, obesity, and inactive lifestyles — all of which are far more common in industrialized societies than in developing nations.** Research studies consistently show that high triglycerides are a risk factor for coronary artery disease (CAD). Triglyceride levels are measured with a simple blood test on a fasting sample taken after 10 to 12 hours without eating. Pinpointing exactly which type of fat-carrying particle in the blood is responsible for the elevated triglycerides is more complex. Hyperlipoproteinemia is a metabolic disorder in which abnormally high levels of specific fat-carrying particles (lipoproteins) build up in the bloodstream. Hyperlipidemia — meaning elevated cholesterol, elevated triglycerides, or both — is a feature of all hyperlipoproteinemias. The primary (inherited) forms include chylomicronemia, hypercholesterolemia, dysbetalipoproteinemia, hypertriglyceridemia, mixed hyperlipoproteinemia, and combined hyperlipoproteinemia. Secondary forms are triggered by other conditions such as diabetes mellitus, pancreatitis, kidney disease, and hypothyroidism. In plain terms, hypertriglyceridemia means there is too much of a type of fat called triglycerides circulating in your bloodstream — a condition that raises your risk of coronary artery disease. The triglycerides in your blood come from two sources: the food you eat and the fat your body makes on its own for energy. High triglycerides are often caused or made worse by obesity, poorly controlled diabetes, and a sedentary lifestyle. Your body needs some triglycerides in the blood for fuel, but when levels climb too high, these fats increase the risk of heart disease, stroke, and other serious health problems. Triglycerides themselves do not directly cause the fatty plaques that build up in the walls of arteries (atherosclerosis), but the cholesterol carried inside triglyceride-rich particles called **very low density lipoproteins (VLDLs)** may contribute to plaque formation. Many people with high triglycerides also have other lipid abnormalities or heart disease risk factors, including obesity and metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur together — high blood pressure, high triglycerides, high blood sugar, excess belly fat, and abnormal cholesterol levels — and dramatically increase cardiovascular risk. After you eat, your body converts any unused calories into triglycerides, which are then stored in fat cells for later use. Between meals, hormones signal those fat cells to release triglycerides as an energy source. If you consistently take in more calories than your body burns, your blood triglyceride levels will rise over time. **A simple blood test can tell you whether your triglyceride level is healthy. A level below 150 mg/dL is considered normal; 150 to 199 mg/dL is borderline high; 200 to 499 mg/dL is high; and 500 mg/dL or above is very high.** Beyond its effects on the heart and blood vessels, high triglyceridemia also raises the risk of pancreatitis — painful inflammation of the pancreas, the organ that produces insulin to regulate blood sugar. Pancreatitis can cause digestive problems, severe abdominal pain, permanent pancreatic damage, and, over time, diabetes. --- ## Understanding High Triglycerides ### Risk Factors for High Triglycerides Triglyceride levels generally tend to rise with age, but a number of specific risk factors can push them too high. **Lifestyle factors:** - Overweight or obesity - Excess alcohol intake - Lack of physical activity - Inherited disorders - Pregnancy - Type 2 diabetes - Metabolic syndrome **Medications that can raise triglycerides:** - Thiazide diuretics - Beta-blockers - Protease inhibitors for HIV - Some cholesterol-lowering drugs - Estrogen therapy - Isotretinoin for acne - Immunosuppressants - Corticosteroids - Some antipsychotics **The most common drivers of high triglycerides are obesity, physical inactivity, type 2 diabetes, metabolic syndrome, and familial hyperlipidemia** — a genetic condition that causes high triglycerides alongside low levels of "good" HDL (high-density lipoprotein) cholesterol. ### The Connection Between Triglycerides and HDL Cholesterol **High triglycerides often travel hand-in-hand with low HDL ("good") cholesterol.** Here's why: when VLDL particles release their triglycerides into the bloodstream, they normally hand off some of their cholesterol to HDL particles. But when triglycerides are being cleared from the blood too slowly, that transfer is reduced — leaving HDL cholesterol levels low and overall blood cholesterol levels high. When triglycerides are elevated, your doctor will often look for and address related conditions such as hypothyroidism, kidney disease, diabetes, and metabolic syndrome. ### Symptoms High triglycerides typically cause no noticeable symptoms until levels reach 1000 to 2000 mg/dL, at which point warning signs may include: - Gastrointestinal pain - Difficulty breathing - Memory loss - Dementia - Xanthelasmas — yellowish fat deposits on or around the eyelids - Corneal arcus — a thin, whitish or grey arc around the outer edge of the cornea of the eye - Xanthomas — yellowish fat deposits under the skin, typically found on the back, chest, buttocks, or upper limbs In rare cases, extremely high triglyceride levels can trigger pancreatitis, causing severe abdominal pain, nausea, vomiting, fever, and loss of appetite. **Sources:** - <https://www.news-medical.net/health/Hypertriglyceridemia-Cause-and-Symptoms.aspx> - <https://emedicine.medscape.com/article/126568-overview> **References:** - <http://emedicine.medscape.com/article/126568-overview> - <http://heartuk.org.uk/health-and-high-cholesterol/triglycerides> - <http://www.hormone.org/patient-guides/2012/hypertriglyceridemia> - <http://www.turner-white.com/memberfile.php?PubCode=hp_sep08_triglyceridemia.pdf> - <http://www.webmd.com/cholesterol-management/tc/high-triglycerides-overview> - <http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186> - <http://www.emedicinehealth.com/triglycerides/article_em.htm> - <http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Triglycerides?open> - <http://www.healthline.com/health/high-cholesterol/lipid-disorder#Overview1> - <http://www.webmd.com/cholesterol-management/tc/high-triglycerides-symptoms> ---
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Care planHypochlorhydria**Hypochlorhydria** is the medical term for having too little stomach acid. It may sound counterintuitive — after all, aren't we always trying to reduce stomach acid? — but adequate stomach acid is absolutely essential for good health. Some people have an even more severe form called **achlorhydria**, in which the stomach produces no acid at all. Understanding why stomach acid matters so much is the first step toward recognizing whether low acid might be affecting your health. - Your stomach acid acts as a powerful disinfectant, killing potentially harmful bacteria and other microorganisms in the food you eat every day. It also plays a critical role in breaking down protein and helping your body absorb key minerals and vitamins. - Stomach acid also sends important signals to your pancreas, triggering the release of the digestive enzymes and bicarbonate your body needs to properly process food. - When stomach acid is too low, food isn't fully broken down before it moves through your digestive tract. Partially digested food particles can trigger food sensitivities, and unprocessed food that reaches the lower intestine becomes fuel for harmful bacteria — allowing them to multiply. The downstream effects of low stomach acid include overgrowth of harmful gut microorganisms, poor absorption of minerals, vitamins, and amino acids, and the development of food sensitivities. Low stomach acid can be inherited or develop over time. --- ## Understanding Hypochlorhydria ### Medical Conditions Associated with Hypochlorhydria Medical conditions commonly associated with higher rates of hypochlorhydria include: - Asthma - Acid Reflux / GERD - Celiac disease - Chronic fatigue syndrome (CFS) - Diabetes mellitus - Eczema - HIV / AIDS - Lupus - Macular degeneration - Multiple chemical sensitivity - Pernicious anaemia - Psoriasis - Reflux - Rheumatoid arthritis - Rosacea - Stomach ulcers / Helicobacter pylori - Urticaria (hives) - Vitiligo ### How Do You Know If Your Stomach Acid Is Too Low? People with low stomach acid often experience several of the following symptoms: - Stomach aching, pain, discomfort, or bloating after meals - Feeling unwell or unusually tired right after eating - Food or water that seems to just "sit" in your stomach - Nausea or stomach upset after eating high-fat foods - Undigested food visible in stool - Reflux and / or heartburn - Poor appetite or feeling overly full after only small amounts of food - Multiple food sensitivities - Difficulty digesting red meat - Constipation - Low iron levels - Frequent nausea - Nausea or reflux after taking supplements (such as fish oil) - Burping after meals **Source:** MedicalNewsToday — July 17, 2018 — Reviewed by Saurabh (Seth) Sethi, MD MPH ---
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Care planHypokalemiaLow potassium — known medically as hypokalemia — means that the level of potassium circulating in your blood is lower than it should be. Potassium is an essential mineral that helps transmit electrical signals throughout your body, and it plays a critical role in keeping your nerves and muscles working properly — especially the muscles of your heart. A healthy blood potassium level falls between 3.6 and 5.2 millimoles per liter (mmol/L). When potassium drops very low (below 2.5 mmol/L), it becomes a medical emergency that requires immediate attention. In most cases, low potassium is discovered incidentally — through a routine blood test ordered because of an illness or because you take a diuretic (water pill). It is uncommon for low potassium alone to cause noticeable symptoms like muscle cramps if you are otherwise feeling well. **Symptoms of low potassium may include:** - Weakness - Fatigue - Muscle cramps - Constipation The most serious concern with very low potassium levels is an abnormal heart rhythm (arrhythmia) — a risk that is especially significant for people who already have heart disease. Treatment for low potassium focuses on addressing the root cause and often includes potassium supplements. --- ## Understanding Low Potassium ### What Causes Low Potassium? Low potassium (hypokalemia) can develop for many reasons. **The most common cause is excess potassium lost through the urine as a side effect of medications that promote urination.** These medications — commonly called water pills or diuretics — are frequently prescribed to manage high blood pressure or heart disease. Vomiting, diarrhea, or both can also drain the body of potassium through the digestive tract. In some cases, simply not getting enough potassium from food is the culprit. **Common causes of potassium loss include:** - Excessive alcohol use - Chronic kidney disease - Diabetic ketoacidosis - Diarrhea - Diuretics (water retention relievers) - Excessive laxative use - Excessive sweating - Folic acid deficiency - Primary aldosteronism - Certain antibiotic use - Vomiting ### Key Facts About Potassium (K) - The daily intake of potassium in normal patients is 60 to 100 mEq, and the amount eliminated is the same — 90% is excreted in the urine and 10% is in the stool. - The normal serum potassium is 3.5–5.5 mEq/L. In children, a value of < 2.5 mEq/L usually indicates Bartter's syndrome. - Extracellular fluid contains only 2–3% of total body potassium. - Each 1 mEq/L decrease of serum potassium reflects a total body deficit of 200–400 mEq. A serum potassium of < 2 mEq/L may reflect a total deficit of > 1,000 mEq (Wallach, J., 7th edition, 2000, p. 76). - 24-hour urine potassium content is 40–120 mEq/day. In France, the reference standard is 35–80 mmol per day. ### Foods Rich in Potassium (K) The following foods are among the highest in potassium, containing > 25 mEq per 100 grams (about 3 ounces): - Dried figs - Molasses - Seaweed This group contains > 12.5 mEq per 100 grams: - Dried dates and prunes - Nuts - Avocados - Lima beans Many vegetables, fruits (including bananas), and most animal meats contain > 6.2 mEq per 100 grams. **References:** - Adams JG. Potassium. In: Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. <https://www.clinicalkey.com>. Accessed May 5, 2017. - Hypokalemia. The Merck Manuals: The Merck Manual for Health Care Professionals. <http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/electrolyte_disorders/hypokalemia.html>. Accessed April 5, 2017. - Mount DB, et al. Causes of hypokalemia in adults. <http://www.uptodate.com/home>. Accessed April 5, 2017. - Mount DB, et al. Clinical manifestations and treatment of hypokalemia in adults. <http://www.uptodate.com/home>. Accessed April 5, 2017. - Potassium, serum. Mayo Medical Laboratories. <http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81390>. Accessed April 28, 2017. - Gennari FJ. *N Engl J Med.* 1998;339. p. 451–458. ---
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Care planHypotensionBlood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is at its highest in the moment your heart contracts and pushes blood forward — this is called your **systolic pressure**. Between beats, when your heart is at rest, your blood pressure falls — this is your **diastolic pressure**. Together, these two numbers make up your blood pressure reading, and both matter. They're typically written one over the other, like 120/80. If your reading is 90/60 or lower, you have what's known as low blood pressure. Some people naturally run on the lower end of the blood pressure spectrum. They feel perfectly fine, and for them, those numbers are simply their normal. For others, blood pressure dips below normal as the result of a specific event or medical condition. Some people notice symptoms — like feeling dizzy or lightheaded — when they stand up too quickly. Low blood pressure only becomes a true problem when it causes dizziness, fainting, or in serious cases, shock. **Source:** *NIH: National Heart, Lung, and Blood Institute* --- ## Understanding Low Blood Pressure ### The Main Types of Low Blood Pressure - **[Orthostatic hypotension (postural hypotension)](https://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/symptoms-causes/syc-20352548).** A sudden drop in blood pressure that happens when you go from sitting or lying down to standing up. It can be triggered by dehydration, prolonged bed rest, pregnancy, certain medical conditions, and some medications. This type is especially common in older adults. - **Postprandial hypotension.** A drop in blood pressure that occurs 1 to 2 hours after eating. It most commonly affects older adults, particularly those with high blood pressure or nervous system conditions like Parkinson's disease. Eating smaller, low-carbohydrate meals, drinking more water, and cutting back on alcohol may help ease symptoms. - **Neurally mediated hypotension.** This type causes blood pressure to drop after standing for long periods of time. It tends to affect young adults and children more than older adults, and may stem from a miscommunication between the heart and the brain. - **Multiple system atrophy with orthostatic hypotension.** Also called Shy-Drager syndrome, this is a rare disorder that disrupts the part of the nervous system responsible for controlling automatic body functions — things like blood pressure, heart rate, breathing, and digestion. It is often associated with very high blood pressure when lying down. ### Low Blood Pressure When Standing Up (Postural or Orthostatic Hypotension) This refers to a sudden drop in blood pressure that occurs when you rise from a seated position or stand up after lying down. Under normal circumstances, gravity causes blood to temporarily pool in your legs when you stand. Your body quickly compensates by speeding up your heart rate and tightening your blood vessels, ensuring that enough blood keeps flowing to your brain. In people with postural hypotension, however, this compensating response doesn't work properly — blood pressure falls, and symptoms like dizziness, lightheadedness, blurred vision, or even fainting can follow. **Postural hypotension** can develop for many reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins, and certain neurological conditions. A number of medications can also be responsible, particularly those used to treat high blood pressure — such as diuretics, beta blockers, calcium channel blockers, and ACE inhibitors — as well as antidepressants and drugs used to treat Parkinson's disease and erectile dysfunction. **Postural hypotension** is particularly common in older adults, affecting as many as 20 percent of those over age 65. That said, it can also occur in young, otherwise healthy individuals — for example, after sitting cross-legged for an extended period or after crouching in a squatting position for a while before standing up suddenly. Your **adrenal (or suprarenal) glands** sit on top of each kidney. They produce hormones that are absolutely essential to life — including sex hormones and cortisol, which helps your body manage stress and carries out many other vital roles, including **keeping your blood pressure stable when you change positions**. ---
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Care planIleostomyWhen the colon is either temporarily taken out of commission or removed entirely, your body begins to have specific, heightened nutritional and fluid needs. Nutritional supplementation is strongly worth considering. ## Understanding Ileostomy An ileostomy is a surgical procedure that connects the small intestine to an opening — called a stoma — in the abdominal wall. It bypasses the large intestine (colon), either because the colon has been removed or is too damaged to function. An ileostomy may be temporary, giving the bowel time to rest and heal after surgery or injury, or it may be permanent. Because a significant portion of your body's nutrient absorption normally happens in the large intestine, living with an ileostomy can put you at risk for nutritional deficiencies. Supplements can help make up for what is lost. Beyond vitamins, most people with an ileostomy may also need to supplement key minerals. ### Fat-Soluble Vitamins (ADEKS) **ADEKS refers to vitamins A, D, E, and K —** all fat-soluble vitamins that are normally absorbed in the ileum (the last section of the small intestine). When a large portion of the ileum is removed or bypassed, these vitamins are no longer efficiently absorbed. Adults and children with short gut syndrome — which develops after removal of a significant part of the ileum — often need ADEKS supplementation. ### Vitamin B-12 Deficiency Approximately 25 percent of all people who undergo an ileostomy eventually develop a B-12 deficiency, according to the National Health Service of Great Britain. This happens when the section of intestine that normally absorbs B-12 is removed. Left untreated, B-12 deficiency can lead to pernicious anemia, causing fatigue, shortness of breath, headaches, ringing in the ears, lightheadedness, and an irregular heartbeat. It may take several years for a deficiency to become apparent, so it is important to monitor your B-12 levels regularly. Regular B-12 injections or tablets can effectively treat this deficiency. ### Minerals Beyond vitamins, poor absorption of minerals can also occur in people who lose a portion of the small intestine in addition to the large intestine. Reduced absorption of calcium, iron, magnesium, and zinc is possible — and this risk increases during illness, when diarrheal output from the ileostomy tends to rise. **Reference:** Burch, J. (2008) Nutrition for people with stomas 1: overview of issues. *Nursing Times*; 104: 48, 24–25. ---
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Care planImmune Support for AdultsA strong, healthy immune system is one of your best defenses against viral infections and the flu. The good news is that there are natural, evidence-based strategies to help build and maintain that defense. Like any well-trained army, your immune system needs reliable fuel to function at its best. Scientists have long recognized that people living in poverty or experiencing malnutrition are far more susceptible to infectious diseases — and there is a clear, well-established link between what you eat and how well your immune system performs. Research confirms that deficiencies in key micronutrients — including zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E — can meaningfully weaken your immune responses. Whenever immune health is a concern, the best place to start is with a strong nutritional foundation: a high-quality multivitamin/mineral supplement and fish oils or omega-3 fatty acids. ---
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Care planImmune Support for ChildrenA strong, healthy immune system is one of the best defenses your child has against viral infections, the flu, and other common illnesses. The good news: there are safe, natural ways to support and strengthen your child's immunity. Think of the immune system like an army — and every army needs reliable fuel. The immune system's "soldiers" perform best when they are consistently well-nourished. Research has long confirmed that children who are undernourished face a much greater risk of infectious illness. The link between nutrition and immune strength is well established and hard to ignore. Science has shown that deficiencies in specific micronutrients — including zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E — can meaningfully weaken immune responses. Whenever immune health is a concern, the best place to start is with a solid nutritional foundation: a quality multivitamin/mineral supplement and fish oils/omega-3 fatty acids. ---
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Care planInfectious MononucleosisInfectious mononucleosis — or simply "mono" — is an infection most commonly caused by the Epstein-Barr virus (EBV). Because the virus travels through saliva, it has earned the nickname "the kissing disease." Mono is most common in teenagers and young adults, but it can strike at any age. Classic symptoms of mono include: - Fever - Sore throat - Swollen lymph nodes In some cases, the spleen may also become enlarged. Serious complications are uncommon. A simple blood test can confirm whether you have mono. Most people recover within two to four weeks, though fatigue can linger for several months. Treatment is focused on relieving symptoms and typically involves pain and fever medication, warm saltwater gargles, and plenty of rest and fluids. **Reference:** NIH — U.S. National Library of Medicine --- ## Understanding Epstein-Barr Virus Epstein-Barr virus is one of the most common and highly contagious viral infections in the world. It spreads through bodily fluids — especially saliva. While most EBV infections are mild or even silent, some lead to mononucleosis, and in rare cases, the virus has been linked to certain cancers. Treatment is aimed at managing symptoms. ### What Is the Epstein-Barr Virus? Epstein-Barr virus (EBV) is an extremely common viral infection that spreads through saliva and other bodily fluids. EBV belongs to the herpesvirus family — specifically, it is classified as herpesvirus 4. Many people infected with EBV never develop any noticeable symptoms. However, in adolescents and young adults, EBV is the most frequent cause of infectious mononucleosis. Once you are infected, EBV does not leave your body. Instead, it enters a dormant, or "sleeping," state — quietly residing in your system for the rest of your life. Under certain circumstances, the virus can reactivate and cause symptoms again, no matter how long ago you were first infected. ### Who Gets Epstein-Barr Virus? While EBV most commonly affects children, teenagers, and young adults, anyone — regardless of age — can become infected. ### How Common Is Epstein-Barr Virus? EBV is remarkably widespread. In the U.S., an estimated 50% of all children up to 5 years of age and about 95% of adults experience an EBV infection in their lifetime. ### How Do You Get Epstein-Barr Virus? EBV is contagious and spreads primarily through saliva. You can pick it up by sharing anything that comes into contact with an infected person's mouth. The most common routes of transmission are drinking from the same glass as — or kissing — someone who carries the virus. ### Is Epstein-Barr Virus Contagious? Yes — EBV is contagious. The virus can spread even during the incubation period, which is the window of time between when a person is first exposed to the virus and when symptoms appear. This period typically lasts between four to six weeks. Although saliva is the primary vehicle of transmission, EBV can also spread through other bodily fluids. You can contract EBV from an infected person through: - Coughing or sneezing. - Kissing. - Sexual contact (blood and semen). - Sharing objects like a toothbrush, utensils, or a cup. - Touching items a child might have put in their mouth or drooled on. Importantly, you do not have to feel sick to pass EBV to someone else. Once the infection takes hold, it remains in your body in a dormant state indefinitely. Certain triggers can cause the virus to "wake up," or reactivate — making it contagious again and potentially causing symptoms. Common reactivation triggers include: - Stress. - A weakened immune system. - Menopause or other significant hormonal changes. ### What Causes Epstein-Barr Virus? EBV is caused by close contact with an infected person. The virus is highly contagious and spreads readily through saliva and other bodily fluids such as blood and semen. It can also be transmitted through blood transfusions or organ transplants. ### How Does Epstein-Barr Virus Affect the Body? EBV attaches itself to a specific type of white blood cell called a lymphocyte B cell — one of the body's key defenders against infection. Once the virus invades these cells, they can no longer do their job properly, and symptoms follow. ### What Are the Symptoms of Epstein-Barr Virus? Symptoms vary from person to person and can range from barely noticeable to quite debilitating. Common symptoms include: - Sore throat and throat inflammation (swelling). - Fatigue or feeling extremely tired. - Fever. - Swollen lymph nodes (a bean-shaped organ in your neck). - Rashes on your skin. - Enlarged spleen and liver. Children with EBV often show no symptoms at all, or experience only mild, cold- or flu-like illness. Teenagers and adults tend to have a more pronounced illness, with symptoms lasting two to four weeks — though fatigue in particular can drag on for months. ### Can Epstein-Barr Virus Symptoms Come Back? After the initial infection, EBV enters a latent (dormant) state in your body. If the virus reactivates — particularly in someone with a weakened immune system — symptoms can return. In some cases, the reactivated virus causes no symptoms in the person carrying it, but can still be passed to others. ### How Is Epstein-Barr Virus Diagnosed? Diagnosing EBV can be tricky because its symptoms closely resemble those of many other common illnesses. Your healthcare provider will review your symptoms, how long you have had them, and whether you may have been exposed to someone with the virus. A blood test is typically used to confirm the diagnosis. The standard diagnostic tool is the Epstein-Barr virus antibody test, which looks for specific antibodies in your blood that signal EBV infection. Because these antibodies may not appear early in the course of the illness, your provider may need to repeat the test between 10 days to two weeks after the first test to get a clear result. ### How Is Epstein-Barr Virus Treated? There is no antiviral medication that eliminates EBV. Treatment focuses on managing symptoms and supporting your body's recovery. This typically includes: - Staying hydrated and drinking plenty of fluids. - Resting. - Taking over-the-counter medicine for a fever and pain. Getting adequate rest is essential — pushing yourself too hard can worsen symptoms. If EBV has caused your spleen to enlarge, it is especially critical to avoid strenuous physical activity, as this raises the risk of a potentially serious ruptured spleen. Most people with symptomatic EBV infection start feeling better within two to four weeks. That said, fatigue can be stubborn — some people feel unusually tired for several weeks or even months after other symptoms have resolved. ### How Can I Prevent Epstein-Barr Virus? There is currently no vaccine against EBV. The best defense is taking practical steps to avoid exposure: - Not sharing food or drinks with someone who has the virus. - Not kissing someone who has the virus. - Not sharing a toothbrush with someone who has the virus. - Using protection when having sex with someone who has the virus. - Washing your hands after touching something with saliva on it, and not putting your hands near your mouth after touching an object that has saliva or drool on it. ### Is There a Cure for Epstein-Barr Virus? No — there is currently no cure for EBV, and no vaccine to prevent it. Treatment is supportive, focused on symptom relief, and most symptoms resolve within two to four weeks. Once infected, the virus remains in your body indefinitely in a dormant state. Stress or a weakened immune system can trigger reactivation, meaning symptoms can potentially return down the road. ### Can I Go to Work or School With Epstein-Barr Virus? If you have EBV symptoms or have developed mononucleosis, you should stay home from work, school, and crowded events. EBV is highly contagious, and close contact with others puts them at risk. Your healthcare provider will advise you to rest at home until your symptoms improve. Keep in mind that fatigue may persist for several weeks after other symptoms have faded — listen to your body and don't rush your recovery. ### Can Epstein-Barr Virus Lead to Cancer? In rare cases, EBV has been linked to certain cancers, including: - White blood cell cancer (Burkitt lymphoma). - Cancer of the nose and throat (nasopharyngeal cancer). This cancer risk arises because viral genes from EBV can alter the normal growth cycle of infected cells, causing them to become malignant. It is important to stress that this outcome is uncommon. ### Is Epstein-Barr Virus Related to Herpes? Yes — EBV is a member of the human herpesvirus family, classified as human herpesvirus 4. However, its symptoms are quite different from those of other herpesviruses, such as genital herpes. The broader herpesvirus family also includes the viruses responsible for chickenpox, shingles, and mononucleosis. EBV is one of several family members that can cause mono. ### Is Epstein-Barr Virus a Sexually Transmitted Infection? EBV can be transmitted sexually — through bodily fluids like blood or semen — but not every case qualifies as a sexually transmitted infection (STI). The most common route of spread remains saliva, which is why EBV-related mononucleosis is famously nicknamed "the kissing disease." To reduce the risk of transmitting or acquiring any STI, use protection during sexual activity. ### A Final Word For most people, Epstein-Barr virus does not cause serious long-term health problems — but it can significantly disrupt daily life, making work or school difficult for weeks at a time. Staying well-hydrated, getting plenty of rest, and avoiding close contact with others while you are contagious are your best tools for a smoother recovery. Take care of yourself, and don't hesitate to reach out to your healthcare provider if your symptoms are severe or prolonged. **Source:** <https://my.clevelandclinic.org/health/diseases/23469-epstein-barr-virus> ---
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Care planIn Vitro Fertilization (IVF)**In Vitro Fertilization (IVF)** is a method of assisted conception in which eggs are retrieved from the ovaries, combined with a sperm sample in a laboratory setting, and fertilized outside the body. The resulting embryo(s) are then carefully transferred into the uterus. Other forms of Assisted Reproductive Technology (ART) include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). > *"Conclusion: Nutrition status could affect infertility treatment outcomes. Greater adherence to the healthy diet may enhance oocyte quality and quantity. Unhealthy diet could adversely affect the chance of getting pregnant."* > > **Reference:** *International Journal of Fertility & Sterility* (2019). <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186288/> It is well established that overall good health and a nutritious diet go hand in hand — and fertility is no exception. While there is no single "perfect" fertility diet, research consistently shows that healthier eating habits are linked to better IVF outcomes. A pro-fertility diet — one that emphasizes supplemental folic acid, vitamin B12, vitamin D, omega-3 fatty acids, low-pesticide produce, whole grains, low-fat dairy, and seafood over other meats — has been associated with a greater likelihood of a live birth in women undergoing IVF. **References:** - <https://www.sciencedirect.com/science/article/abs/pii/S000293781930345X> - <https://www.fertilitycenter.com/fertility_cares_blog/mediterranean-diet/> - <https://www.fertilitycenter.com/fertility_cares_blog/eating-more-seafood-is-associated-with-a-higher-chance-of-becoming-pregnant/> - <https://www.fertilitycenter.com/fertility_cares_blog/women-who-consume-high-amounts-of-fast-food-may-take-longer-to-conceive/> ---
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Care planIron-Deficiency AnemiaIron is an essential mineral your body simply cannot live without. It sits at the heart of every red blood cell, tucked inside a protein called hemoglobin — the molecule responsible for picking up oxygen in your lungs and delivering it to every corner of your body. When iron runs low, hemoglobin production suffers, and so does everything that depends on it. This is how iron-deficiency anemia develops — and it is one of the most common nutritional deficiencies seen in children today. ## Understanding Iron-Deficiency Anemia Your body needs iron to build hemoglobin. Without enough of it, hemoglobin production slows, fewer red blood cells (RBCs) are made, and the ones that are made carry less oxygen. This shortfall — too little hemoglobin and too few RBCs — is what we call anemia. Because every cell and tissue in your body depends on a steady oxygen supply, anemia can quietly erode your health in ways that are easy to overlook. Iron-deficiency anemia (IDA), most often caused by not getting enough iron in the diet, is the leading form of anemia in childhood. Encouragingly, it has become far less common in the United States over the past 30 years — largely thanks to iron-fortified infant formulas and cereals. IDA does not appear overnight. It unfolds in stages: first, iron depletion, in which the body's iron stores shrink while the iron inside RBCs remains intact. Left unaddressed, depletion deepens into iron deficiency, and eventually into full-blown IDA. ### What Causes IDA? Iron-deficiency anemia can arise from several different sources, including: - Not getting enough iron through food - Poor absorption of iron by the gut - Ongoing blood loss — most commonly from menstruation or slow, gradual bleeding in the intestinal tract - Unusually heavy menstrual periods - Periods of rapid growth, when iron demands spike ### Who Is at Risk, and When? - The World Health Organization considers iron deficiency the number one nutritional disorder in the world. As many as **80% of the world's population** may be iron deficient, while **30%** may have iron-deficiency anemia. - Iron deficiency develops gradually, typically beginning with a negative iron balance — a state in which daily iron intake simply does not keep up with daily iron needs. At first, the body dips into its stored iron reserves while blood hemoglobin levels remain normal. IDA represents the advanced end of this spectrum, when storage sites are exhausted and blood iron can no longer meet the body's demands. At this stage, hemoglobin levels fall below normal. - IDA is closely tied to low dietary iron intake, poor iron absorption, or excessive blood loss. Those at greatest risk include women of childbearing age, pregnant women, preterm and low birth weight infants, older infants and toddlers, and teenage girls — all groups with especially high iron needs. Women with heavy menstrual periods can lose a substantial amount of iron and face considerable risk of deficiency. Adult men and post-menopausal women, by contrast, lose very little iron and carry a much lower risk. - Individuals with kidney failure — particularly those on dialysis — face a high risk of IDA. Failing kidneys cannot produce enough erythropoietin, a hormone the body needs to make red blood cells. Both iron and erythropoietin can be lost during dialysis treatments, making supplementation of both often necessary. - Vitamin A plays a supporting role in iron metabolism by helping release iron from its storage sites. A deficiency of vitamin A can therefore limit the body's ability to use stored iron — resulting in what looks like iron deficiency even when iron stores are technically adequate. Though uncommon in the U.S., this issue is frequently seen in developing countries where vitamin A deficiency is prevalent. - Chronic malabsorption — difficulty absorbing nutrients through the gut — can deplete iron both by limiting how much dietary iron is absorbed and by contributing to intestinal blood loss. Most iron absorption takes place in the small intestine, so gastrointestinal conditions that inflame this area can lead to diarrhea, poor iron absorption, and progressive depletion. - A diet low in iron is the most common driver of IDA in infants, toddlers, and teenagers. Children who eat too little, or who rely heavily on foods that are poor iron sources, are especially vulnerable. Poverty compounds the problem — families living at or below the poverty line may struggle to access iron-rich foods consistently. - Iron deficiency can also increase the body's absorption of lead — raising the risk of lead poisoning in children, particularly those living in older homes. The combination of IDA and lead poisoning can make children seriously ill and place them at risk for learning and behavioral difficulties. - During infancy and adolescence, the body's iron demands surge. Children moving through these periods of rapid growth are at higher risk for IDA if their diet does not supply enough iron to meet the increased need. - In infants, switching away from iron-fortified formula and introducing cow's milk before 12 months of age can set the stage for IDA. Cow's milk is naturally low in iron — and it tends to crowd out the iron-rich foods a growing infant needs. Cow's milk also interferes with iron absorption and can irritate the intestinal lining, causing small amounts of ongoing bleeding. This slow, steady blood loss — combined with inadequate iron intake — can gradually tip a child into iron deficiency and anemia. ### A Closer Look at Risk by Age - **Premature and low birth weight infants:** Full-term, healthy-weight babies are born with iron stores built up during pregnancy — stores that typically last 4–6 months. Premature infants, however, miss out on much of that in-utero iron accumulation, and their stores may be depleted in as little as 2 months. - **Toddlers (ages 1–3):** Children in this age group remain at risk for iron deficiency and IDA, even though this isn't a period of exceptionally fast growth. Most toddlers have transitioned away from iron-fortified formula and infant cereal, and they often aren't eating enough iron-rich foods to compensate. Toddlers also tend to drink large amounts of cow's milk — often more than 24 ounces a day — which can irritate the stomach lining and cause chronic low-level blood loss that gradually leads to iron deficiency. - **Adolescent boys and girls:** Boys experience a heightened risk of IDA during the early stages of puberty, when rapid growth places heavy demands on iron stores. But adolescent girls face an even greater risk than boys — they have smaller iron reserves to begin with, and they lose iron each month through menstrual blood flow. Many teenage girls also tend to eat diets that are relatively low in iron. - **Those with celiac disease or Crohn's disease:** Both conditions are associated with gastrointestinal malabsorption and can interfere with the body's ability to absorb iron effectively. If these conditions contribute to IDA, iron supplementation may be necessary. - **Women using contraception:** Women taking oral contraceptives often experience lighter menstrual bleeding, which lowers their risk of developing iron deficiency. Women using an intrauterine device (IUD) for contraception, however, may experience heavier bleeding and face a greater risk of iron deficiency. If blood tests confirm IDA, iron supplements are often recommended. - **Vegetarians:** Vegetarian diets can provide adequate total iron intake, but the form of iron found in plant foods — non-heme iron — is absorbed less efficiently than the iron found in meat. As a result, vegetarians who avoid all animal products may need nearly twice as much dietary iron each day as non-vegetarians. Pairing plant-based iron sources with a good source of vitamin C — such as citrus fruits — can meaningfully improve non-heme iron absorption. ### Iron and Intense Exercise Many men and women who exercise regularly and intensely — including runners, competitive swimmers, and cyclists — have marginal or inadequate iron levels. Several factors likely contribute: increased gastrointestinal blood loss after running, a faster-than-normal turnover of red blood cells, and the physical rupture of red blood cells in the soles of the feet during running. For these reasons, regular intense exercisers may need up to **30% more iron** than the average person. Three groups of athletes face the greatest risk of iron depletion and deficiency: female athletes, distance runners, and vegetarian athletes. For these individuals, meeting recommended iron intake and paying close attention to dietary factors that support iron absorption is especially important. When nutritional strategies alone are not enough to maintain normal iron status, supplementation may be warranted. In one study of female swimmers, researchers found that supplementation with **125 milligrams of ferrous sulfate per day** prevented iron depletion. These swimmers maintained adequate iron stores, and did not experience the gastrointestinal side effects often seen with higher doses of iron supplementation. ### Recognizing the Symptoms Many people with iron deficiency experience no symptoms at all in the early stages, because the body's iron stores are drawn down slowly. As anemia progresses, however, you may begin to notice one or more of the following: - Fatigue and weakness - Pale skin and pale mucous membranes - A rapid heartbeat or a new heart murmur (detected during a physical exam) - Irritability - Decreased appetite - Dizziness or lightheadedness In rare cases, someone with IDA may develop pica — an unusual craving to eat non-food items such as paint chips, chalk, or dirt. Pica is thought to be linked to inadequate iron in the diet. ### Getting a Diagnosis IDA is often first detected during a routine checkup. Because its symptoms — fatigue, poor appetite, and others — overlap with many common conditions, your doctor will need additional information to make a confident diagnosis. If IDA is suspected, your doctor will likely ask about your diet and may order one or more of the following blood tests: - **A complete blood count (CBC)** may reveal low hemoglobin levels and low hematocrit (the percentage of your blood made up of RBCs). The CBC also provides information about the size of your RBCs — cells low in hemoglobin tend to be smaller and carry less oxygen per cell. - **The reticulocyte count** measures how quickly immature RBCs are being produced. In IDA, the bone marrow produces these cells too slowly to maintain normal levels. - **Serum iron** directly measures the amount of iron circulating in the blood, though it may not fully reflect how much iron is stored throughout the body's tissues. - **Serum ferritin** reflects the body's total iron stores. It is one of the earliest indicators of iron depletion and is most informative when interpreted alongside other tests, such as a CBC. Your doctor may also order a **stool test**, since IDA can be caused by the gradual, often invisible loss of small amounts of blood through the gastrointestinal tract. A stool sample is placed on a specially treated card and tested with a drop of solution — a color change signals the presence of blood. ---
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Care planJet LagJet lag — sometimes called jet lag disorder — is a temporary sleep disruption that can happen to anyone who travels rapidly across multiple time zones. Deep within your biology, you carry a finely tuned internal clock known as your **circadian rhythm**. This clock tells your body when to feel alert and when to wind down for sleep. Jet lag happens because your internal clock remains anchored to your home time zone, even as your body lands somewhere entirely different. The greater the number of time zones you cross, the more pronounced your jet lag is likely to be. Jet lag can bring on daytime exhaustion, a general sense of feeling unwell, difficulty concentrating, and digestive upset. While these symptoms are short-lived, they can put a real damper on a vacation or a critical business trip. The good news: there are concrete steps you can take to prevent jet lag or significantly soften its impact. --- ## Understanding Jet Lag ### What Does Jet Lag Feel Like? Jet lag affects everyone a little differently. You might experience just one symptom, or you might feel several at once. Common symptoms include: - Sleep difficulties, such as trouble falling asleep or waking up far too early. - Daytime exhaustion and fatigue. - Difficulty concentrating or performing at your normal level. - Digestive issues such as constipation or diarrhea. - A general sense of feeling "off" or unwell. - Mood changes or irritability. **The farther you travel, the worse you may feel.** Jet lag symptoms typically appear within a day or two of crossing at least two time zones. The farther you travel, the more severe or prolonged your symptoms are likely to be — especially when flying east. A useful rule of thumb: expect roughly one day of recovery for each time zone crossed. ### Why Does Jet Lag Happen? **Your body clock gets thrown off course.** Jet lag can strike any time you cross two or more time zones. When you do, your internal clock — your circadian rhythm, which governs your sleep-wake cycle — falls out of sync with the local time at your destination. Here's a concrete example: you leave New York at 4 p.m. on Tuesday and touch down in Paris at 7 a.m. Wednesday. But your internal clock still believes it's 1 a.m. — meaning your body is ready for bed right as Parisians are starting their day. It takes a few days for your biology to catch up. In the meantime, your sleep-wake cycle, hunger cues, and digestive rhythms remain stubbornly out of step with local time. **Sunlight is a powerful time-setter.** One of the most important influences on your circadian rhythm is light — specifically, sunlight. Light directly controls the release of melatonin, a hormone that coordinates the timing of countless processes throughout your body. Specialized cells in the back of your eye detect light and send signals to a region of the brain called the hypothalamus. When darkness falls, the hypothalamus instructs a tiny brain structure called the pineal gland to release melatonin, helping you feel sleepy. In daylight, melatonin release is suppressed, keeping you alert. Because of this powerful relationship between light and your clock, strategically timing your exposure to bright light can help you adapt more quickly to a new time zone. **Cabin pressure and dry air play a role too.** Research suggests that the changes in cabin pressure and high-altitude conditions of air travel may themselves contribute to some jet lag symptoms — independent of how many time zones you cross. Additionally, airplane cabins are notably low in humidity. If you aren't drinking enough water during your flight, mild dehydration can set in — and dehydration can worsen jet lag symptoms considerably. ### Who Is Most at Risk? Several factors can increase your chances of experiencing jet lag: - **Number of time zones crossed.** The more time zones you cross, the more likely you are to feel jet lag. - **Flying east.** You may find it harder to fly east, when you "lose" time, than to fly west, when you "gain" time. - **Being a frequent flyer.** Pilots, flight attendants, and business travelers are most likely to experience jet lag. - **Being an older adult.** Older adults may need more time to recover from jet lag. ### Are There Any Serious Risks? One worth noting: drowsy driving accidents may be more likely in people experiencing jet lag. If you're feeling fatigued after a long-haul trip, be especially cautious behind the wheel. ---
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Care planKeloids & ScarsAdhesions are rope-like bands of scar tissue that form between internal surfaces of the body, causing them to stick together. Normally, the organs and tissues inside your body can shift and glide past one another freely — thanks to their naturally slippery surfaces. When adhesions form, that freedom of movement is lost. ## Understanding Adhesions ### What Causes Adhesions? Inflammation, surgery, or injury can trigger adhesion formation almost anywhere in the body, including: - Joints, such as the shoulder - The eyes - Inside the abdomen or pelvis Once adhesions form, they tend to grow larger or pull tighter over time. This can become a real problem if they cause an organ or body part to twist, get yanked out of position, or lose its ability to move freely — leading to symptoms or other complications. The risk of developing adhesions is particularly high after surgeries involving the bowel or female reproductive organs. Minimally invasive (laparoscopic) surgery carries a much lower risk of causing adhesions than traditional open surgery. Other common triggers of abdominal or pelvic adhesions include: - Appendicitis — especially when the appendix ruptures - Cancer - Endometriosis - Infections in the abdomen or pelvis - Radiation therapy Adhesions around joints may develop: - After surgery or trauma - With certain types of arthritis - From overuse of a joint or tendon ### Recognizing the Symptoms When adhesions affect joints, tendons, or ligaments, they can limit range of motion and cause pain. When they develop in the abdomen and create a kink, twist, or pulling sensation, they may lead to a bowel obstruction. Warning signs of a bowel obstruction include: - Bloating or swelling of the belly - Constipation - Nausea and vomiting - Inability to pass gas - Severe, crampy abdominal pain Pelvic adhesions may also be responsible for ongoing, long-term pelvic pain. ### Potential Complications Depending on where adhesions form, they can lead to a range of serious problems: - In the eye, adhesion of the iris to the lens can lead to glaucoma. - In the intestines, adhesions can cause partial or complete bowel obstruction. - Adhesions inside the uterine cavity — known as Asherman syndrome — can cause irregular menstrual cycles and infertility. - Pelvic adhesions involving the fallopian tubes can impair fertility and reproductive function. - Abdominal and pelvic adhesions can be a source of chronic pain. ### Other Names for This Condition Pelvic adhesion | Intraperitoneal adhesion | Intrauterine adhesion **References:** - Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. *Surg Clin N Am*. 2010;90:1227–1236. - Kulaylat MN, Dayton MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. *Sabiston Textbook of Surgery*. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 15. - Paine R. Rehabilitation and therapeutic modalities: a language of exercise and rehabilitation. In: DeLee JC, Drez D Jr, Miller MD, eds. *DeLee and Drez's Orthopaedic Sports Medicine*. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009: chap 5 section A. --- ## Understanding Keloids Keloids are overgrown scar tissue that forms at the site of a healed skin wound — essentially, the body's repair process goes into overdrive and produces far more scar tissue than is needed. ### What Causes Keloids? Keloids can develop after many types of skin injury, including: - Acne - Burns - Chickenpox - Ear piercing - Minor scratches - Surgical cuts - Traumatic wounds - Vaccination sites Keloids are most common in people between the ages of 10 and 20, and occur more frequently in African Americans, Asians, and Hispanics. They also tend to run in families. When a person develops many keloids or keeps developing them repeatedly, this is referred to as keloidosis. ### Recognizing the Symptoms A keloid typically appears as a skin lesion that is: - Flesh-colored, red, or pink - Located directly over the site of a wound or injury, with a lumpy (nodular) or ridged texture - Itchy while it is actively forming and growing ### How Is It Diagnosed? A keloid is usually diagnosed simply by looking at the skin or scar. In some cases, a skin biopsy may be recommended to rule out other types of skin growths or tumors. ### Treatment Options Keloids often don't require treatment. When treatment is desired, their size can be reduced using: - Corticosteroid injections - Freezing (cryotherapy) - Laser treatments - Radiation - Surgical removal ### What to Expect Keloids are rarely dangerous to your health, but they can affect your appearance. In some cases, they gradually become smaller, flatter, and less noticeable over several years. One important note: sun exposure during the first year after a keloid forms can cause it to tan darker than the surrounding skin — and that color difference may be permanent. Surgical removal does not guarantee a permanent fix. In fact, the procedure itself may trigger the growth of an even larger keloid scar. ### Potential Complications - Cosmetic changes that affect your appearance - Discomfort or tenderness at the site of the keloid - Irritation from rubbing against clothing or other friction, and limited mobility if the keloids are extensive - Psychological distress if the keloid is large or disfiguring, and the possibility of the keloid returning after treatment ### Prevention Tips You can help prevent sun-related discoloration by covering a forming keloid with a patch or bandage, and by applying sunblock whenever you're outdoors. These extra protective measures should be kept up for at least 6 months after an injury or surgery in adults, or up to 18 months in children. Imiquimod cream has also been used more recently to help prevent keloids from forming after surgery, or to reduce the chance of them coming back after surgical removal. ### Other Names for This Condition Hypertrophic scar | Keloid scar | Scar - hypertrophic **References:** - Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. *Am Fam Physician*. 2009;80(3):253–260. - Habif TP. Benign skin tumors. In: Habif TP, ed. *Clinical Dermatology*. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009: chap 20. ---
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Care planKetogenic DietA ketogenic diet is an ultra-low-carbohydrate way of eating that pairs moderate amounts of high-quality protein with generous amounts of healthy fat. By dramatically cutting back on carbohydrates, your body shifts into a powerful fat-burning mode — breaking down fats from both your food and your body's own stores to produce molecules called ketone bodies, entering a metabolic state known as "ketosis." Once you've reached ketosis, your brain and other organs rely on these ketones as their primary fuel. Ketones can be measured in your blood and urine, giving you a reliable window into whether you're staying in that fat-burning sweet spot.
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Care planKidney CystsKidney cysts are fluid-filled sacs that form on or within the kidneys. While some kidney cysts can be linked to serious conditions that affect how well your kidneys work, the most common type — called simple kidney cysts — are noncancerous and rarely cause problems. We don't fully understand what causes simple kidney cysts to form. Usually, just one cyst appears on the surface of a kidney, though multiple cysts can develop on one or both kidneys. It's important to know that simple kidney cysts are different from the cysts seen in polycystic kidney disease, which is a more complex, inherited condition. Simple kidney cysts are most often discovered by accident — spotted on an imaging scan done for an entirely different reason. When they aren't causing any symptoms or affecting kidney function, they typically don't need treatment. --- ## Understanding Kidney Cysts ### What Causes Kidney Cysts? The exact cause of simple kidney cysts remains unknown. One leading theory suggests that they begin when the outer layer of the kidney develops a weak spot, which then bulges outward to form a small pouch (called a diverticulum). This pouch gradually fills with fluid, eventually pinches off, and becomes a cyst. ### Who Is Most at Risk? Simple kidney cysts become more common as we age, though they can appear at any stage of life. They also tend to develop more frequently in men than in women. ### Symptoms Most of the time, simple kidney cysts cause no symptoms at all. However, if one grows large enough, you might notice: - A dull ache in your back or side - Fever - Pain in your upper abdomen ### Can Kidney Cysts Cause Serious Problems? Although rare, kidney cysts can sometimes lead to complications, such as: - **An infected cyst.** A kidney cyst may become infected, causing fever and pain. - **A burst cyst.** A kidney cyst that bursts causes severe pain in your back or side. - **Urine obstruction.** A kidney cyst that obstructs the normal flow of urine may lead to swelling of the kidney (hydronephrosis). ### How Are Kidney Cysts Diagnosed? Your doctor has several reliable tools for identifying and evaluating simple kidney cysts: - **Imaging tests.** Imaging tests, such as an ultrasound, a computerized tomography (CT) scan and magnetic resonance imaging (MRI), are often used to investigate simple kidney cysts. Imaging tests can help your doctor determine whether a kidney mass is a cyst or a tumor. - **Kidney function tests.** Testing a sample of your blood may reveal whether a kidney cyst is impairing your kidney function. ### Treatment Options Treatment may not be necessary. If your simple kidney cyst causes no signs or symptoms and doesn't interfere with your kidney function, you may not need treatment. Instead, your doctor may recommend that you have an imaging test, such as ultrasound, periodically to see whether your kidney cyst has enlarged. If your kidney cyst changes and causes signs and symptoms, you may choose to have treatment at that time. Sometimes a simple kidney cyst goes away on its own. **When a cyst does need to be treated** If your simple kidney cyst is causing signs and symptoms, your doctor may recommend treatment. Options include: **Puncturing and draining the cyst, then filling it with alcohol.** Rarely, to shrink the cyst, your doctor inserts a long, thin needle through your skin and through the wall of the kidney cyst. Then the fluid is drained from the cyst. Your doctor may fill the cyst with an alcohol solution to prevent it from reforming. **Surgery to remove the cyst.** A large or symptomatic cyst may require surgery to drain and remove it. To access the cyst, the surgeon makes several small incisions in your skin and inserts special tools and a small video camera. While watching a video monitor in the operating room, the surgeon guides the tools to the kidney and uses them to drain the fluid from the cyst. Then the walls of the cyst are cut or burned away. Depending on the type of procedure your doctor recommends, treatment for your kidney cyst may require a brief hospital stay. **Source:** <https://www.mayoclinic.org/diseases-conditions/kidney-cysts/symptoms-causes/syc-20374134> **References:** - Bennett WM, et al. Simple and complex renal cysts in adults. <http://www.uptodate.com/home>. Accessed June 5, 2018. - Wein AJ, et al., eds. Benign renal tumors. *Campbell-Walsh Urology*. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. <http://www.clinicalkey.com>. Accessed May 15, 2015. - Simple kidney cysts. National Institute of Diabetes and Digestive and Kidney Diseases. <https://www.niddk.nih.gov/health-information/kidney-disease/simple-kidney-cysts>. Accessed June 5, 2018. - Bas O, et al. Management of renal cysts. *Journal of the Society of Laparoendoscopic Surgeons*. 2015;19:e2014.00097. - AskMayoExpert. Renal cysts (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. - Simple kidney cysts. National Kidney Foundation. <https://www.kidney.org/atoz/content/Simple-Kidney-Cysts>. Accessed June 5, 2018. - Albright RC (expert opinion). Mayo Clinic, Rochester, Minn. May 26, 2015. ---
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Care planKidney StonesA kidney stone is a hard deposit that forms inside the kidney when certain substances in your urine become too concentrated. Stones can range from as tiny as a grain of sand to as large as a pearl. Many kidney stones pass on their own, without any medical intervention. However, some stones get stuck along the urinary tract, block the flow of urine, and cause serious pain. **Watch for these warning signs of kidney stones:** - Severe, persistent pain in your back or side - Blood in your urine - Fever and chills - Vomiting - Urine that is cloudy or has an unusual odor - A burning sensation when you urinate **Source:** NIH: National Institute of Diabetes and Digestive and Kidney Diseases --- ## Understanding Kidney Stones With the right diet, plenty of water, and appropriate medications when needed, you can meaningfully reduce your chances of developing kidney stones — and perhaps pass them right out of your life for good. ### Prevention You may have heard the old saying about kidney stones: these, too, shall pass. But wouldn't it be better if they never formed in the first place? The good news is that preventing kidney stones may be easier than you think. ### Who Is at Greater Risk? "Kidney stones" is actually an umbrella term for several types of small, hard crystals that can form in the kidneys. They come in different varieties, stem from different causes, and are triggered by different dietary factors. Some develop as a result of kidney infections. Others form when certain minerals build up to excessive levels in your body. Genetics also play a meaningful role. Forty percent of people who develop kidney stones have family members who have had them too. In these individuals, the body may excrete too much calcium or too little citrate (a naturally occurring compound found in citrus fruits) in the urine. Middle-aged men are most commonly affected by kidney stones, though they can develop in people of any age or sex. Other conditions that raise your risk of kidney stones include: - **Obesity.** Carrying excess weight increases your likelihood of developing kidney stones. The same is true if you have diabetes. - **Gout.** This painful condition occurs when uric acid accumulates in the blood, leading to crystal formation in the joints or kidneys. - **Intestinal surgery.** Certain types of gastric bypass or other bowel surgeries can increase your risk. - **Hyperthyroidism.** An overactive thyroid can raise calcium levels in the blood, which may trigger kidney stone formation. - **Certain kidney diseases.** For example, polycystic kidney disease — in which clusters of cysts develop in the kidneys — and medullary sponge kidney, a congenital condition in which cysts form in the kidney's collecting tubes, both increase risk. **More Americans than ever are developing kidney stones, and the demographics of those at increased risk are changing**, a study published online January 14, 2016 in the *Clinical Journal of the American Society of Nephrology* has shown. > *"The emergence of kidney stones in children is particularly worrisome, because there is limited evidence on how to best treat children for this condition."* **The highest rate of increased incidence was observed among 15- to 19-year-olds, at 26% per 5 years after adjustment for age and sex.** The researchers believe that increased sodium intake, decreased calcium intake, and/or dehydration may be driving the rise in kidney stones among young people. **Postmenopausal hormone use linked to risk for kidney stones** — Estrogen therapy was associated with risk for nephrolithiasis in healthy postmenopausal women, according to the results of an analysis from the Women's Health Initiative (WHI) published in the October 11, 2010 issue of the *Archives of Internal Medicine*. > *"These data suggest that estrogen therapy increases the risk of nephrolithiasis in healthy postmenopausal women. These findings should be considered in decision making regarding postmenopausal estrogen use. The mechanisms underlying this higher susceptibility remain to be determined."* **Reference:** *Arch Intern Med.* 2010;170:1678–1685. ---
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Care planLactose IntoleranceLactose intolerance is the inability to break down lactose — a natural sugar found in dairy products like milk and yogurt. It happens when your small intestine stops making enough of an enzyme called **lactase**, which is responsible for digesting lactose. Without enough lactase, undigested lactose passes into your large intestine, where bacteria interact with it and trigger uncomfortable symptoms like bloating, gas, and diarrhea. You may also hear this condition referred to as **lactase deficiency**. Lactose intolerance is extremely common in adults — particularly those of Asian, African, and Hispanic descent. According to the Cleveland Clinic, more than 30 million Americans are lactose intolerant. While the condition isn't dangerous, it can certainly be disruptive to daily life. Symptoms typically appear within 30 minutes to two hours of consuming milk or other dairy products. Fortunately, there are practical strategies — from dietary adjustments to medications containing the lactase enzyme — that can help you manage or prevent these symptoms. ## Understanding Lactose Intolerance ### The Different Types of Lactose Intolerance Lactose intolerance isn't one-size-fits-all. There are three main types, each with a distinct cause: **Primary Lactose Intolerance (the most common type, related to aging)** Most people are born with plenty of lactase — babies need it to digest breast milk. But as we age and diversify our diets, our bodies naturally produce less of it. This gradual decline in lactase is the most common reason people develop lactose intolerance, and it's especially prevalent among people of Asian, African, and Hispanic ancestry. **Secondary Lactose Intolerance (triggered by illness or injury)** Certain conditions — such as celiac disease, inflammatory bowel disease (IBD), or an injury or surgery involving the small intestine — can impair lactase production. The good news is that if the underlying condition is treated, lactase levels may recover. **Congenital Lactose Intolerance (present from birth)** In very rare cases, lactose intolerance is inherited. A defective gene passed from parent to child can result in a complete absence of lactase from birth. Babies born with this condition cannot tolerate breast milk or lactose-containing formulas and will develop diarrhea as soon as these are introduced. If not recognized and treated early, the resulting dehydration and electrolyte loss can be life-threatening. Fortunately, switching to a lactose-free infant formula is an effective solution. **Developmental Lactose Intolerance (related to premature birth)** Premature babies can sometimes experience a temporary form of lactose intolerance because lactase production in the developing gut doesn't typically begin until after 34 weeks of pregnancy. This type usually resolves as the baby matures. ### Recognizing the Symptoms Symptoms of lactose intolerance typically appear within 30 minutes to two hours of eating or drinking dairy products. They may include: - Abdominal cramps - Bloating - Gas - Diarrhea - Nausea Symptom severity varies from person to person and depends on two key factors: how much lactose was consumed and how much lactase your body is still producing. ### How Is Lactose Intolerance Diagnosed? If you're experiencing cramps, bloating, and diarrhea after consuming dairy, your doctor may recommend testing to confirm lactose intolerance. The most common diagnostic tests measure how well lactase is working in your body and include: **Lactose Intolerance Blood Test** This blood test measures your body's response to drinking a liquid that contains a high concentration of lactose, tracking how well your body processes it. **Hydrogen Breath Test** After drinking a lactose-rich beverage, the amount of hydrogen in your breath is measured. When lactose isn't fully digested, the bacteria in your intestine ferment it — a process that releases hydrogen and other gases, which are eventually exhaled. Higher-than-normal hydrogen levels in your breath signal incomplete lactose digestion. **Stool Acidity Test** This test is most commonly used in infants and young children. It measures lactic acid in a stool sample, which accumulates when gut bacteria ferment undigested lactose. ### How Is Lactose Intolerance Treated? There is currently no way to boost your body's lactase production, but there are many effective ways to manage the condition. Treatment typically centers on reducing or eliminating dairy from your diet — though complete elimination isn't always necessary. Many lactose-intolerant people can still tolerate up to ½ cup of milk without symptoms. Lactose-free dairy products are widely available at most supermarkets, and not all dairy is equally problematic. Hard cheeses like cheddar, Swiss, and Parmesan, as well as cultured products like yogurt, tend to be lower in lactose and may be well tolerated. Low-fat and nonfat dairy products also tend to have less lactose. Over-the-counter lactase enzyme supplements — available as capsules, pills, chewables, or drops — can be taken before eating dairy to help with digestion. Drops can even be added directly to a carton of milk. If you do cut out dairy, be aware that you may become deficient in important nutrients, including: - Calcium - Vitamin D - Riboflavin - Protein It's recommended that you take calcium supplements or prioritize foods that are naturally rich in calcium or fortified with it to make up for any shortfall. ---
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Care planLeaky Blood-Brain BarrierYour brain is arguably the most important organ in your body — and nature knows it. To protect it from the countless potentially harmful substances circulating in your bloodstream, your brain is surrounded by a remarkable defense system called the **Blood-Brain Barrier (BBB)** — a single layer of tightly interlocked cells that acts like a highly selective security gate, keeping most substances out while carefully allowing only what the brain needs to pass through. On the "keep out" list: heavy metals, pesticides, PCBs, and damaging proteins. On the "welcome in" list: oxygen, hormones, and essential nutrients. ## Understanding Leaky Brain ### What Is a "Leaky Brain"? A leaky brain occurs when the Blood-Brain Barrier has been compromised. When the tight junctions holding the BBB together become loose or broken, the barrier becomes too permeable — and harmful substances that should be blocked can slip through into the brain. Once those harmful chemicals and proteins get in, they trigger inflammation. Put simply: a leaky brain is an inflamed brain. ### What Causes a Leaky Brain? The connection between your brain and your gut is deeper than most people realize — and science continues to confirm it. The microbes living in your gut influence your brain in powerful ways, both for better and for worse. Interestingly, the lining of the stomach and small intestine functions much like the blood-brain barrier, acting as its own protective shield against harmful substances. This means that many of the same factors that damage your gut lining — poor gut health, an unhealthy diet, food intolerances, food sensitivities, toxins, and infections — can also compromise your blood-brain barrier and contribute to a leaky brain. Research from Harvard has shown that wheat triggers leaky gut in everyone. A protein found in wheat and gluten called gliadin stimulates the production of another protein called zonulin. Zonulin weakens the tight junctions of both the gut lining and the BBB, paving the way for both leaky gut and leaky brain. ### Mental Health and the Leaky Brain Connection It makes intuitive sense that a leaky brain — with its resulting inflammation — can drive mental health conditions. What's less well-known is that the relationship works both ways: mental health conditions can themselves fuel inflammation and contribute to a leaky brain. Peripheral inflammation, which is causatively implicated in the pathogenesis of major psychiatric disorders, is associated with elevated peripheral pro-inflammatory cytokines, which in turn cause increased blood-brain barrier permeability. Reactive oxygen species, such as superoxide radicals and hydrogen peroxide, and reactive nitrogen species, such as nitric oxide and peroxynitrite, play essential roles in normal brain capillary endothelial cell functioning; however, chronically elevated oxidative and nitrosative stress can lead to mitochondrial dysfunction and damage to the blood-brain barrier. Factors that may be driving this cycle include: - Toxins - Stress hormones - Neurotransmitters - Stress ### The Brain-Gut Highway: Your Vagus Nerve Your brainstem connects to the vagus nerve, which in turn reaches every one of your digestive organs. It's a two-way communication highway: your brain sends signals down to your organs, and your organs send signals back up to your brain. The vagus nerve plays a key role in many critical digestive functions — including stomach acid production, digestive enzyme release, gallbladder activity, and the movement of food through your intestines. When brain-to-vagus communication breaks down, the consequences can be wide-ranging: - Chronic inflammation - Poor digestion - Leaky gut - An inflamed brain - Depression and related mental health conditions ### Signs and Symptoms of a Leaky Brain Leaky brain can show up in many different ways. Rather than dismissing these signs, pay close attention to them: - ADD/ADHD/Autism spectrum disorders - Brain fog or difficulty concentrating - Chronic fatigue that does not improve with rest or sleep - Headaches or migraines that come on suddenly, become worse with standing, and grow more severe as the day progresses - Memory loss or other cognitive decline, which may progress toward dementia and Alzheimer's disease - Mood disorders, particularly anxiety, depression, and schizophrenia - Peripheral neuropathy or muscular sclerosis - Seizures These symptoms matter — and they shouldn't be ignored. People living with a leaky brain face a higher risk of developing serious neurological or psychiatric conditions over time. Importantly, many of these conditions are not only signs and symptoms of leaky brain, but can also contribute to causing it. ### What Can a Leaky Brain Lead To? - Reduced mental ability, difficulty concentrating or multitasking, short and long-term memory loss, collectively referred to as **brain fog**, via prolonged activation of mast cells - An increase in VCAM-1 adhesion molecules which allow beta-amyloid peptides to accumulate in the brain forming plaques around nerve cells interrupting their function and blocking their nutrient supply, a process more commonly known as **Alzheimer's disease** - Changes in the transport of molecules between the brain and bloodstream which allow **Huntington Disease** to progress and decrease the number of proteins available to form tight junctions within the BBB - Brain inflammation and oxidative damage, increasing the risk for **schizophrenia**, by destroying BBB-supporting astroglial cells and triggering the release of toxic inflammatory agents further breaking down the BBB - Insufficient blood flow to the brain as well as abnormal brain activity, as seen in patients living with **depression**, because extended periods of brain inflammation disable adequate nerve function similar to schizophrenia ### Conditions That Can Contribute to a Leaky Brain - **Multiple Sclerosis** — People with this disease have high levels of MMP9 which damages nerves along with significant albumin in the brain which promotes inflammation and makes nerves more susceptible to glutamate toxicity. - **Autism** — More of a reciprocal relationship, Autism can cause Leaky Brain and vice versa; BBB permeability is higher in people diagnosed on the Autism spectrum thereby tolerating mast cell activation and inflammation. - **Seizures & Epilepsy** — Seizures interrupt BBB function, and prolonged seizures permit inflammation and albumin to rise in the brain increasing BBB permeability which can lead to chronic epilepsy. ---
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Care planLeaky BrainYour brain has its own built-in security system called the **blood-brain barrier** — a highly selective filter that lines the blood vessels of your brain. Think of it as a vigilant gatekeeper: it keeps dangerous substances out, lets nourishing nutrients in, and escorts cellular waste out. But this barrier isn't invincible. Under certain conditions, it can become compromised and "leaky," allowing unwanted substances to slip into the brain and trigger inflammation. This brain inflammation has been linked to a surprisingly wide range of conditions, including: - Depression - Anxiety - Brain fog - Headaches and migraines - Cognitive impairment - Alzheimer's - Parkinson's disease - ADHD - Schizophrenia and other psychological disorders --- ## Understanding Leaky Brain ### What's Behind a Leaky Brain? If you've heard of leaky gut, you're already partway to understanding leaky brain. The two conditions share many of the same root causes — and if you have one, there's a good chance you have the other. Here are the most common culprits behind both leaky gut and leaky brain: - Chronic stress - Systemic inflammation - Poor diet and antioxidant status - Head trauma - Elevated glucose and diabetes - Elevated homocysteine from B vitamin deficiency - Environmental toxins - Heavy metals - Autoimmune disease - Oxidative stress - Food additives - Sleep issues - Chronic infections - Excess alcohol consumption If any of these causes resonate with you — and especially if you're experiencing symptoms of leaky brain — it's well worth taking a closer look at how to protect and strengthen your blood-brain barrier. ---
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Care planLegg-Calve-Perthes DiseaseLegg-Calvé-Perthes (LEG-kahl-VAY-PER-tuz) disease is a childhood hip condition that occurs when blood flow to the "ball" portion of the hip joint — called the **femoral head** — is temporarily cut off, causing the bone to begin to die. As the bone weakens, it gradually breaks apart and can lose its naturally round shape. The body eventually restores blood flow to the ball, and healing begins. But if the ball is no longer round once it has healed, it can lead to lasting pain and stiffness. The entire cycle — bone death, fracture, and renewal — can unfold over the course of several years. To give the ball the best chance of healing in a round shape, doctors use a variety of treatments designed to keep it nestled snugly inside the socket portion of the joint. In this way, the socket acts as a natural mold for the healing femoral head. ## Understanding Legg-Calvé-Perthes Disease ### What to Watch For Signs and symptoms of Legg-Calvé-Perthes disease include: - Limping - Pain or stiffness in the hip, groin, thigh, or knee - Limited range of motion of the hip joint - Pain that worsens with activity and improves with rest Legg-Calvé-Perthes disease usually affects just one hip. In some children, both hips are involved — though typically at different points in time. ### When to Call the Doctor Schedule an appointment with your child's doctor if they begin limping or complain of pain in the hip, groin, or knee. If your child develops a fever or is unable to put weight on the leg, seek emergency medical care right away. ### Who Is Most at Risk? Risk factors for Legg-Calvé-Perthes disease include: - **Age.** Although Legg-Calvé-Perthes disease can affect children of nearly any age, it most commonly begins between ages 4 and 10. - **Your child's sex.** Legg-Calvé-Perthes is about four times more common in boys than in girls. - **Race.** White children are more likely to develop the disorder than are black children. - **Genetic mutations.** For a small number of people, Legg-Calvé-Perthes disease appears to be linked to mutations in certain genes, but more study is needed. ### Possible Long-Term Complications Children who have had Legg-Calvé-Perthes disease face a higher risk of developing hip arthritis as adults — especially if the hip joint heals in an abnormal shape. When the bones of the hip don't fit together properly after healing, the joint can wear out prematurely. In general, children diagnosed with Legg-Calvé-Perthes after age 6 are more likely to experience hip problems later in life. The younger a child is at the time of diagnosis, the greater the chances that the hip joint will heal in a normal, round shape. ### How Is It Diagnosed? During a physical exam, your child's doctor will move the legs into various positions to assess range of motion and identify any movements that cause pain. **Imaging studies** are essential to confirming a diagnosis of Legg-Calvé-Perthes disease and may include: - **X-rays.** Initial X-rays might look normal because it can take 1–2 months after symptoms begin for the changes associated with Legg-Calvé-Perthes disease to become evident on X-rays. Your doctor will likely recommend several X-rays over time to track the progression of the disease. - **MRI.** This technology uses radio waves and a strong magnetic field to produce very detailed images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by Legg-Calvé-Perthes disease more clearly than X-rays can, but are not always necessary. ### Treatment Options In Legg-Calvé-Perthes disease, the complete process of bone death, fracture, and renewal can take several years. The types of treatment recommended will depend on the: - Age when symptoms began - Stage of the disease - Amount of hip damage As Legg-Calvé-Perthes disease progresses, the ball part of the joint (femoral head) weakens and fragments. During healing, the socket part of the joint can serve as a mold to help the fragmented femoral head retain its round shape. For this molding to work, the femoral head must sit snugly within the socket. Sometimes this can be accomplished with a special type of leg cast that keeps the legs spread widely apart for 4–6 weeks. Some children require surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thigh bone or pelvis to realign the joint. Surgery usually isn't needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket typically continue to fit together well without surgery. ### Additional Conservative Treatments Some children, particularly very young ones, may need only conservative treatments or careful monitoring. Conservative treatments can include: - **Activity restrictions.** No running, jumping, or other high-impact activities that might accelerate hip damage. - **Crutches.** In some cases, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint. - **Physical therapy.** As the hip stiffens, the muscles and ligaments around it may shorten. Stretching exercises can help keep the hip more flexible. - **Anti-inflammatory medications.** Your doctor might recommend ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) to help relieve your child's pain. **Source:** <https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/symptoms-causes/syc-20374343> ---
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Care planLeptin & Leptin ResistanceLeptin is a hormone made by your body's fat cells that acts as a messenger between your body's fat stores and your brain, helping to control your appetite and keep your energy in balance. It is often called the "satiety hormone" or the "starvation hormone." Scientists discovered leptin in 1994, and research into its full range of effects is still ongoing. ## Understanding Leptin ### What Is Leptin? Leptin's primary target is your brain — specifically a region called the hypothalamus. Leptin tells your brain when you have enough fat stored, helping to prevent overeating and supporting healthy calorie burning. When the brain stops responding to leptin's signal — a state called **leptin resistance** — it can set the stage for obesity. ### What Does Leptin Actually Do? While leptin plays roles in fertility, immunity, and brain function, its central job is to regulate your body's energy over the long term — balancing how many calories you eat and burn, and how much fat your body holds onto. Leptin helps keep your food intake and energy use in long-term balance. It works to suppress hunger and maintain energy equilibrium so that your body doesn't trigger a hunger response when it already has plenty of fuel. Leptin acts primarily on your brainstem and hypothalamus to regulate hunger and energy balance, though leptin receptors are found throughout the body. Importantly, leptin doesn't influence your hunger from meal to meal. Instead, it operates on a longer timescale — fine-tuning your food intake and energy output over time to help keep your weight stable. Leptin's influence becomes especially pronounced when you lose weight. As body fat decreases, leptin levels fall — signaling to your brain that you may be starving. This can trigger intense hunger and appetite, driving you to eat more. Scientists continue to study leptin and believe it also plays a role in metabolism, hormonal regulation, and immune system function. ### What Controls Your Leptin Levels? Leptin is made and released by your white adipose tissue — the main type of body fat, found just under your skin, around your internal organs, and within the central cavity of your bones. Beyond energy storage, white adipose tissue also acts as cushioning to protect various parts of your body. The amount of leptin in your blood is directly proportional to how much body fat you have. Simply put: less body fat means less leptin, and more body fat means more leptin. Leptin levels rise as fat mass increases over time, and fall as fat mass decreases over time. ### How Is Leptin Measured? A simple blood test drawn from a vein in your arm can measure your leptin level. That said, leptin testing is not a routine part of medical care, and not all laboratories offer it. Doctors typically consider ordering a leptin test only in specific circumstances — such as when someone has obesity alongside persistent, uncontrollable hunger, or when a young child has severe obesity. **What are normal leptin levels?** Normal leptin level ranges can vary slightly from lab to lab. Always refer to the reference range listed on your specific laboratory report, or ask your doctor if you have questions about your results. In general, normal ranges for leptin levels include: | **Population** | **Normal Range** | |---|---| | Adults assigned female at birth | 0.5–15.2 nanograms per milliliter (ng/mL) | | Adults assigned male at birth | 0.5–12.5 ng/mL | ---
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Care planLeukoaraisis**White Matter Disease** is a condition that affects the nerve fibers connecting different regions of the brain to each other and to the spinal cord. These nerve fibers make up what is known as "white matter." Over time, white matter disease causes these critical connections to break down and lose function. You may also hear this condition referred to as **leukoaraiosis**. White matter disease involves the gradual deterioration of tissue found deep within the brain's largest region. This tissue houses millions of nerve fibers, called axons, that act like electrical cables — carrying signals between different parts of the brain and spinal cord. Wrapping these fibers is a protective, fatty coating called myelin, which gives white matter its characteristic color and helps signals travel quickly and efficiently. Healthy white matter allows you to think quickly, walk steadily, and maintain your balance. When disease sets in, the myelin breaks down, and those vital signals can no longer get through properly. The result is a brain that struggles to do what it once did with ease — much like a kinked garden hose that disrupts the steady flow of water. People living with white matter disease often notice a slow but steady decline in their ability to think clearly, along with worsening problems with balance and coordination. White matter disease is both age-related and progressive — meaning it tends to affect older individuals and worsens over time. How long someone lives after a diagnosis depends on how quickly the disease advances and whether it leads to other serious conditions, such as stroke or dementia. White matter disease is believed to contribute to both stroke and dementia, though scientists are still working to fully understand these connections and confirm the relationship. ### What Are the Symptoms? One of the challenges of white matter disease is that symptoms often don't become noticeable until the disease has already progressed. Early on, symptoms may be subtle — but they tend to become more pronounced over time. Symptoms of white matter disease may include: - Problems with balance - A slower, more cautious walking pace - Falling more often than usual - Difficulty doing two things at once, such as talking while walking - Depression - Unusual or unexplained mood changes It's worth noting that white matter disease is distinct from Alzheimer's disease, which primarily affects the brain's gray matter. If you or a loved one is experiencing memory difficulties, a physician will need to conduct testing to arrive at the correct diagnosis. ### What Causes White Matter Disease — and Who Is Most at Risk? At least one study suggests that white matter disease may be triggered by extremely small, silent strokes — strokes so minor that the person having them doesn't even realize it. These "silent strokes" are thought to damage white matter tissue over time and may also play a role in causing a type of memory loss called vascular dementia. More research is underway to confirm these links. A range of diseases, injuries, and toxic exposures can alter white matter. Doctors often point to the same blood vessel problems that drive heart disease and stroke as key culprits: - Chronically high blood pressure - Ongoing inflammation in the blood vessels - Smoking Women may be at somewhat greater risk. You may also be more vulnerable if you have any of the following: - Diabetes - High cholesterol - Parkinson's disease - A history of stroke Your genes may also play a role in your susceptibility. **Additional risk factors for white matter disease include:** - Cigarette smoking - Advancing age - Heart disease - High blood pressure - High cholesterol Of all these risk factors, age is the most common — which makes sense given that this is, at its core, an age-related disease. ### How Is Leukoaraiosis / White Matter Disease Diagnosed? Your doctor can diagnose white matter disease by carefully reviewing your symptoms and ordering imaging studies. Many people first come to their doctor with concerns about balance. After asking targeted questions about what you've been experiencing, your doctor will likely recommend an MRI of the brain. An MRI uses magnetic resonance technology to generate detailed images of the brain. To get the clearest look at the white matter, your doctor may order a specific type of MRI called a T2 FLAIR scan. This technique highlights the fine details of white matter and makes it easier to spot any abnormalities hiding within it. These abnormalities appear as areas that are brighter than the surrounding tissue — often described as "bright spots" or "white matter lesions." Both how many of these spots are present and where they appear in the brain help guide the diagnosis. The final diagnosis brings together the MRI findings, an assessment of your cardiovascular health, and a full picture of your symptoms. ### Potential Complications The complications of white matter disease arise from both its symptoms and the additional health conditions it can trigger. Some of the most significant potential complications include: - Balance problems that limit your ability to get around independently - Strokes - Vascular dementia - Difficulties with thinking and memory - A more difficult recovery after a stroke ### Prevention While age-related white matter disease does tend to progress, you are not powerless. There are meaningful steps you can take to slow its spread — and scientists believe that catching it early may even allow for some degree of repair. Keeping your blood pressure and blood sugar well-controlled is especially important, as both can drive white matter changes. To protect your heart and blood vessels, aim for a diet that is low in saturated fat and sodium, and strive for roughly 2 and a half hours of moderate-intensity physical activity each week. If you have diabetes, managing it carefully matters. Keep your cholesterol in a healthy range. And if you smoke — quitting now is one of the most powerful things you can do for your brain health. ### Treatment Options There is currently no cure for white matter disease, but treatments exist that can meaningfully improve quality of life and help manage symptoms. The cornerstone of treatment is physical therapy, which can address the balance and walking difficulties that so often accompany the disease. When you are able to move more freely and confidently — with less need for assistance — your overall physical and mental wellbeing tends to improve as well. Emerging research also suggests that protecting your vascular health is one of the most effective strategies for slowing the disease's progression. Avoiding smoking and taking prescribed blood pressure medications consistently may help keep symptoms from worsening. ### What's the Outlook? If you are experiencing any symptoms that may point to white matter disease, the most important step you can take is to talk with your doctor. There may be treatments available that can help slow the progression or better manage what you're experiencing. Research into white matter disease is actively ongoing, and the science is encouraging. The possibility that silent, mini-strokes are a root cause opens exciting doors — because if the cause can be confirmed, researchers may one day be able to prevent the disease entirely or develop targeted treatments. This understanding could also eventually lead to better ways of preventing and treating vascular dementia. **Sources:** - <https://www.healthline.com/health/white-matter-disease#outlook> - <https://www.webmd.com/brain/white-matter-disease> **References:** - Black S, et al. (2009). Understanding white matter disease: Imaging-pathological correlations in vascular cognitive impairment. doi: 10.1161/STROKEAHA.108.537704 - Chutinet A, et al. (2014). White matter disease as a biomarker for long-term cerebrovascular disease and dementia. doi: 10.1007/s11936-013-0292-z - Filley CM. (2012). White matter dementia. doi: 10.1177/1756285612454323 - Grueter BE, et al. (2012). Age-related cerebral white matter disease (leukoaraiosis): A review. doi: 10.1136/postgradmedj-2011-130307 - Sparto PJ. (n.d.). White Matter Disease [Fact sheet]. neuropt.org/docs/vsig-english-pt-fact-sheets/white-matter-disease.pdf?sfvrsn=2 - University Health Network. (2014). Researchers discover possible cause of common dementia, opening avenues for treatment [Press release]. uhn.ca/corporate/News/PressReleases/Pages/researchers_discover_possible_cause_dementia.aspx - University Health Network. (2014). What is white matter disease? It might be a cause of vascular dementia [Press release]. uhn.ca/corporate/News/Pages/what_is_white_matter_disease.aspx - White matter disease. (n.d.). ucl.ac.uk/drc/research-studies/white-matter-disease ---
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Care planLeukopeniaA low white blood cell count is a sign that your immune system is under stress — and the causes are more varied than you might think. Your emotional state, chronic stress, poor diet, and inadequate nutrition can all dial down your immune response and suppress white blood cell production. Certain health conditions, medical treatments, and even the natural process of aging can have the same effect. Whatever the underlying cause, a weakened immune system and low white blood cell count leave your body less equipped to defend itself against infections and illness. ## Understanding Low White Blood Cell Count White blood cells (WBCs) are the cornerstone of your immune defenses, and what you eat has a profound impact on how well they work. The following nutrients have been identified as especially important for keeping your WBCs healthy and functioning at their best: ### 1. Vitamin C - **What it does:** Vitamin C is essential for the activity of phagocytes and lymphocytes — two key types of WBCs that your body deploys to fight infection. It also stimulates the production of interferons, proteins that amplify your immune response. - **Where to find it:** Citrus fruits, bell peppers, strawberries, and broccoli. - **What the research says:** Studies have shown that vitamin C deficiency weakens immune function, while supplementation can boost WBC production and activity and lower your risk of infections. (see **[Vitamin C 1000 Complex](https://nutridyn.com/vitamin-c-1000-complex)**) ### 2. Vitamin D - **What it does:** Vitamin D guides the development and activity of T cells and macrophages — immune cells that power both your targeted (adaptive) and frontline (innate) immune responses. - **Where to find it:** Sun exposure, fortified foods, fatty fish, and supplements. - **What the research says:** Vitamin D deficiency is linked to greater vulnerability to infections and lower WBC counts. A major meta-analysis found that vitamin D supplementation reduces the risk of respiratory infections by strengthening WBC function. (see **[D3 5000 with K2](https://nutridyn.com/d3-5000-with-k2)**) ### 3. Zinc - **What it does:** Zinc is essential for the growth and activity of neutrophils, macrophages, and natural killer cells. It also plays a key role in cytokine signaling and the process by which immune cells engulf and destroy pathogens. - **Where to find it:** Shellfish, meat, legumes, seeds, and nuts. - **What the research says:** Zinc deficiency impairs immune function and lowers WBC counts, while zinc supplementation can restore WBC activity — particularly in older adults. (see **[Zinc Pro](https://nutridyn.com/zinc-pro)**) ### 4. Iron - **What it does:** Iron fuels the multiplication of immune cells — especially lymphocytes — and supports the enzymes that drive your immune response. - **Where to find it:** Red meat, spinach, lentils, and fortified cereals. - **What the research says:** Iron deficiency anemia has been shown to reduce WBC counts and weaken immune defenses, particularly in women and children. (see **[Iron Support](https://nutridyn.com/iron-support)**) ### 5. Omega-3 Fatty Acids - **What they do:** Omega-3 fatty acids help fine-tune your body's inflammatory response by influencing cytokine production and supporting the resolution of inflammation — helping to keep your immune system balanced and your WBCs working properly. - **Where to find them:** Fatty fish (e.g., salmon), flaxseeds, walnuts, and fish oil supplements. - **What the research says:** Omega-3 supplementation has been shown to reduce chronic inflammation and support the production and function of WBCs in response to infection. (see **[Omega Pure Complete](https://nutridyn.com/omega-pure-complete)**) ### 6. Folate and Vitamin B12 - **What they do:** Folate and vitamin B12 are both required for DNA synthesis and cell division — processes that are absolutely critical for generating new WBCs, particularly lymphocytes. - **Where to find them:** Leafy green vegetables and legumes (for folate); meat, fish, and dairy products (for B12). - **What the research says:** Deficiencies in either of these vitamins can cause WBC counts to drop, impairing your body's ability to mount an effective immune response. (Folate and Vitamin B12 are included in **[Iron Support](https://nutridyn.com/iron-support)** if there is an iron deficiency, or consider the **[B-Complex](https://nutridyn.com/b-complex)** if no iron-related deficiency.) ### 7. Protein - **What it does:** Your body depends on adequate protein to manufacture antibodies and produce new WBCs. The amino acids that make up proteins are indispensable building blocks for immune cell function. - **Where to find it:** Lean meats, poultry, fish, legumes, and dairy products. - **What the research says:** Protein malnutrition can impair immune function, reduce lymphocyte numbers, and diminish your body's capacity to fight off infections. (consider **[Paleo Protein](https://nutridyn.com/dynamic-paleo-protein)** or **[Whey Protein](https://nutridyn.com/dynamic-whey-protein-18243)**) ### The Bottom Line Nutrition is a foundational pillar of immune health. Deficiencies in protein and key vitamins and minerals — including vitamin C, vitamin D, folate, vitamin B12, zinc, and iron — can weaken your immune response. Conversely, meeting your nutritional needs helps your body produce and maintain healthy WBCs and better defend itself against infection. **References:** 1. Hemilä H, et al. Vitamin C and Infections. *Nutrients*, 2017. 2. Carr AC, et al. Vitamin C and Immune Function. *Nutrients*, 2017. 3. Martineau AR, et al. Vitamin D Supplementation to Prevent Acute Respiratory Tract Infections. *BMJ*, 2017. 4. Chun RF, et al. Vitamin D and Immunity. *Dermato-Endocrinology*, 2011. 5. Prasad AS, et al. Zinc in Human Health: Effect of Zinc on Immune Cells. *Molecular Medicine*, 2008. 6. Barnett JB, et al. Zinc Status and Immune Function: The Biological Basis of Altered Resistance to Infection. *American Journal of Clinical Nutrition*, 2010. 7. Weiss G, et al. Anemia of Chronic Disease and Anemia of Inflammation. *Blood*, 2005. 8. Simopoulos AP. The Importance of the Omega-6/Omega-3 Fatty Acid Ratio in Cardiovascular Disease and Other Chronic Diseases. *Experimental Biology and Medicine*, 2008. 9. Calder PC. Omega-3 Fatty Acids and Inflammatory Processes. *Nutritional Research Reviews*, 2009. 10. McNulty H, et al. Folate and Vitamin B12: Their Role in Health. *Critical Reviews in Food Science and Nutrition*, 2008. 11. Calder PC, et al. Protein and Amino Acids in the Immune System. *Proceedings of the Nutrition Society*, 2002. 12. Chandra RK. Nutrition and the Immune System: An Introduction. *The American Journal of Clinical Nutrition*, 1997. ---
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Care planLewy Body DementiaLewy body dementia — sometimes called dementia with Lewy bodies — is the second most common form of progressive dementia, ranking just behind Alzheimer's disease. It occurs when abnormal protein clumps, called **Lewy bodies**, build up inside nerve cells in the parts of the brain that govern thinking, memory, and movement. Lewy body dementia causes a steady decline in mental function over time. People living with the condition may experience vivid visual hallucinations and unpredictable shifts in alertness and attention. Many also develop physical symptoms resembling Parkinson's disease — things like muscle stiffness, slowed movement, difficulty walking, and tremors. ## Understanding Lewy Body Dementia ### Signs and Symptoms Lewy body dementia can show up in many different ways. Common signs and symptoms include: - **Visual hallucinations.** Seeing things that aren't there is often one of the earliest signs, and it tends to happen repeatedly. People may see shapes, animals, or people that don't exist. Hallucinations involving sound, smell, or touch are also possible. - **Movement problems.** Parkinson's-like symptoms — such as slowed movement, stiff muscles, tremors, or a shuffling gait — are common and can lead to falls. - **Trouble with automatic body functions.** The part of the nervous system that quietly regulates things like blood pressure, heart rate, sweating, and digestion is often affected. This can cause blood pressure to drop suddenly when standing up, dizziness, falls, loss of bladder control, and constipation. - **Thinking and memory problems.** Confusion, trouble focusing, visual-spatial difficulties, and memory loss — similar to what's seen in Alzheimer's disease — may develop. - **Sleep disturbances.** REM sleep behavior disorder can cause a person to physically act out their dreams — punching, kicking, yelling, or screaming while asleep. - **Fluctuating alertness.** Episodes of drowsiness, long stretches of staring blankly, daytime napping, or disorganized speech can come and go unpredictably. - **Depression.** Feelings of depression may develop. - **Apathy.** A loss of motivation or interest in things that once mattered is common. ### What Causes It? Lewy body dementia is driven by an abnormal accumulation of a protein that clumps together into structures called Lewy bodies. This same protein is involved in Parkinson's disease. Interestingly, people whose brains contain Lewy bodies often also have the plaques and tangles associated with Alzheimer's disease — suggesting significant overlap between these conditions. ### Who Is at Risk? Several factors appear to raise a person's chances of developing Lewy body dementia: - **Age.** People over 60 face a higher risk. - **Sex.** Lewy body dementia is more common in men than in women. - **Family history.** Having a close relative with Lewy body dementia or Parkinson's disease increases the risk. ### How Does It Progress? Lewy body dementia is a progressive disease, meaning symptoms worsen over time. As the condition advances, it can lead to: - Severe dementia - Aggressive behavior - Depression - Increased risk of falling and injury - Worsening of parkinsonian signs and symptoms, such as tremors - Death, on average about seven to eight years after symptoms start ### How Is It Diagnosed? A diagnosis of Lewy body dementia requires evidence of a progressive decline in thinking ability, plus at least two of the following: - Fluctuating alertness and thinking function - Repeated visual hallucinations - Parkinsonian symptoms - REM sleep behavior disorder, in which people act out their dreams during sleep Instability in blood pressure and heart rate, poor body temperature regulation, and excessive sweating can further support the diagnosis. Sensitivity to antipsychotic medications — especially older ones like haloperidol (Haldol) — is another important clue; these drugs can trigger a severe and dangerous reaction in people with Lewy body dementia and must be avoided. No single test can confirm Lewy body dementia. Diagnosis relies on the overall pattern of signs and symptoms and ruling out other conditions. The following tests are commonly used: **Neurological and physical examination.** Your doctor will look for signs of Parkinson's disease, stroke, tumors, or other conditions affecting the brain and body. A neurological exam evaluates reflexes, strength, walking, muscle tone, eye movements, balance, and sense of touch. **Cognitive testing.** A brief version of this test — which checks memory and thinking — can be completed in under 10 minutes at your doctor's office. While it won't necessarily distinguish Lewy body dementia from Alzheimer's disease, it can confirm whether cognitive problems are present. More detailed testing, lasting several hours, is better at pinpointing Lewy body dementia specifically. **Blood tests.** Blood work can rule out physical conditions that impair brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. **Brain imaging.** An MRI or CT scan may be ordered to look for evidence of stroke, bleeding, or tumors. While dementia is primarily diagnosed through history and physical examination, brain imaging can reveal patterns that help distinguish between types — such as Alzheimer's versus Lewy body dementia. If the diagnosis remains unclear or symptoms are atypical, additional imaging may be recommended, including: - Fluorodeoxyglucose PET brain scans, which assess brain function. - Single-photon emission computerized tomography (SPECT) or PET imaging, which can determine whether dopamine transporter uptake is reduced in the brain. **Sleep testing.** A sleep study called a polysomnogram may be ordered to detect REM sleep behavior disorder. An autonomic function test may also be used to look for instability in heart rate and blood pressure. **Heart imaging.** In some countries, a heart imaging test called myocardial scintigraphy is used to check blood flow to the heart for signs pointing toward Lewy body dementia. This test is not currently used in the United States. **Emerging biomarkers.** Researchers are actively investigating new biological indicators of Lewy body dementia. These biomarkers hold the promise of allowing earlier diagnosis — even before the full disease takes hold. ---
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Care planLichen PlanusLichen planus (like-en play-nes) is an inflammatory skin condition that produces a distinctive rash. It can appear on your arms, legs, scalp, nails, genitals, and the inside of your mouth. For most people, it clears up on its own — but when symptoms like itching become bothersome, effective treatments are available. Lichen planus can affect your: - Skin - Inside of your mouth (oral mucosa) - Scalp (the skin on your head, usually covered with hair) - Nails - Genitals (penis, vagina, and vulva) Lichen planus belongs to a family of skin conditions called **lichenoid dermatoses** — a term doctors use to describe disorders marked by firm, raised, discolored bumps on the skin. --- ## Understanding Lichen Planus ### Who Gets Lichen Planus — and Why? No single cause has been pinpointed, but a number of medical conditions and environmental factors appear to contribute to its development. - **Genetics:** Your risk is higher if a close family member has been diagnosed with lichen planus. - **Hepatitis C:** Research has found a meaningful link between hepatitis C infection and lichen planus, including a rarer form called lichen planus pigmentosus. - **Allergens:** Exposure to certain artificial dyes and chemicals may trigger an outbreak. - **Medications:** Certain drugs containing arsenic, bismuth, gold, or quinidine — including some antibiotics, diuretics, and medications for diabetes, malaria, high blood pressure, and heart disease — can provoke a flare. A drug that triggers a lichen planus eruption is called a *lichenoid drug*. - **Bone marrow transplant** recipients are at increased risk. - **Age and sex:** It is most common in middle-aged adults. Perimenopausal women appear to be at greater risk than most other healthy adults. - **Amalgam dental fillings:** Metal fillings may act as an allergen and contribute to the development of oral lichen planus. ### Is Lichen Planus an Autoimmune Condition? Lichen planus isn't technically an autoimmune disease, but it can trigger a similar kind of response. It's an idiopathic condition — meaning its root cause is unknown — that produces inflammation in the skin. **In lichen planus, your body's own immune system turns against parts of itself rather than defending you from outside threats like bacteria or viruses.** In a healthy immune system, specialized cells called T cells stand guard against infection. In people with lichen planus, those same T cells mistakenly attack a protein found in the skin and mucous membranes. Why this happens remains a mystery. ### Who Is Most Likely to Develop Lichen Planus? Anyone can develop lichen planus, but it is most common in adults between the ages of 30 and 60, and it occurs more frequently in women. Some studies suggest women may be affected twice as often as men. Women tend to develop it in their 60s, while men are more likely to develop it in their 40s. If you have lichen planus on your skin, there is a **50% to 75%** chance you also have it in your mouth. ### How Common Is Lichen Planus? Lichen planus affects approximately **0.22% to 1%** of the adult population. The oral form affects **1% to 4%** of people worldwide. ### How Does Lichen Planus Affect the Body? Lichen planus most commonly appears around the wrists and elbows (flexor surfaces), the backs of the hands, and the fronts of the lower legs. About half of all people with lichen planus also develop oral lichen planus, which affects the skin inside the mouth and on the tongue. The affected spots (lesions) typically begin as tiny raised dots (papules) roughly the size of a pin tip (0.4 mm) and may grow to about the width of a pencil (1 cm). Oral lichen planus usually starts as tiny white dots on the inner cheeks or tongue. In more severe cases, the surrounding skin can become inflamed and painful sores may develop. ---
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Care planLipedemaLipedema is a chronic, progressive condition in which abnormal fat builds up — typically in the lower body (hips, thighs, buttocks, and legs), and sometimes in the arms. It primarily affects women and is closely tied to hormonal shifts like puberty, pregnancy, or menopause. Here is what makes lipedema distinct: - **Where the Fat Goes:** Fat builds up disproportionately in affected areas, giving the legs — and sometimes arms — a thick, column-like appearance. Notably, the feet and hands are typically unaffected. - **Pain and Tenderness:** Affected areas are often painful to the touch and bruise easily. Many people experience tenderness and swelling that worsens over time. - **Swelling That Doesn't Respond to Diet or Exercise:** Lipedema is frequently confused with obesity or lymphedema because of swelling, but unlike general obesity, it does not respond to diet and exercise in the usual way. - **Challenges with Movement:** As lipedema advances, the abnormal fat buildup can make everyday movement uncomfortable and increasingly difficult. - **Impact on the Lymphatic System:** In later stages, lipedema can disrupt the lymphatic system, giving rise to a secondary condition called lipo-lymphedema — where both fat and lymphatic fluid accumulate, causing more pronounced swelling. The exact cause of lipedema remains unknown, though it appears to have a genetic component and is linked to hormonal changes. While there is no cure, treatment focuses on managing symptoms and improving day-to-day quality of life. --- ## Understanding Lipedema Below is a summary of natural approaches to managing lipedema, drawn from the references listed further below. ### Natural Management Approaches 1. **Manual Lymphatic Drainage (MLD):** A gentle massage technique designed to stimulate the lymphatic system and reduce swelling. It is often combined with compression therapy for even better results. 2. **Compression Therapy:** Wearing compression garments helps support the lymphatic system, reduce swelling, and improve mobility. 3. **Dietary Changes:** - **Anti-inflammatory eating patterns** — such as the Mediterranean diet, low-carb, ketogenic, and plant-based diets — can help reduce inflammation and swelling in lipedema. - **Low-carb and ketogenic diets** are thought to help manage fat accumulation and curb inflammation. 4. **Exercise:** Low-impact activities like swimming, walking, and cycling are highly recommended — they stimulate circulation without placing excessive strain on the body. Staying regularly active improves lymphatic flow and supports healthy weight management. 5. **Physical Therapies:** Approaches such as **physiotherapy, aqua therapy, and movement therapy** can improve mobility and ease the discomfort associated with lipedema. 6. **Herbal Supplements and Anti-Inflammatory Agents:** Certain natural supplements — including turmeric, omega-3 fatty acids, systemic enzymes, and other anti-inflammatory agents — may help reduce pain and swelling. 7. **Lymphatic Imaging (to guide treatment):** Imaging of the lymphatic system can lead to a more accurate diagnosis and help tailor therapies like MLD and compression to each individual. 8. **Complementary Therapies:** **Acupuncture** and other complementary treatments have been explored as additional tools for managing symptoms like pain and swelling. These natural strategies are most effective when used together — combining approaches to reduce swelling, support healthy weight, and improve quality of life for people living with lipedema. ### References on Natural Approaches to Lipedema Below is a list of references exploring natural approaches to lipedema management, including dietary, lifestyle, and complementary therapies: 1. Földi E, Földi M. *Földi's Textbook of Lymphology: For Physicians and Lymphedema Therapists*. Elsevier Health Sciences; 2012. - This textbook includes approaches to managing lymphatic and fat disorders like lipedema, focusing on manual lymphatic drainage (MLD), compression therapy, and exercise. 2. Herbst KL. "Lipedema and the effects of keto, low-carb, and anti-inflammatory diets." *International Journal of Obesity*. 2012;36(5):665–674. - This article explores dietary modifications, particularly low-carb and ketogenic diets, for managing lipedema. 3. Rasmussen JC, et al. "New lymphatic imaging techniques and their role in lipedema diagnosis and treatment." *Journal of Vascular Surgery*. 2010;52(4):1068–1074. - Discusses the role of lymphatic imaging in lipedema diagnosis and how this can guide natural treatments like lymphatic massage and movement therapies. 4. Stutz J, Krahl D. "Liposuction in the treatment of lipedema: A longitudinal study." *Plastic and Reconstructive Surgery*. 2009;123(2):891–897. - Though this study focuses on liposuction, it provides insight into non-invasive supportive therapies, including compression garments and physical activity as part of a comprehensive care approach. 5. Langendoen SI, et al. "The Netherlands Lipedema Study: Non-surgical interventions to improve quality of life." *Lymphatic Research and Biology*. 2009;7(1):2–10. - Discusses various non-surgical, natural interventions to manage symptoms of lipedema, including massage, dietary strategies, and exercise. 6. Sztanek F, et al. "The impact of anti-inflammatory diets and physical therapies on lipedema progression: A review." *Journal of Inflammation Research*. 2017;10:123–133. - This review covers the effects of different anti-inflammatory diets, such as Mediterranean and low-inflammatory diets, on lipedema symptoms, as well as the role of physical therapies like swimming and walking. 7. Wollina U, et al. "Natural Treatments and Conservative Care Approaches in Lipedema Management." *Journal of Dermatology and Cosmetology*. 2021;5(1):34–42. - This article outlines conservative treatments for lipedema, emphasizing the benefits of natural remedies, herbal supplements, and alternative therapies like acupuncture. 8. Bertsch T, Erbacher G. "Manual lymphatic drainage in combination with natural anti-inflammatory strategies for lipedema." *Lymphology*. 2018;51(1):25–31. - This article examines the synergistic effects of lymphatic drainage and dietary adjustments on managing lipedema symptoms. These references span both conventional and natural approaches to lipedema, with a shared emphasis on dietary changes, lymphatic support, and complementary therapies. ---
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Care planLiver DiseaseYour liver is the largest organ inside your body — and one of the hardest working. It helps you digest food, store energy, and filter out harmful substances before they can do damage. **Liver disease comes in many forms.** Some are caused by viruses, such as hepatitis A, hepatitis B, and hepatitis C. Others develop from exposure to certain drugs, environmental toxins, or long-term alcohol use. When the liver becomes so damaged that it begins forming scar tissue, the condition is called cirrhosis. One of the most recognizable warning signs of liver disease is jaundice — a yellowing of the skin and eyes. --- ## Understanding Liver Disease ### Cirrhosis: When the Liver Scars Cirrhosis is the medical term for scarring of the liver. This scar tissue forms in response to injury or chronic, ongoing disease. Unlike healthy liver tissue — which makes proteins, helps fight infections, cleans the blood, supports digestion, and stores energy — scar tissue cannot perform any of these vital functions. Over time, cirrhosis can lead to a range of serious complications: - Easy bruising or bleeding, or nosebleeds - Swelling of the abdomen or legs - Extra sensitivity to medicines - High blood pressure in the vein entering the liver - Enlarged veins called varices in the esophagus and stomach; varices can bleed suddenly - Kidney failure - Jaundice - Severe itching - Gallstones A small number of people with cirrhosis go on to develop liver cancer. In the United States, the most common causes of cirrhosis are chronic alcohol use and hepatitis. **Source:** <https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487> ---
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Care planLiver / Gallbladder Dysfunction and Gallstones**Liver Disease (Hepatopathy)** refers to any disease of the liver. A hepatotoxin is a poison that damages or destroys liver cells. **Cirrhosis** is a serious liver disease in which healthy liver tissue is gradually replaced by scar tissue (fibrous bands of connective tissue), destroying the liver's normal internal architecture and squeezing it into irregular, lumpy nodules. The term is sometimes used more broadly to describe chronic scarring and inflammation of other organs as well. Cirrhosis of the liver is actually an umbrella term for a group of chronic liver diseases. It often hides quietly for years — then suddenly announces itself with symptoms like abdominal pain and swelling, vomiting of blood, fluid accumulation in the legs, or yellowing of the skin (jaundice). In advanced stages, massive fluid buildup in the belly (ascites), deep jaundice, dangerously elevated blood pressure in the liver's venous system (portal hypertension), and brain dysfunction — potentially leading to liver-related coma — become the defining features. **Cholestasis** is a condition in which bile flow is slowed or completely blocked, either due to a problem within the liver itself (intrahepatic cholestasis) or from an obstruction outside the liver (extrahepatic cholestasis). **Gallstones** are the most common problem affecting the gallbladder — small, rounded deposits made up of cholesterol, bile, pigments, and a fatty substance called lecithin. Women over forty who are fair-skinned and overweight are at the greatest risk for gallstones. Overall, women are four times more likely than men to develop them. Important factors to consider include: food allergies (especially to dairy products and eggs), digestive problems (especially those caused by low stomach acid, or HCl deficiency), intestinal disease, a diet that is very low in fiber, food intolerances, parasites, rapid weight loss, and chronic stress. Constipation may also play a role in gallstone formation. Jonathan V. Wright, M.D. states that most gallbladder surgeries could be easily avoided through nutritional and natural intervention, with emphasis on nutritional support for healthy liver and gallbladder function, along with identification, avoidance, and treatment of food allergies. ---
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Care planLow Back PainIf you suffer from lower back pain, you are far from alone. About **80 percent** of adults will experience it at some point in their lives — making it the most common cause of work-related disability and one of the top reasons people miss work. In fact, in a large national survey, more than a quarter of adults reported having low back pain in just the past 3 months. Low back pain affects men and women equally, and it can feel very different from person to person — ranging from a dull, persistent ache to a sudden, sharp jolt that stops you in your tracks. It can come on suddenly after an accident or an awkward lift, or it can creep in gradually as your spine naturally ages. Even a sedentary lifestyle can set the stage for back pain, particularly when long, inactive workweeks are interrupted by intense weekend exercise. Most low back pain is acute — meaning short-term — and resolves within a few days to a few weeks, often with simple self-care and no lasting effects. The majority of acute low back pain is mechanical in nature, meaning something has gone slightly awry in the way the parts of your back — the spine, muscles, discs, and nerves — work together and move. When pain lingers between 4 and 12 weeks, it's called subacute. When it persists beyond 12 weeks — even after the original injury or underlying cause has been addressed — it becomes chronic back pain. About **20 percent** of people with acute low back pain go on to develop chronic pain with symptoms still present at the one-year mark. While treatment helps many people find lasting relief, others continue to struggle even after medical or surgical intervention. The overall burden of low back pain has grown significantly in recent decades. In 1990, it ranked sixth among the most burdensome health conditions in the United States in terms of death and disability. By 2010, it had climbed to third — surpassed only by ischemic heart disease and chronic obstructive pulmonary disease. --- ## Understanding Low Back Pain ### What Structures Make Up Your Back? Most back pain originates in the lumbar region — the lower portion of the spine made up of five vertebrae (labeled L1–L5) that bear much of the weight of your upper body. Between these vertebrae sit round, rubbery cushions called intervertebral discs, which act as shock absorbers as you move. Strong bands of tissue called ligaments hold the vertebrae in place, while tendons anchor your muscles to the spinal column. Thirty-one pairs of nerves branch out from the spinal cord, controlling body movements and carrying signals back and forth between your body and brain. **The human disc is made of 66% to 86% water, with the remainder consisting primarily of type II collagen (it may also contain type VI, IX, and XI) and proteoglycans.** The proteoglycans include the larger aggrecan and versican that bind to hyaluronic acid and several small leucine-rich proteoglycans. **Source:** <https://www.ncbi.nlm.nih.gov/books/NBK470583/> ### What Causes Lower Back Pain? The vast majority of low back pain is mechanical in origin. It is frequently linked to spondylosis — a broad term for the general wear-and-tear degeneration that naturally affects the joints, discs, and bones of the spine as we age. Some of the most common mechanical causes of low back pain include: - **Sprains and strains** are responsible for most cases of acute back pain. Sprains involve overstretching or tearing ligaments, while strains affect tendons or muscles. Both can result from twisting, lifting improperly, lifting something too heavy, or overexertion — and both can trigger painful muscle spasms in the back. - **Intervertebral disc degeneration** is among the most common mechanical causes of low back pain. As we age, the normally resilient discs gradually lose their structure and hydration, diminishing their ability to cushion the vertebrae and support flexible movement. - **Herniated or ruptured discs** occur when intervertebral discs are compressed and bulge outward (herniation) or tear open (rupture), both of which can cause significant low back pain. - **Radiculopathy** is pain caused by compression, inflammation, or injury to a spinal nerve root. When a nerve root is irritated or pinched, it can produce pain, numbness, or tingling that radiates into other parts of the body supplied by that nerve. Radiculopathy commonly results from spinal stenosis or a herniated disc pressing on the nerve root. - **Sciatica** is a specific type of radiculopathy caused by compression of the sciatic nerve — the large nerve that runs through the buttocks and down the back of the leg. It produces a characteristic shock-like or burning pain that travels from the lower back through the buttock and down one leg, sometimes reaching the foot. In severe cases, where the nerve is pinched between a disc and adjacent bone, it can also cause numbness and muscle weakness in the leg. Sciatica can also be caused by a tumor or cyst pressing on the sciatic nerve or its roots. - **Spondylolisthesis** occurs when a vertebra in the lower spine slips forward out of alignment, compressing the nerves that exit the spinal column. - A **traumatic injury** — from a sports collision, car accident, or fall — can damage tendons, ligaments, or muscles and cause low back pain. Trauma can also compress the spine, potentially causing a disc to rupture or herniate and press on nearby nerves. When spinal nerves are compressed and irritated this way, both back pain and sciatica can develop. - **Spinal stenosis** is a narrowing of the spinal canal that puts pressure on the spinal cord and surrounding nerves. It can cause pain or numbness with walking and, over time, may lead to leg weakness and loss of sensation. - **Skeletal irregularities** such as scoliosis (an abnormal sideways curvature of the spine that typically doesn't cause pain until middle age), lordosis (an exaggerated inward arch of the lower back), and other spine abnormalities present from birth can also contribute to low back pain. ### Important Heads-Up: Anti-Inflammatory Drugs May Actually Make Pain Harder to Treat Over Time A May 2022 study challenges the longstanding practice of reaching for steroids or anti-inflammatory medications like ibuprofen when low back pain doesn't quickly respond to exercise or other non-drug therapies. **Those medications offer relief from acute pain but may actually increase a person's chances of developing chronic pain,** said the study published in *Science Translational Medicine*. **The study indicates that inflammation is a normal part of recovering from a painful injury and that inhibiting inflammation may result in more-difficult-to-treat chronic pain.** McGill University noted that other studies support these findings, including an analysis of 500,000 people in the United Kingdom. That analysis found that people who took anti-inflammatory drugs for pain were more likely to still be experiencing pain 2 to 10 years later. **Sources:** - *Science Translational Medicine*: "Acute inflammatory response via neutrophil activation protects against the development of chronic pain." 11 May 2022. Vol 14, Issue 644. doi: 10.1126/scitranslmed.abj9954. <https://www.science.org/doi/10.1126/scitranslmed.abj9954> - McGill University: "Discovery reveals blocking inflammation may lead to chronic pain." - CDC: "Acute Low Back Pain." - The New York Times: "Common Medications Can Prolong Back Pain When Overused, Study Says." ### A Closer Look: Could a Bacterial Infection Trigger Disc Disease? - Bacteria are commonly found in the disc material of people undergoing spinal surgery - There is moderate evidence linking the presence of bacteria to both low back pain with disc herniation and Modic Type 1 changes - Research has identified bacterial proteins and immune defense proteins in disc tissue, strengthening the hypothesis that infection may be an early trigger of disc disease **References:** - Rajasekaran S, Tangavel C, Aiyer SN, et al. ISSLS Prize in Clinical Science 2017: Is infection the possible initiator of disc disease? An insight from proteomic analysis. *Eur Spine J*. 6 Feb 2021;26:1384–1400. - Urquhart DM, Zheng Y, Cheng AC, et al. Could low grade bacterial infection contribute to low back pain? A systematic review. *BMC Med*. 2015;13:13. ---
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Care planLow EstrogenEstrogen and progesterone are two of the most important sex hormones in the human body. Estrogen drives the development of female sex characteristics and reproductive function. Progesterone plays a key supporting role in the menstrual cycle and throughout pregnancy. When estrogen and progesterone levels fall — as they naturally do during menopause — you may notice real effects on your mood, libido, bone strength, and more. The good news? Certain foods, vitamins, and herbs may help naturally support your estrogen levels. Promising options include soybeans, B vitamins, evening primrose oil, and dong quai. ---
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Care planLow-FODMAP DietThe low-FODMAP diet was developed at Monash University in Australia as a way to help people manage digestive symptoms. It works by avoiding certain types of carbohydrates that some people have trouble absorbing. **FODMAP** is an acronym that stands for **F**ermentable **O**ligosaccharides, **D**isaccharides, **M**onosaccharides, **A**nd **P**olyols. Think of these as specific types of sugars and fibers that your gut may struggle to absorb properly. When they aren't absorbed, bacteria living in your digestive tract begin to feast on them — producing gases and other byproducts that can trigger symptoms like bloating, cramping, and diarrhea. Over time, this can also allow those bacteria to multiply and spread into areas of the gut where they don't belong, contributing to a range of other health concerns. --- ## Understanding the Rules Behind the Diet ### Why Are Some Sweeteners Allowed While Others Are Not? It all comes down to how well your body absorbs them. Glucose is a sugar that your gut handles with ease. Other sweeteners contain sugars that are not as readily absorbed. The classic example involves fructose: when a food contains more free fructose than glucose, your gut can struggle to keep up — which is exactly why some fruits are perfectly fine on a low-FODMAP diet while others are not. ### Adding Flavor to Your Meals One of the trickier aspects of the low-FODMAP diet is giving up garlic and onions — two of the most beloved flavor-builders in the kitchen. But here's a helpful workaround: FODMAPs don't dissolve in oil. That means you can sauté garlic or onions in olive oil for about 5 minutes, then remove and discard the solids. The fragrant, flavored oil that remains is low-FODMAP and can be used to season your dishes without the digestive consequences. Beyond that, the green tops of scallions are safe to use, as are chives and most everyday spices including salt, pepper, and chile peppers. ---
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Care planLow Testosterone in WomenTestosterone is a hormone that belongs to a family called androgens. While it's often labeled a "male" hormone, testosterone is an important part of a woman's biology too — and having too much or too little of it can affect her overall health. In women, testosterone plays several important roles, including: - Producing new blood cells - Enhancing libido - Influencing follicle-stimulating hormones that can affect reproduction According to the Department of Health & Human Services in Victoria, Australia, testosterone production in women is often age-dependent. By the time a woman is 40 years old, her levels of androgens have decreased by half. Researchers are still working to fully understand low testosterone in women and how best to treat it — but promising new approaches are on the horizon. --- ## Understanding Low Testosterone in Women ### How Does Low Testosterone Show Up? Recognizing the Symptoms Low testosterone in women can manifest in a number of ways, including: - Reduced sexual desire - Decreased sexual satisfaction - Low mood or depression - Persistent fatigue or low energy - Muscle weakness ### Getting a Diagnosis Low testosterone in women is frequently missed or mistaken for something else — stress, depression, or the natural changes of menopause are common culprits when it comes to misdiagnosis. A simple blood test can measure testosterone levels, though the exact numbers that define "low" can vary depending on the laboratory. According to the Boston University School of Medicine in 2002, if a woman's plasma total testosterone level is less than 25 ng/dL in women under 50 years old, this is low. Testosterone levels lower than 20 ng/dL in women aged 50 and older are considered low. One challenge with diagnosing low testosterone in women is that hormone levels naturally fluctuate throughout the day and across the menstrual cycle. For the most accurate result, women who are still menstruating should ideally have their blood drawn about 8 to 20 days after their period begins. ### What Causes Low Testosterone in Women? Women produce testosterone in several parts of the body, including the: - Ovaries - Adrenal glands - Peripheral tissues Because the ovaries are a primary source of testosterone, the hormonal shifts that come with menopause can lead to a meaningful drop in testosterone levels in both pre- and post-menopausal women. While declining estrogen has long been blamed for reduced libido around menopause, researchers are increasingly recognizing that falling testosterone levels play an important role as well. Interestingly, many women continue to produce testosterone from their ovaries well into and after menopause. For these women, low testosterone may stem from genetic differences that affect their ability to produce DHEA and DHEA-S — the building blocks the body uses to make testosterone. Some women may also lack the enzymes needed to convert these precursors into active testosterone. ---
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Care planLung InfectionsBreathing is more intricate than it seems. When injury, illness, or other factors disrupt any part of that process, the consequences can range from mildly uncomfortable to life-threatening. Consider, for example, the tiny hair-like structures called cilia that line your upper airways. Their job is to filter out germs before they can cause harm — but they don't always catch everything. When germs slip through, they can trigger an infection in your bronchial tubes (**bronchitis**) or reach deep into your lungs (**pneumonia**). These infections cause mucus and fluid to build up, narrowing your airways and making it harder to breathe. Lung infections can be caused by viruses, bacteria, and sometimes even fungi. **Pneumonia is one of the most common — and most serious — types of lung infection.** It affects the tiny air sacs deep within the lungs and is most often caused by contagious bacteria, though viruses can be responsible too. It spreads when you breathe in bacteria or viral particles released by an infected person who has coughed or sneezed nearby. Respiratory syncytial virus, or RSV, is another very common respiratory virus. It usually causes mild, cold-like symptoms, and most people recover within a week or two. However, RSV can become serious — particularly in infants and older adults. In fact, RSV is the leading cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children under 1 year of age in the United States. When the large bronchial tubes that carry air in and out of your lungs become infected, the condition is called bronchitis — and it's more likely to be caused by a virus than by bacteria. Viruses can also attack the lungs or the air passages leading to them, a condition known as bronchiolitis. Viral bronchiolitis most commonly affects infants. Lung infections like pneumonia and RSV are usually mild, but they can turn serious — especially in people with weakened immune systems or ongoing conditions like chronic obstructive pulmonary disease (COPD). ---
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Care planLyme DiseaseLyme disease is the most common tick-borne illness in North America and Europe. It is caused by the bacterium *Borrelia burgdorferi*, which is carried by deer ticks — tiny parasites that feed on the blood of animals and humans, and can pass the bacteria along during a feeding. The Centers for Disease Control and Prevention (CDC) conservatively estimates that, in the US alone, more than 300,000 cases of Lyme disease are diagnosed every year. Cases are most heavily concentrated in the Northeast and upper Midwest; in fact, just 14 states account for over 95% of all cases reported to the CDC. Your risk of getting Lyme disease is higher if you live or spend time in grassy and heavily wooded areas where ticks thrive. Taking sensible precautions in areas where Lyme disease is common is one of the most important things you can do to protect yourself. Although Lyme disease was only formally recognized in the 1960s, the pathogen behind it has been around for millennia. Remarkably, DNA from *Borrelia burgdorferi* — the bacterium responsible for Lyme disease — was discovered in a 5,300-year-old mummy known as "Ötzi the Iceman," found in 1991 by hikers in the Eastern Alps near the modern-day border of Austria and Italy. Yet even after all this time, many clinicians are still not well-versed in the wide-ranging damage this ancient pathogen can inflict on the human body. Healthcare providers frequently lack experience in accurate diagnostic techniques and appropriate treatment options for patients suffering from Lyme. Patients often show up with vague, non-specific symptoms — fatigue, pain, headaches, and a general sense of feeling unwell. Without a proper diagnosis, these individuals may be incorrectly labeled with fibromyalgia or chronic fatigue syndrome, sending them down a frustrating path of ineffective treatments that never address the true, infectious root cause. Patient stories about Lyme disease fill the internet — voices of people who feel marginalized, dismissed, depressed, and still sick with no real answers. Lyme-literate, or at least Lyme-aware, healthcare providers are more important than ever as cases continue to rise across the country. ---
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Care planLymphedemaLymphedema develops when the lymphatic system — the body's internal drainage network — becomes damaged or blocked, causing fluid to accumulate in soft tissues and produce swelling. It is a well-recognized complication of cancer and its treatment, most commonly affecting the arms or legs, though other parts of the body can be involved as well. Beyond the physical discomfort, lymphedema can significantly affect a person's emotional well-being and daily life. ## Understanding Lymphedema The lymphatic system is a vast, body-wide network of vessels, tissues, and organs that circulate a fluid called lymph. The components of the lymphatic system most directly involved in lymphedema include: - **Lymph:** A clear fluid that contains lymphocytes (white blood cells) that fight infection and the growth of tumors. Lymph also contains plasma, the watery part of the blood that carries the blood cells. - **Lymph vessels:** A network of thin tubes that helps lymph flow through the body and returns it to the bloodstream. - **Lymph nodes:** Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin. > 📝 **NOTE:** The spleen, thymus, tonsils, and bone marrow are also part of the lymph system but do not play a direct part in lymphedema. ---
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Care planMacular DegenerationMacular degeneration is a painless, progressive eye disease affecting more than 10 million Americans — and it is the leading cause of legal blindness in people over the age of 55 in the United States. While complete blindness is uncommon, macular degeneration frequently interferes with everyday activities like reading, driving, and recognizing faces. There are two forms of macular degeneration: - **Dry macular degeneration** affects about 90% of those with the disease and causes gradual loss of central vision, initially only in one eye. - **Wet macular degeneration**, which accounts for 90% of all severe vision loss from the disease, involves a very sudden loss of central vision. ### Recognizing the Signs & Symptoms Macular degeneration can present with the following signs and symptoms: - Slightly blurred vision - Dry type: a blurred spot in the central field of vision, which may become larger and darker - Wet type: straight lines that appear wavy and the rapid loss of central vision; sometimes, wet macular degeneration starts with a sudden blind spot ### What Causes Macular Degeneration? Dry macular degeneration occurs when the light-sensitive cells in the center of the retina — a region called the macula — gradually break down. Wet macular degeneration occurs when abnormal new blood vessels grow behind the retina toward the macula, where they leak blood and fluid, causing rapid vision changes. ### Who Is Most at Risk? The following conditions and characteristics can increase your risk of developing macular degeneration: - Age — risk increases with age - Cigarette smoking - Family history of macular degeneration - Cardiovascular disease - Elevated cholesterol levels - Light eye color - Excessive exposure to sunlight - Frequent aspirin use - de Jong P, et al. Frequent aspirin use linked with early and wet late AMD (Age-Related Macular Degeneration). *Ophthalmology*. 2012;119:112–118. ### The Role of Nutrition Antioxidants that protect your retina — such as carotenoids, selenium, zinc, and vitamins C and E — may either slow the progression of macular degeneration if you already have it (meaning your vision may not worsen as quickly) or help prevent the condition from developing in the first place. Two carotenoids in particular, lutein and zeaxanthin, appear to be especially beneficial. These antioxidants can be obtained from both foods and supplements. For most people, eating a diet naturally rich in vitamins C and E and carotenoids is likely sufficient to reduce the risk of developing macular degeneration — supplements are probably not necessary for prevention alone. Carotenoid-rich vegetables include orange and yellow squash, and dark, leafy greens such as kale, collards, spinach, and watercress. High dietary intake of antioxidants is associated with a lower risk for early age-related macular degeneration (AMD) in genetically predisposed individuals, according to the results of a nested case-control study reported in the June 2011 issue of the *Archives of Ophthalmology*. > *"Regular consumption of omega-3 fatty acids is associated with a significantly reduced risk for the development of age-related macular degeneration."* > > **Reference:** *Archives of Ophthalmology*, March 14, 2011. Reducing the genetic risk of age-related macular degeneration with dietary antioxidants, zinc, and omega-3 fatty acids: the Rotterdam study. *Arch Ophthalmol*. 2011;129:758–766. Carotenoid and antioxidant supplementation is associated with improvements in visual function in people with non-advanced age-related macular degeneration. The October 2017 issue of *Investigative Ophthalmology & Visual Science* reported the outcome of a randomized trial which found an increase in macular pigment and improvement in measures of visual function in association with antioxidant supplementation among individuals with nonadvanced age-related macular degeneration (AMD). > *"Eye care professionals should be aware of the observed visual benefits afforded to patients with nonadvanced AMD as a result of supplementation with macular carotenoids (and coantioxidants) in the short, medium, and long terms, and the indication for recommending such supplements should no longer be limited to risk reduction for disease progression in the long term. Also, and importantly, further augmentation of macular pigment and further improvements in psychophysical function are realized in patients with nonadvanced AMD after 24 months of sustained supplementation, and it may well be that the improvements observed in this study (duration of 24 months) understate the visual improvements that patients can expect."* > > **Reference:** Kwadwo Owusu Akuffo et al. *Investigative Ophthalmology & Visual Science*. October 2017. Higher vitamin D blood levels appear to be associated with a decreased risk for the development of early age-related macular degeneration (AMD) — April 2011 issue of the *Archives of Ophthalmology*. Adults with the lowest concentrations of circulating 25-hydroxyvitamin D (25OHD) had the highest risk for age-related macular degeneration (AMD), according to a new systematic review and meta-analysis published online April 2, 2016 in *Maturitas*. Vitamin D levels may substantially alter the odds of developing age-related macular degeneration (AMD) in women with certain gene variants associated with an elevated AMD risk, according to a 2015 *JAMA Ophthalmol* study. ---
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Care planMale Pattern BaldnessMale pattern baldness is the most common reason men lose their hair. It affects roughly 30% of men by the age of 30, 50% by 50, and 57% by 60. ## Understanding Male Pattern Baldness ### What Causes Male Pattern Baldness? Male pattern baldness is rooted in your genes and male sex hormones. It typically unfolds in a familiar way — the hairline begins to recede, and the hair on top of the head gradually thins. Both your hormones and your inherited genetic blueprint play a role in this process. Each hair on your head grows out of a tiny pocket in the skin called a follicle. Over time, these follicles can shrink, producing hair that becomes shorter and finer with each growth cycle — until eventually, no new hair grows at all. Importantly, the follicles themselves stay alive, which means the possibility of regrowing hair remains. ### What Does It Look Like? Male pattern baldness follows a recognizable path. It usually starts at the hairline, which gradually pulls back and forms an "M" shape. As time goes on, the hair becomes finer, shorter, and thinner, eventually leaving a U-shaped or horseshoe pattern of hair around the sides and back of the head. ### How Is It Diagnosed? In most cases, a doctor can diagnose male pattern baldness simply by looking at the appearance and distribution of the hair loss — no tests needed. That said, hair loss doesn't always follow the classic pattern, and other conditions can be the culprit. If you're noticing patchy hair loss, shedding large amounts of hair, hair that breaks easily, or hair loss accompanied by redness, scaling, or pain, it's worth digging deeper. In those situations, a small skin sample (biopsy) or other tests may be needed to identify underlying conditions contributing to the hair loss. Hair analysis — while sometimes marketed as a diagnostic tool — is not reliable for uncovering nutritional causes of hair loss. It may, however, detect certain substances in the body, such as arsenic or lead. ### Treatment Options If you're at peace with your appearance, treatment isn't required. Many men find that hair weaving, hairpieces, or simply changing their hairstyle does a great job of minimizing the look of hair loss. This is often the most affordable and lowest-risk approach. Two medications are approved to treat male pattern baldness: - **Minoxidil (Rogaine)** is a solution that you apply directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. Hair loss returns when you stop using this medicine. - **Finasteride (Propecia, Proscar)** is a pill that interferes with the production of a certain male hormone linked to baldness. It slows hair loss. It works a bit better than minoxidil. Hair loss returns when you stop using this medicine. Hair transplant surgery involves taking tiny plugs of hair from areas that are still growing and moving them to areas that are thinning or bare. This can result in minor scarring and, rarely, infection. Multiple sessions are typically needed and costs can add up — but results are often excellent and long-lasting. Surgically attaching hairpieces directly to the scalp is not recommended. This approach carries risks of scarring, infection, and abscess. Artificial fiber hair implants were banned by the FDA due to an unacceptably high rate of infection. ---
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Care planMast Cell Activation Syndrome (MCAS)Mast cells are your body's allergy sentinels — specialized immune cells responsible for triggering immediate allergic reactions. They do this by releasing chemical signals called "mediators," which are either stored inside them or manufactured on demand. In a classic allergic reaction, this release is set off when allergy antibodies called IgE — which sit on the surface of mast cells like antennae — latch onto allergy-triggering proteins called allergens. This triggering process is called activation, and the release of those mediators is called degranulation. Some of these mediators are pre-packaged in storage compartments called granules and are released almost instantly, while others are freshly synthesized only after the cell has been activated. Mast cells can also be set off by a wide range of other stimuli — including certain medications, infections, and insect or reptile venoms. These responses, while unwanted, come from perfectly "normal" mast cells. They are called "secondary activation" because they are triggered by (secondary to) outside forces. Sometimes, however, mast cells themselves go haywire — releasing mediators due to abnormal signals from within. Certain genetic mutations can cause mast cells to multiply into populations of identical copies — called clones — that overproduce and spontaneously release mediators without any outside trigger. This spontaneous release of mediators in these clonal mast cell disorders is called "primary activation." These abnormal cells can grow unchecked and become unusually hair-trigger sensitive, a condition known as mastocytosis. --- ## Understanding Mast Cell Activation Syndrome (MCAS) ### Idiopathic MCAS: When the Trigger Is Unknown MCAS is a condition in which a person experiences repeated episodes of anaphylaxis-like symptoms — including hives, swelling, low blood pressure, difficulty breathing, and severe diarrhea. During these episodes, high levels of mast cell mediators flood the body. The episodes respond to treatment with medications that block or inhibit those mediators. They are called "idiopathic" — a medical term meaning the underlying mechanism is unknown — because they are not caused by allergic antibodies and are not explained by any other known condition that triggers normal mast cells. Evaluating for MCAS begins with establishing whether symptoms occur in distinct episodes and fit the classic pattern of an anaphylactic reaction without an obvious cause. Mast cell mediators should be measurably elevated during those episodes. This means measuring mediator levels both during acute flares and during symptom-free periods to look for meaningful differences. Finally, a clear improvement with mediator-blocking treatments completes the diagnostic picture. ### What Does MCAS Feel Like? Recognizing the Symptoms The symptoms most consistent with anaphylaxis are: - **Heart-related symptoms:** rapid pulse (tachycardia), low blood pressure (hypotension), and passing out (syncope). - **Skin-related symptoms:** itching (pruritus), hives (urticaria), swelling (angioedema), and skin flushing (redness). - **Lung-related symptoms:** wheezing, shortness of breath, and a harsh noise when breathing (stridor) caused by throat swelling. - **Gastrointestinal symptoms:** diarrhea, nausea with vomiting, and crampy abdominal pain. ### What Gets Measured? Understanding Mast Cell Mediators Mast cells produce many inflammation-driving molecules, but only a handful of mediators — or their stable breakdown products (metabolites) — have been reliably found to be elevated during MCAS episodes and detectable through standard commercial laboratory tests. Elevations in serum mast cell tryptase and urinary levels of N-methylhistamine, 11β-Prostaglandin F2α (11β-PGF2α), and/or Leukotriene E4 (LTE4) are the only tests currently useful for diagnosing MCAS. Total serum mast cell tryptase should be drawn between 30 minutes and two hours after the start of an episode, with a baseline level obtained several days later when you are feeling well. The urine tests are performed on a 24-hour urine collection that begins immediately after the episode starts. Since these are not routine laboratory tests, patients should work closely with their local allergist, who can coordinate with emergency department staff and lab personnel to ensure the tests are ordered and collected at the right time. ### How Is MCAS Diagnosed? A Closer Look at the Testing Different physicians may order different tests to evaluate whether mast cell mediators are elevated. **A Range of Mast Cell Mediators** It's worth knowing that all of these tests can come back negative even in true MCAS — but if mediators, especially Serum Tryptase, are measured during the first 1–4 hours of an attack, a rise above your personal baseline can provide objective evidence supporting the diagnosis. **Serum Tryptase** Serum Tryptase is a particularly important marker. During an episode, clinicians look for at least a two-fold plus 20% increase above your baseline level to consider the result meaningful. If Tryptase is elevated even at rest, and above six (6.0), this may point toward an underlying genetic enzyme abnormality that warrants further investigation. **Histamine** Histamine can be measured directly in the blood (plasma), while its breakdown product, N-methylhistamine, can be measured in the urine. Clinicians generally look for levels more than 10 times the upper limit of normal — though any meaningful elevation matters. **Prostaglandin D2** Prostaglandin D2 can be measured in the plasma and is also reflected in tests for Heparin or Factor 8. Chromogranin A is another marker — though nonspecific, as it can be elevated in neuroendocrine tumors, other gastrointestinal disorders, or kidney failure. When elevated in someone who does not have those other conditions, Chromogranin A raises strong suspicion for MCAS. Leukotriene E4 in the urine is another valuable mediator to test for. PG-D2, also known as 11β PGF2α, measured in the urine is another important marker. In addition, biopsies of the skin or the GI tract — obtained during a routine endoscopy or colonoscopy — can sometimes provide critical diagnostic clues. ### Beyond Blood and Urine: Additional Testing for MCAS If a biopsy reveals focal or widespread mast cell infiltrates, abnormal collections of mast cells, a characteristic spindle-shaped mast cell appearance, or mast cells that stain positive for the CD25 marker under special laboratory staining, this significantly strengthens the case for MCAS. To be thorough, other conditions that can look like MCAS must be ruled out — including Diabetes, Porphyria, Thyroid disease, Amyloidosis, Hepatitis, Gallbladder disease, infectious Enteritis, Carcinoid tumors, Pheochromocytoma (a tumor of the adrenal gland that can raise blood pressure), pancreatic endocrine tumors, Eosinophilic Syndrome abnormalities, hereditary Angioedema, Vasculitis, and, rarely, intestinal Lymphomas. ### Treatment: Finding Relief and Confirming the Diagnosis **The goals of treatment are both to confirm the diagnosis and to provide real relief.** The immediate priority is symptom relief. In fact, a lack of response to these treatments is itself informative — it suggests that MCAS may not be the right diagnosis. Treatment of acute episodes should follow established guidelines for anaphylaxis, beginning with epinephrine when the severity of symptoms warrants it. - **Antihistamines**, such as the first-generation histamine type 1 receptor blockers diphenhydramine and hydroxyzine, can relieve itching, abdominal discomfort, and flushing — though drowsiness can limit their use. Second-generation antihistamines, including loratadine, cetirizine, and fexofenadine, are generally preferred because they cause fewer side effects. - **Histamine type 2 receptor blockers**, such as ranitidine or famotidine, can help with abdominal pain and nausea. - **Aspirin** works by blocking the production of prostaglandin D2 and can help reduce flushing. - **Montelukast** and **zafirlukast** block the effects of leukotriene C4 (LTC4), while zileuton blocks LTC4 production — together, these medications can reduce wheezing and abdominal cramping. - **Corticosteroids** can help with swelling, hives, and wheezing, but should be reserved as a last resort. - **Omalizumab** (which works by blocking IgE from binding to its receptors) has been reported to reduce mast cell reactivity and lower sensitivity to activation, potentially reducing the frequency of anaphylactic episodes. ### Putting It All Together: The MCAS Diagnostic Summary Because the symptoms of anaphylaxis can overlap with many other conditions that have nothing to do with mast cells, specific diagnostic criteria are essential to confirm that mast cell activation is truly responsible. These criteria require three key elements: the presence of anaphylactic symptoms, measurably elevated mast cell mediators during those symptoms, and clear symptom improvement with appropriate treatment. Once these criteria are met, further testing should be done to rule out primary clonal mast cell disorders, which can produce an identical clinical picture. A blood test for the KIT D816V mutation — a genetic change in the mast cell growth receptor — should be performed. A positive result points strongly toward a clonal mast cell disorder. A negative result is reassuring, but not definitive — so one of several validated scoring systems should be used to track symptoms and lab results over time to assess whether the overall picture is consistent with a clonal disorder. If it is, a bone marrow biopsy and aspirate is recommended. This procedure is highly sensitive for detecting the KIT D816V mutation and also allows direct examination of bone marrow mast cells for abnormal shape and atypical surface markers. If the bone marrow biopsy comes back negative for abnormal or clonal mast cells, the diagnosis of idiopathic mast cell activation syndrome is confirmed. **Source:** <https://www.aaaai.org/conditions-and-treatments/related-conditions/mcas> ---
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Care planMastitis / Intramammary Infections (IMI)Mastitis is one of the most common infections affecting breastfeeding women. It causes the breast to become tender, red, and warm to the touch — and comes with a wave of flu-like symptoms, including fever, fatigue, and sometimes nausea and vomiting. Breast infections typically develop when milk ducts become plugged or when the nipples crack and allow bacteria to enter. In rare cases, the deeper connective tissue of the breast itself can become infected. If you are nursing and notice a breast that is inflamed and painfully tender alongside flu-like symptoms, mastitis may be the cause. Feeding frequently or pumping from the affected breast, resting as much as possible, and staying well-hydrated are all helpful first steps. Mastitis usually affects only one breast and responds well to antibiotics. Continuing to breastfeed — or pumping from both breasts — is strongly encouraged to prevent a more serious complication called a breast abscess. Importantly, mastitis is not dangerous to your baby, because the milk itself is not infected. --- ## Understanding Mastitis ### What Contributes to Recurring Breast Infections? Here are some of the factors that may contribute to recurring breast infections: - **Not fully recovering from your first bout of mastitis can set the stage for it to come back.** If antibiotics were part of your treatment, it is essential to finish the entire course — even if you start feeling better sooner. If a previous antibiotic did not seem to work, culturing your baby's throat and your breast milk can help identify the right medication. - **Fatigue and stress** — whether from the everyday demands of life or special events like travel, holidays, parties, or moving — can leave your breasts sore and more vulnerable to infection. - **Anemia may be a contributing factor.** A check-up with your healthcare provider can determine whether you might benefit from supplemental vitamins or iron. - **Cigarette smoking can weaken your body's defenses against infection.** It can also interfere with your milk let-down reflex, causing milk to pool in the breast — a setup for repeated infections. - **An overabundant milk supply can prevent your baby from fully emptying the breast.** Let your baby finish the first breast completely before offering the second. If your breasts feel uncomfortably full, pump or hand-express just enough to ease the pressure. - **Sore, cracked, or bleeding nipples create an entry point for bacteria.** If nipple soreness keeps recurring, pay close attention to how your baby is positioned and latched during feeding. - **If you notice dried milk blocking one of your nipple openings,** try applying a warm, moist compress and gently expressing some milk until the opening is clear. Some mothers find that a thick, yellowish plug comes out with gentle expression. (If your baby removes the plug while nursing, that is perfectly safe.) - **Nipple shields can slow milk flow and encourage infection.** Pacifiers and artificial nipples can also affect how your baby sucks, contributing to nipple soreness and increasing the risk of mastitis. - **Some babies go through phases where they are reluctant to breastfeed or temporarily refuse the breast,** possibly due to sensitivities or other reasons. Irregular feeding patterns can contribute to recurring breast infections. - **Take a close look at what you are wearing,** especially your bra. Clothing that fits too snugly — including some bras, bathing suits, and especially underwire styles — can put too much pressure on the breast. Even a heavy shoulder bag or a frequently used baby carrier can be a culprit. Try switching sides regularly when carrying bags or your baby. - **A vehicle seat belt shoulder strap can also cause breast soreness.** A strap worn too tight may press directly on the breast, and the jolt from a sudden stop can cause discomfort as well. Blunt impact from an energetic toddler — a kick or an elbow — can have the same effect. Any of these injuries can block milk flow and should be managed with rest, warmth, and frequent nursing. - **A prior history of breast surgery, breast lumps, or breast injury can increase your risk of infection.** - Research suggests that **cutting back on saturated fats and taking one tablespoon of lecithin per day** may help women with a history of plugged ducts and/or mastitis. - **Too much sodium in your diet may cause fluid retention,** which can lower your resistance to infection. At the same time, chronically too little salt in your diet can also contribute to recurring mastitis. - **Food intolerances and allergen exposure can also play a role in recurrent breast infections.** - **Repetitive upper arm movements are considered a risk factor for recurring mastitis.** Common examples include vacuuming, scrubbing shower stalls, washing windows, and gardening. - **Your sleeping position is another factor worth examining if you keep getting breast infections.** Varying your position may help. When a breast stays under prolonged pressure, the ducts in that area may not drain freely — and poor drainage can lead to infection. **References:** - <http://www.lalecheleague.org/faq/repeatmastitis.html> - Worthington-Roberts BS, Rodwell Williams S, editors. *Nutrition in Pregnancy and Lactation*. 6th ed. Madison, WI: Brown & Benchmark; 1993. ---
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Care planMediterranean DietThe **Mediterranean Diet** brings together the building blocks of healthy eating with the time-honored flavors and cooking traditions of the Mediterranean region. ## What Is the Mediterranean Diet? The Mediterranean diet is a way of eating rooted in the traditional cuisines of countries along the Mediterranean Sea. While there is no single, rigid definition, it is consistently rich in vegetables, fruits, whole grains, beans, nuts and seeds, and olive oil. **The core pillars of the Mediterranean diet include:** - Daily helpings of vegetables, fruits, whole grains, and healthy fats - Regular weekly servings of fish, poultry, beans, and eggs - Moderate amounts of dairy products - Only occasional red meat Beyond what's on your plate, the Mediterranean diet embraces a broader lifestyle — sharing meals with people you care about, savoring a glass of red wine, and staying physically active. ### Built on Plants, Not Meat The heart of the Mediterranean diet is plant-based: vegetables, fruits, herbs, nuts, beans, and whole grains form the foundation of every meal. Moderate amounts of dairy, poultry, and eggs round out the diet, as does seafood. Red meat, by contrast, makes only rare appearances. ### The Right Kinds of Fat Healthy fats are a cornerstone of Mediterranean eating — used in place of less healthy options like saturated and trans fats, which are known contributors to heart disease. Olive oil is the primary source of added fat in this diet. It is rich in monounsaturated fat, which research has shown can lower total cholesterol and low-density lipoprotein (LDL) — the so-called "bad" cholesterol. Nuts and seeds are also excellent sources of monounsaturated fat. Fish play an equally important role. Fatty fish — such as mackerel, herring, sardines, albacore tuna, salmon, and lake trout — are packed with omega-3 fatty acids, a type of polyunsaturated fat that can help reduce inflammation throughout the body. Omega-3s also help lower triglycerides, reduce the tendency for blood to clot, and decrease the risk of stroke and heart failure. ### A Word About Wine The Mediterranean diet traditionally includes red wine in moderation. While some studies have linked moderate alcohol consumption to a reduced risk of heart disease, alcohol is far from risk-free. The Dietary Guidelines for Americans advise against starting to drink — or drinking more than you already do — solely for potential health benefits. ---
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Care planMelasma**Melasma** is a common skin condition that causes dark, discolored patches to appear on the skin. It's also known as **chloasma**, or the **"mask of pregnancy,"** when it develops in pregnant women. Melasma is far more common in women than in men, though men can develop it as well. According to the American Academy of Dermatology, 90 percent of people who develop melasma are women. ## Understanding Melasma ### Recognizing Melasma: What to Look For Melasma typically shows up as patches of skin that are noticeably darker than your natural skin tone. It most commonly appears on the face, usually in a symmetrical pattern — meaning you'll often see matching patches on both sides. Sun-exposed areas of the body beyond the face can also be affected. These brownish patches most often appear on the: - Cheeks - Forehead - Bridge of the nose - Chin Melasma can also show up on the neck and forearms. While the discoloration is physically harmless, it can understandably affect how you feel about your appearance. If you notice these changes in your skin, it's worth seeing your healthcare provider. They may refer you to a dermatologist — a physician who specializes in skin conditions. ### What Causes Melasma and Who Is at Risk? The exact cause of melasma isn't fully understood. People with darker skin tones tend to be more susceptible than those with lighter skin. Sensitivity to the hormones estrogen and progesterone is also linked to the condition, which is why birth control pills, pregnancy, and hormone therapy can all bring on melasma. Stress and thyroid disease are also believed to play a role. Sun exposure is another important trigger — ultraviolet (UV) rays can stimulate the cells responsible for skin pigmentation, known as **melanocytes**, contributing to the development of melasma. ### How Is Melasma Diagnosed? In most cases, a simple visual examination of the affected skin is enough to make the diagnosis. However, your healthcare provider may run additional tests to help identify the underlying cause. One common tool is a **Wood's lamp examination** — a specialized light that, when held close to the skin, helps your provider check for bacterial or fungal involvement and assess how deeply the melasma has penetrated the skin's layers. In some cases, a biopsy may be performed, which involves removing a tiny sample of affected skin to rule out other serious skin conditions. ### Can Melasma Be Treated? For some women, melasma resolves on its own — particularly when it's triggered by pregnancy or birth control pills. If it doesn't fade naturally, your healthcare provider can prescribe skin-lightening creams or topical steroids to help reduce the appearance of the patches. When creams alone aren't enough, procedures like chemical peels, dermabrasion, and microdermabrasion may be considered. These treatments work by removing the outermost layers of skin and can help fade dark patches. It's important to know that none of these treatments guarantee melasma won't return, and some cases may not fully resolve. Ongoing care — including limiting sun exposure and wearing sunscreen every day — is often essential to keeping melasma at bay over the long term. ### Treatment Options Treatment isn't always necessary for melasma. If hormonal shifts — such as those during pregnancy or while using birth control pills — are the cause, melasma will often fade on its own once the baby arrives or the pills are stopped. For others, melasma can persist for years or even indefinitely. When the patches don't improve with time, there are effective options available to help fade or eliminate them. It's worth knowing, however, that not every treatment works for every person, and melasma can return even after a successful course of treatment. **Common treatment options for melasma include:** - **Hydroquinone —** This is typically the first treatment doctors reach for when addressing melasma. Available as a lotion, cream, or gel, hydroquinone is applied directly to the discolored patches to gradually lighten them. It can be purchased over the counter, though your doctor can also prescribe a stronger formulation if needed. - **Corticosteroids and tretinoin —** These come in cream, lotion, or gel form and can both help lighten melasma patches when applied to the skin. - **Combined creams —** Sometimes a dermatologist will prescribe a single cream that combines hydroquinone, corticosteroids, and tretinoin all in one. These are commonly referred to as triple creams. - **Additional topical medications —** Azelaic acid or kojic acid may be recommended alongside — or instead of — other medicated creams to further help lighten areas of darkened skin. ### In-Office Procedures When topical medications don't deliver the desired results, a dermatologist may suggest one of several in-office procedures, such as: - Microdermabrasion - Chemical peel - Laser treatment - Light therapy - Dermabrasion Some of these options carry potential side effects or may lead to other skin concerns. It's always a good idea to have a thorough conversation with your doctor or dermatologist about the risks before proceeding. If you've had melasma before, you can take steps to reduce the chance of it coming back by: - Limiting sun exposure - Wearing a hat when you're outdoors - Using sunscreen consistently ### Living Well with Melasma: Day-to-Day Tips Not every case of melasma will clear up completely, but there's quite a bit you can do to prevent it from worsening and to minimize how noticeable the discoloration is. Helpful habits include: - Using makeup to conceal areas of discoloration - Taking any prescribed medication as directed - Wearing sunscreen every day with SPF 30 - Wearing a wide-brimmed hat that shields your face from direct sun Sun protection is especially important during extended time outdoors. If melasma is affecting your confidence or emotional well-being, don't hesitate to bring this up with your healthcare provider. They can point you toward local support groups or counselors — connecting with others who share the experience can make a meaningful difference. **Sources:** - <https://www.healthline.com/health/melasma#diagnosis> - <https://www.medicalnewstoday.com/articles/323715#treatment> ---
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Care planMelatonin Stress ProtocolThis protocol is based on the clinical experience of Dr. Robert Rakowski and is designed as a nutritional support strategy for people who struggle to bring down persistently **high cortisol or stress levels**. --- ## Understanding the Cortisol–Melatonin Connection Cortisol is a hormone made by your adrenal glands — the two small glands that sit atop your kidneys. Under normal, healthy conditions, cortisol is highest in the morning to help get you moving, and gradually falls throughout the day. By around 8–10 pm, cortisol should be at its lowest point, making way for the rise of melatonin — the hormone that signals to your brain and body that it's time to sleep. Think of cortisol as your internal "wake-up alarm" and melatonin as your natural "lights out" signal. When you're under chronic stress, this elegant balance gets disrupted: cortisol stays elevated into the evening hours instead of falling, interfering with melatonin's ability to do its job. Persistently high cortisol is a common finding in people with autoimmune conditions, including severe rheumatoid arthritis, where it can also disrupt the body's natural day-night rhythms. Beyond sleep, chronically elevated cortisol has been associated with stress-related and hormone-sensitive cancers. Melatonin, notably, may help counteract some of these effects — research suggests it can block the ability of estrogen to drive certain hormone-sensitive cancers, including cancers of the breast, endometrium, ovaries, and uterus. It's also worth knowing that heavy alcohol use depletes important hormones while simultaneously driving cortisol higher, and that smoking has been shown to suppress melatonin levels. The Melatonin Stress Reset Program centers on melatonin, a hormone naturally produced in both the brain and the gut. **The program is designed to support healthy adrenal function and cortisol metabolism, which are processes associated with a healthy physiological response to stress.** ---
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Care planMenopause / PerimenopauseAs women approach perimenopause and move through menopause, shifting and declining levels of estrogen and progesterone can trigger a wide range of distressing symptoms — ones that can take a real toll on quality of life, physical health, and emotional well-being. Hot flashes, disrupted sleep, and other symptoms can be so overwhelming that nearly 90% of women turn to a healthcare provider for help managing them. --- ## Understanding Perimenopause Perimenopause refers to the years of hormonal turbulence that precede a woman's final menstrual period. It can begin as early as the mid-30s or 40s — but make no mistake, perimenopause is a state of body and mind, not simply a birthday on the calendar. It begins with falling progesterone levels and ends with falling estrogen levels. Most women — and honestly, many of their doctors — don't fully appreciate what perimenopause really looks and feels like. Here's the surprising truth: perimenopause is often rockier and more disruptive than menopause itself, because hormones can swing wildly from month to month — sometimes mildly, sometimes fiercely. Once you know what to look for, perimenopausal symptoms are remarkably common. Many younger women picture menopause as a distant cliff they'll tumble off around age 50. But the body has been quietly preparing for that cliff for years. Understanding the "perfect storm" of perimenopausal hormone imbalances now can make an enormous difference in how you navigate what's ahead. Common perimenopausal symptoms that can begin in the late thirties include more frequent periods, worsening PMS, declining libido, and a growing waistline. It's worth knowing that a typical cycle can shorten from about every 28 days to every 21 days — and if bleeding occurs more often than every 21 days, it warrants a gynecologic evaluation. Old coping strategies — occasional exercise, yoga a few times a week, a square of chocolate, a glass of wine most nights — may start to feel less effective. Metabolism becomes less forgiving. Stress feels harder to shake. Sleep suffers. Emotional reactivity can spike almost daily, as the brain's more primitive, reactive centers temporarily override rational thinking, and overreaction becomes the norm. Relationships — even the closest ones — can feel strained. Perimenopause doesn't have a single hormonal root cause. It's really an expression of hormonal interdependence — the complex interplay of your body's major hormones during a time of significant neuroendocrine upheaval. For some women, this generates substantial symptoms. But this life stage doesn't have to feel like a slow march through misery. Perimenopause is simply a stretch of biological rough water — and with the right navigator at the helm, it can be sailed through with skill and confidence. That's exactly where personalized, functional medicine comes in. --- ## Understanding Menopause Menopause is the point in a woman's life when menstruation permanently stops. It usually occurs naturally, most often after age 45, when the ovaries cease producing estrogen and progesterone. The average age of a woman's last menstrual period is 51, and menopause is officially defined as the absence of menstrual periods for 1 full year. The years leading up to that point — often called perimenopause — involve a gradual decline in estrogen levels and changes in the menstrual cycle. In general, perimenopause spans from about ages 45 to 55, though timing varies considerably from woman to woman. ### What Does It Look and Feel Like? Every woman's experience of perimenopause and the menopausal transition (MT) is unique. Many women don't report any major complaints beyond irregular periods that eventually stop. But most women do experience a number of unwanted symptoms — ones that can begin as early as six years before the final menstrual period. As the menopausal and postmenopausal years unfold, the ovaries become increasingly less responsive to hormonal signals, and many of the mood-related symptoms of the MT tend to ease over time. ### The Most Common Complaints The symptom reported most often — by more than 75% of perimenopausal women — is vasomotor symptoms (VMS), better known as hot flashes. These can cause significant embarrassment and discomfort. When they strike at night, they're called "night sweats" and can seriously disrupt sleep. VMS episodes typically last one to five minutes and may be accompanied by sweating, flushing, chills, anxiety, and even heart palpitations. > ⚠️ **IMPORTANT NOTE:** Research published in *JAMA* from Erasmus Medical Center indicates hot flashes are more than annoyances — they are indicators for serious cardiac outcomes including hypertension, atherosclerosis, stroke, and MI in perimenopausal and menopausal women. Other widely reported symptoms include: - Vaginal dryness and itching - New or more frequent urinary tract infections - Insomnia - Mood swings and mood disorders (most commonly anxiety and/or depression) - Weight changes - Breast pain or tenderness - Headaches - Difficulty concentrating or "brain fog" - Joint and muscle pain - Thinning hair on the scalp, increased facial hair ### What Your Clinician May Observe During a pelvic examination, a clinician may notice more tangible signs of hormonal decline. The reproductive organs of a woman before perimenopause look and function quite differently from those seen during the MT or perimenopause itself. Some common physical signs include: - Thinning of the vaginal lining, which contributes to vaginal dryness, painful intercourse, and itching - Shrinking of the uterus and ovaries (ovaries are often too small to feel during a pelvic exam in menopause) - Reduction in the size and symptoms of uterine fibroids - Improvement or resolution of endometriosis symptoms - Loss of pelvic floor muscle tone (sometimes experienced as prolapse) ### Other Conditions to Consider A diagnosis of perimenopause or the MT can usually be made through a thorough history and physical exam. However, other conditions that cause changes in the menstrual cycle should also be considered — especially when symptoms don't fit neatly into the expected picture or when a woman is younger than typical. Other causes of menstrual changes include: - Hyperthyroidism: irregular periods, sweating, and mood changes - Pregnancy: missed periods, breast tenderness, and mood changes - Hyperprolactinemia: absent periods, headaches, vaginal dryness, breast tenderness, and discharge - Medication effects or interactions that may cause increased sweating and/or headaches - Malignancy A growing body of evidence suggests that environmental exposures may influence the timing of perimenopause. **Endocrine-disrupting chemicals (EDCs)** are known to negatively affect human health, and data from a recent study evaluated the effects of 111 EDCs on 31,000 women who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999–2008. Of the initial 111 EDCs evaluated, researchers found 15 chemicals that showed significant associations in any of the threshold or dose-response analyses to earlier age at menopause. The 15 chemicals included nine PCBs, three pesticides, a furan, and two phthalates. Fourteen of the 15 EDCs examined showed evidence of a dose-response relationship in at least one analysis, suggesting that increasing levels of environmental exposures of these chemicals could adversely affect ovarian function. The observed magnitudes of effect ranged from 1.9 to 3.8 years earlier menopause — larger than those previously documented for primary exposure to tobacco smoke, which has been shown in prior NHANES studies to associate with 0.8 to 1.4 years earlier menopause. Another important hormonal shift during this time involves the **HPA (hypothalamic-pituitary-adrenal) axis** and cortisol — the body's primary stress hormone. Cortisol levels naturally fluctuate throughout the day, rising in the morning and dipping in the evening, and they also spike in response to stress. Studies show that cortisol levels tend to be elevated during the transition from perimenopause to menopause. As ovarian follicles age, they become less responsive to hormonal signals, causing FSH and LH levels to rise. These elevated levels then trigger an increase in estrone (a weaker form of estrogen) and a decrease in estradiol (the more potent form). Other hormonal shifts during the MT include declines in DHEAS and HDL ("good" cholesterol), alongside increases in total cholesterol, LDL ("bad" cholesterol), and apolipoprotein B — all of which can affect cardiovascular health. Although in smaller quantities than men, women also produce the hormone testosterone — in the ovaries and adrenal glands. During the reproductive years, normal testosterone levels (15–70 ng/dL) support bone strength, cognitive health, and sex drive. As a woman ages, testosterone levels naturally decline as ovarian production decreases. The evidence on treating low testosterone in older women is still evolving. In 2014, a task force convened by the Endocrine Society, American Congress of Obstetricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), European Society of Endocrinology (ESE), and International Menopause Society (IMS) concluded that treating low testosterone in women was not advisable due to insufficient research — with one notable exception: women with hypoactive sexual desire disorder (HSDD). Non-hormonal approaches to support symptoms related to low testosterone may include: - Sex therapy - Stress management - Prioritizing sleep - A nutrient-rich diet - DHEA supplementation One additional consideration: even after ovulation stops, the body may continue producing estrogen — now without progesterone to balance it. This prolonged exposure to "unopposed estrogen" can lead to a thickening of the uterine lining known as **endometrial hyperplasia**, which is a precursor to endometrial cancer and warrants monitoring. ### Putting It All Together With an aging population, more and more women are navigating the hormonal rollercoaster known as the "change of life." While the most familiar complaints include more frequent and then skipped periods, hot flashes, vaginal dryness, and disrupted sleep, many women are unaware of how profoundly perimenopause and the menopausal transition affect the rest of the body — including bone health, heart health, and brain function. Estrogen, it turns out, is the master regulator of the female body. Without it, some women describe feeling fundamentally altered. The goal of personalized, lifestyle-based medicine is to guide women through the sometimes turbulent journey of perimenopause and menopause with expert, evidence-based strategies — finding the safest and most effective solutions for each individual woman. ---
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Care planMenopause Weight GainWeight gain is common as women age through menopause — but it's not something you simply have to accept. With the right lifestyle habits, you can take control of your weight and your health. If you've noticed that keeping the number on the scale steady has gotten harder as you've gotten older, you're not imagining it. Weight gain during and after the menopause transition is genuinely common. The good news? It's not inevitable. By tuning into your eating habits and staying physically active, you can turn things around. ## Understanding Menopause-Related Weight Gain ### Why Do Women Gain Weight During Menopause? The hormonal shifts of menopause make your body more prone to storing fat around your belly rather than your hips and thighs. But hormones alone don't tell the whole story. Weight gain during menopause is usually a combination of factors — the natural aging process, your lifestyle, and your genetics. Here's one key reason: muscle naturally shrinks as we age, while body fat tends to grow. Less muscle means your body burns fewer calories at rest — what we call a slower metabolism. So even if you're eating the same way you always have and not moving any less, the pounds can quietly creep on. Your family history matters too. If your parents or close relatives tend to carry extra weight around the middle, there's a good chance your body will follow a similar pattern. Other everyday habits — like not exercising regularly, making less-than-ideal food choices, or consistently getting too little sleep — can also contribute. Sleep is more important than many people realize: when we're sleep-deprived, we tend to snack more and take in more calories overall. ### How Your Changing Hormones Affect Your Metabolism During perimenopause — the years leading up to menopause — progesterone levels decline gradually and steadily, while estrogen levels swing dramatically, sometimes varying widely within a single day. In the earlier phase of perimenopause, the ovaries can actually go into overdrive, producing unusually high amounts of estrogen. This happens because of disrupted communication between the ovaries, the hypothalamus, and the pituitary gland — the body's hormonal "control center." As perimenopause progresses and periods become more irregular, estrogen production falls — and drops even further once menopause is complete. Research suggests that high estrogen levels may encourage fat storage, which is consistent with patterns seen during the childbearing years, when higher estrogen is associated with more body fat. Before perimenopause, estrogen tends to direct fat storage to the hips and thighs — what's known as subcutaneous fat. This fat is stubborn to lose, but it's relatively benign in terms of health risk. **During and after menopause, however, falling estrogen levels shift fat storage to the belly — a type called visceral fat. This deeper abdominal fat is far more concerning, as it's linked to insulin resistance, type 2 diabetes, heart disease, and other serious health conditions.** ### Why Does Weight Gain After Menopause Matter for Your Health? Gaining weight during and after menopause isn't just a cosmetic concern — it can have real consequences for your long-term health. Carrying excess weight, particularly around your midsection, raises your risk of: - Breathing problems - Heart and blood vessel disease - Type 2 diabetes Excess weight also raises your risk of several cancers, including breast, colon, and endometrial cancers. ### What Actually Works for Preventing Weight Gain After Menopause? There's no secret shortcut — but there are proven strategies. Staying at a healthy weight after menopause comes down to the fundamentals: - **Keep moving.** Regular physical activity — both cardio and strength training — helps you burn calories, shed excess weight, and maintain a healthy body composition. For most healthy adults, experts recommend at least 150 minutes per week of moderate aerobic activity (like brisk walking) or at least 75 minutes per week of vigorous activity (like jogging). - **Build strength.** Resistance training improves your body composition, increases your strength, and helps you build and hold onto lean muscle. More muscle means a more efficient calorie-burning engine — which makes it easier to manage your weight over time. - **Eat a little less.** To maintain your current weight — let alone lose excess pounds — you might need about 200 fewer calories a day during your 50s than you did during your 30s and 40s. - **Cut calories without cutting nutrition.** Be intentional about what you eat and drink. Lean toward more fruits, vegetables, and whole grains — especially those that are minimally processed and naturally high in fiber. - **Ease up on carbs.** Reducing your carbohydrate intake can help limit the belly fat accumulation that drives many metabolic problems. - **Prioritize fiber.** A high-fiber diet — including foods like flaxseeds — may help improve your body's sensitivity to insulin. - **Take a closer look at your sugar intake.** Added sugars contribute nearly 300 calories per day to the average American's diet. About half of those calories come from sugary drinks — sodas, juices, energy drinks, flavored waters, and sweetened coffees and teas. Other major sources include cookies, pies, cakes, doughnuts, ice cream, and candy. - **Cut back on alcohol.** Alcoholic beverages add extra calories to your diet and increase the likelihood of weight gain. - **Consider a higher-protein / low-glycemic-index diet for lasting weight loss.** Research studies looking at ways of promoting weight loss and maintaining weight loss in subjects who've successfully shed pounds through a restricted-calorie diet have found that a higher-protein, lower glycemic-index diet was significantly better than other diets either lower in protein, or with a higher glycemic index, or both. Be choosy — the best high-protein plans focus on lean proteins and include some carbs. Avoid huge helpings of fatty meats and make sure to include vegetables. - **Protect your sleep.** Wind down before bedtime and make quality sleep a priority — it plays a surprisingly important role in regulating your hormones and keeping appetite in check. - **Build your support system.** Surround yourself with people who encourage your healthy habits. Even better — make these lifestyle changes together with someone you care about. Menopause can be a challenging season of life, both physically and emotionally. But nourishing your body well, staying active, and getting enough rest can go a long way toward preventing weight gain and protecting your health. Lasting weight loss — at any age — requires lasting changes in how you eat and how you move. Commit to those changes, and a healthier version of yourself is absolutely within reach. It may take some time to make peace with the changes happening in your body — and that's okay. These shifts are a natural part of aging, and accepting them with grace is part of the journey too. **Sources:** - <https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058> - <https://www.healthline.com/nutrition/menopause-weight-gain#hormones-and-metabolism> **References:** - Hoffman BL, et al. Menopausal transition. In: *Williams Gynecology*. 3rd ed. New York, N.Y.: McGraw-Hill Education; 2016. <https://accessmedicine.mhmedical.com> - Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. <https://health.gov/paguidelines/second-edition> - 2015–2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. <http://health.gov/dietaryguidelines/2015/guidelines> - Understanding adult overweight and obesity. National Institute of Diabetes and Digestive and Kidney Diseases. <https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/all-content> - *Endocrine.* 2005 Apr;26(3):297–300. doi: 10.1385/ENDO:26:3:297. Ovarian aging and the perimenopausal transition: the paradox of endogenous ovarian hyperstimulation. - *Obes Rev.* 2009 Mar;10(2):168–77. doi: 10.1111/j.1467-789X.2008.00539.x. Epub 2008 Oct 23. Does oestrogen allow women to store fat more efficiently? A biological advantage for fertility and gestation. - *Endocr Rev.* 2013 Jun;34(3):309–38. doi: 10.1210/er.2012-1055. Epub 2013 Mar 4. The role of estrogens in control of energy balance and glucose homeostasis. - Larsen TM, Dalskov S-M, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. *N Engl J Med* 2010;363:2102–2113. - Ludwig DS, Ebbeling CB. Weight-loss maintenance: Mind over matter? *N Engl J Med* 2010;363:2160–2162. - <https://www.healthline.com/nutrition/high-protein-diet-plan> ---
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Care planMenorrhagia**Menorrhagia** is the medical term for periods with unusually heavy or prolonged bleeding. While heavy menstrual bleeding is something many women worry about, true menorrhagia — bleeding severe enough to meet the clinical definition — is actually less common than you might think. **Menometrorrhagia** is a condition characterized by abnormally heavy, prolonged, and irregular uterine bleeding. Women with this condition typically lose more than 80 ml, or 3 ounces, of blood during a menstrual cycle. The bleeding also tends to be unpredictable and frequent — meaning you may bleed at times when your period isn't expected at all. Menometrorrhagia is actually a combination of two distinct menstrual disorders: - **Menorrhagia** — heavy uterine bleeding that occurs at regular intervals - **Metrorrhagia** — irregular bleeding **Dysfunctional uterine bleeding** accounts for 30–40% of all gynecological visits, and 60% of all dilatation and curettage procedures. Fifty percent of patients undergoing hysterectomy for menorrhagia in Oxford, England were scheduled for surgery because of regular heavy menstrual bleeding of unknown cause. **Hormonal imbalance —** Having too much estrogen can cause the uterine lining to grow thicker than it should. When that thickened lining begins to shed, the result can be heavier blood loss and clotting. Estrogen imbalances can develop for many reasons, including chronic stress and obesity. ## Understanding Heavy Menstrual Bleeding The most frequently identified causes of truly excessive menstrual bleeding are: leiomyomas (fibroids) of the uterus, pelvic inflammatory disease, endometriosis and adenomyosis, lesions in the uterine cavity such as submucous leiomyoma, intrauterine polyps, and intrauterine contraceptive devices. When none of these conditions are found on examination, excessively heavy menstrual bleeding is referred to as "dysfunctional uterine bleeding." Benjamin and Seltzer describe dysfunctional uterine bleeding as "abnormal uterine bleeding in which there is absolutely no organic pathological condition to be detected on clinical pelvic examination." In one study, 42 women who underwent hysterectomy for excessive menstrual blood loss were found to have no identifiable physical abnormality — no obvious pathology, no excess arterial supply, no abnormal glandular distribution. This tells us something important: it is surprisingly common for women to experience excessive menstrual bleeding with no clear structural cause. In many cases, the underlying driver is a biochemical or hormonal imbalance rooted in nutritional deficiencies — including vitamins, minerals, or essential fatty acids — that may affect the whole body or specific tissues. ### What May Be Contributing to Your Symptoms - High fat diet - Low iron - Impaired fatty acid conversion - Obesity and excess adipose tissue - Estrogen toxicity / hormone dysregulation ### What Is Endometrial Ablation? Endometrial ablation is a minimally invasive procedure used to treat heavy menstrual bleeding by removing or destroying the endometrium — the inner lining of the uterus. It is typically recommended for women who haven't found relief from medications and prefer to avoid more involved surgeries, like a hysterectomy. Here's a plain-language overview of what you need to know: 1. **The Procedure:** During endometrial ablation, your doctor uses one of several methods — heat, cold, microwave energy, or radiofrequency — to destroy the uterine lining. The specific technique chosen will depend on your individual situation and your doctor's clinical judgment. 2. **How Well Does It Work?** Most women experience a significant reduction in menstrual bleeding after the procedure, and some stop having periods entirely. That said, it is generally only recommended for women who do not plan to have more children, as it can affect fertility. 3. **Recovery:** Endometrial ablation is performed as an outpatient procedure, and most women return to their normal routines within a few days. Mild cramping and some discharge are normal in the days that follow. 4. **Risks to Be Aware Of:** The procedure is generally safe, but like any medical procedure, it carries some risks — including infection, uterine perforation, or injury to nearby organs. In rare cases, additional treatment may be needed if heavy bleeding returns. 5. **Who Is It Right For?** Endometrial ablation is best suited for women with abnormal uterine bleeding who have finished having children, as pregnancy following the procedure carries significant risks. Endometrial ablation offers a less invasive path to managing heavy periods, with a strong success rate and a lower risk of complications compared to major surgery. **Sources:** [MDPI](https://www.mdpi.com/2077-0383/9/5/1479) | [SpringerLink](https://link.springer.com/article/10.1007/s43032-023-01418-2) ### Natural Strategies After Endometrial Ablation After endometrial ablation, many women look to natural strategies to prevent symptoms like heavy bleeding from returning. These approaches center on lifestyle changes, dietary improvements, and targeted supplements or herbs that support hormonal balance and uterine health. Here are some well-supported natural approaches to consider: **1. Eating for Hormonal Health** A nutrient-dense, anti-inflammatory diet can help reduce the risk of recurring uterine issues. Key priorities include: - **Fruits and vegetables** rich in antioxidants (like berries, leafy greens, and citrus) that help reduce inflammation. - **Omega-3 fatty acids** from sources like fish, flaxseeds, and walnuts, which have anti-inflammatory properties. - Reducing intake of processed foods, refined sugars, and trans fats, as these can promote inflammation and hormonal imbalances. **Source:** [SpringerLink](https://link.springer.com/article/10.1007/s13669-016-0156-0) **2. Supportive Herbal Supplements** Certain herbs are thought to promote hormonal balance and protect uterine health: - **Vitex (Chaste Tree)** is known for helping to regulate hormonal balance, particularly in stabilizing progesterone levels. - **Turmeric and Ginger**, both anti-inflammatory herbs, may help reduce uterine inflammation. - **Green tea extract (EGCG)** has been studied for its ability to improve uterine health and may help prevent fibroid growth. **Sources:** [MDPI](https://www.mdpi.com/2077-0383/9/5/1479) | [Contemporary OB/GYN](https://www.contemporaryobgyn.net/view/vitamins-and-dietary-compounds-play-a-role-in-uterine-fibroids) **3. Restoring Hormonal Balance** Because endometrial ablation treats the symptom — not the underlying hormonal imbalances that often drive uterine problems — keeping estrogen and progesterone in balance remains essential. Some practical natural strategies include: - **Regular exercise** to help regulate weight and reduce excess estrogen stored in fat cells. - **Stress management** techniques such as yoga, meditation, or acupuncture, which can help regulate cortisol and improve overall hormonal health. **Source:** [Contemporary OB/GYN](https://www.contemporaryobgyn.net/view/vitamins-and-dietary-compounds-play-a-role-in-uterine-fibroids) **4. Targeted Nutritional Supplements** The following supplements may help reduce the risk of symptom recurrence: - **Vitamin D:** Low levels are linked to increased risks of uterine conditions, so supplementation can help maintain uterine health. - **Magnesium:** Helps in muscle relaxation and may reduce cramping and inflammation in the uterus. **Source:** [SpringerLink](https://link.springer.com/article/10.1007/s13669-016-0156-0) When these natural strategies are combined with regular medical follow-up, many women are able to meaningfully improve their long-term uterine health and reduce the chances of symptoms returning after endometrial ablation. ---
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Care planMethylationMethylation is one of the most fundamental processes keeping your body alive and well. At its core, methylation is a chemical process in which a tiny molecular tag — called a methyl group — gets passed from one molecule to another. This seemingly simple handoff has enormous consequences: methylation is required for cell division, DNA and RNA production, early brain development, gene expression, immune cell development, processing of chemical messengers after they're made, the production and breakdown of neurotransmitters, clearing histamine, detoxifying harmful substances, balancing hormones, producing cellular energy, building cell membranes, and insulating the nerves of your body. Methylation of DNA also plays a starring role in epigenetics — the science of how your genes get switched on or off without changing the DNA itself. **For most genes, less methylation = ON; more methylation = OFF.** These methylation patterns can be inherited and shape the gene activity of future generations. Fortunately, diet and lifestyle choices can also reshape them. Given how many critical jobs methylation performs, it should come as no surprise that **gaps in methylation can ripple outward into a wide range of health problems. Impaired methylation has been linked to depression, anxiety, histamine intolerance, increased cancer risk, hormone imbalance, poor detoxification, infertility, birth defects, persistent fatigue, and low energy.** --- ## Understanding Methylation Testing ### There's More to the Story Than MTHFR You may have heard of MTHFR — it's perhaps the gene that first put methylation in the spotlight. Methylenetetrahydrofolate reductase (MTHFR) is the rate-limiting enzyme of the methyl cycle; it is responsible for the activation of folate for the subsequent reduction of homocysteine to methionine.[1] Certain single nucleotide polymorphisms (SNPs), or variants of this gene, result in the reduced capacity of this enzyme.[2] Indeed, MTHFR variants are associated with increased risk for many diseases, including depression, fertility issues, insomnia, and thyroid conditions.[3] Because of this, many people — on their own or at the suggestion of a healthcare provider — have pursued genetic testing for MTHFR and related genes, then started taking supplements to fix a supposed "methylation deficiency" based on those genetic results alone. **This is a fundamentally flawed approach, since genes do not tell you about functional methylation capacity.** Just because you carry a gene variant that might predispose you to impaired methylation doesn't mean your methylation is actually impaired. In fact, it could be completely normal. On the flip side, someone with no methylation-related gene variants at all could have serious methylation imbalance that genuinely needs treatment. **While genetic information can certainly be useful, it's important to look at genetic results alongside functional methylation markers.** Markers of impaired methylation on a typical functional blood chemistry panel include low serum folate, low serum B12, high serum MMA, and high serum homocysteine. Additional indicative markers include low RBC folate, high urine MMA, and high urine FIGLU. ### Recommended Methylation Testing Labs The **Health Diagnostics and Research Institute (HDRI)** has a comprehensive test called the Methylation Pathways Panel that measures the many distinct folate derivatives in the methylation cycle, oxidized and reduced glutathione, and levels of methyl donor SAM-e and methylation inhibitor SAH. <https://hdri-usa.com/test/methylation-pathway-panel/> **Doctor's Data** offers a similar panel with faster turnaround time, but it is not as complete as HDRI. <https://www.doctorsdata.com/Methylation-Profile-plasma> These tests provide a true, accurate picture of how well your methylation system is actually functioning. ---
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Care planMigrating Motor ComplexThe **Migrating Motor Complex (MMC)** is a cyclic, recurring motility pattern that occurs in the stomach and small bowel during fasting; it is interrupted by feeding. The physiological role of the MMC is incompletely understood, but its absence has been associated with gastroparesis, intestinal pseudo-obstruction, and small intestinal bacterial overgrowth. Think of the MMC as your digestive tract's built-in cleaning crew. By sweeping food particles and debris through the gut between meals, the migrating motor complex helps keep digestion regular and guards against infections like SIBO (small intestinal bacterial overgrowth). It is, quite simply, one of the cornerstones of a healthy digestive system. ## Understanding the Migrating Motor Complex Among the many factors that shape your digestion, the Migrating Motor Complex (MMC) rarely gets the attention it deserves — yet it is one of the most fundamental processes in your entire digestive system, and one that genuinely depends on your daily habits to work properly. When patients learn about the MMC, their health outcomes improve. The good news is that working with your MMC is not complicated — it starts with a few straightforward changes to the way you eat. ### What Exactly Is the MMC? At its core, the MMC is a pattern of electrical activity that coordinates and drives gut movement. When you eat, your body breaks food down and shuttles nutrients through the stomach and small intestine. Once that job is done, this "housekeeping" wave moves leftover waste into the large intestine for elimination. It earns the name "motor" because the byproducts of digestion send signals cascading through your digestive organs, generating waves of coordinated activity that keep everything moving in the right direction. Ultimately, the MMC governs transit time — how long it takes food to travel from one end of your digestive tract to the other. What does the MMC need to do its job? The single most important requirement is a break from eating between meals. The moment food enters your system, the housekeeping cycle stops. Research tells us that one complete MMC cycle takes anywhere from 90 to 230 minutes, with meaningful variation from person to person. The gastrointestinal hormones motilin and pancreatic polypeptide, as well as the autonomic nervous system, are involved in the regulation of MMC cycling. ### Beyond Meal Timing: Other Factors That Shape Your MMC Stress, exercise, food quality, and slow, mindful eating habits can all leave a mark on MMC function. The essential takeaway is this: understanding how your digestive system works — and honoring it with meaningful breaks between meals — matters. How long those breaks need to be will depend on your individual health history and circumstances. Learning to tune into your body's own rhythms is one of the most powerful things you can do to keep your MMC's housekeeping cycle running smoothly. Meditation and relaxation practices such as deep breathing and yoga are genuinely valuable tools for supporting gut health and MMC function. These time-honored techniques help lower circulating cortisol levels in the body, and in doing so, may meaningfully improve how well your MMC operates. For people dealing with SIBO, the MMC is especially important to understand. SIBO patients almost universally have a poorly functioning MMC — and that dysfunction is precisely what creates the conditions allowing bacteria to overgrow in the small intestine. In fact, the frustratingly high relapse rates that many SIBO patients experience can often be traced back to one root cause: the underlying MMC dysfunction was never identified and addressed. ---
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Care planMitral Valve Prolapse (MVP)The **mitral valve** — also called the bicuspid valve — is the heart's left atrioventricular valve, sitting between the upper left chamber (left atrium) and the lower left chamber (left ventricle). It is made up of two flaps, called the anterior and posterior cusps, that open and close to keep blood flowing in the right direction. **Mitral Valve Prolapse (MVP)** is a condition in which one or both flaps (leaflets) of the mitral valve contain extra tissue — though no clear disease process causes this — causing the valve to bulge slightly backward during each heartbeat. This bulging produces a characteristic clicking sound near the end of the heart's pumping phase, followed by a whooshing sound (called a systolic murmur) as a small amount of blood leaks backward through the valve into the left atrium. Because of these sounds, MVP is sometimes called "click-murmur syndrome." A heart imaging test called an echocardiogram can clearly show the valve as it bulges into the left atrium. MVP is also known as Barlow's syndrome, named after the physician who, in 1968, first linked the condition to a small number of potentially serious complications — including heart valve infection (infective endocarditis), mini-strokes (transient ischemic attack), and irregular heart rhythms (arrhythmia). That said, the vast majority of people in whom MVP is detected — typically through listening to the heart with a stethoscope — have no other symptoms at all, and the condition is so mild that it requires no treatment. MVP occurs across all age groups and is relatively common. The small number of people who do experience symptoms may notice some chest discomfort, shortness of breath, awareness of their heartbeat (palpitations), and fatigue. Fainting and anxiety can also occur, though less frequently. Many patients feel significantly reassured once they understand that MVP is fundamentally different from coronary (blockage-related) heart disease. Heart rhythm testing (an electrocardiogram, or ECG) may reveal some extra heartbeats called premature ventricular contractions (PVCs) — but unlike PVCs seen in coronary heart disease, these are harmless and do not signal any damage to the heart muscle. Because MVP has only been recognized as a distinct condition for a relatively short time, its long-term effects have not yet been fully studied. However, the available evidence consistently shows that nearly all people with MVP go on to live completely normal, full lives. ---
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Care planModified Elimination DietAn elimination diet is a structured way to find out whether specific foods may be triggering your symptoms — or making them worse. When problem foods are identified, avoiding them can itself become a powerful treatment strategy. ---
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Care planMold / Fungus ExposureAccording to Dr. Robert Rakowski, when dealing with **Mold & Fungal Exposure or Infection**, there are **6 key areas** to focus on from a nutritional support standpoint. ---
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Care planMolluscum ContagiosumMolluscum contagiosum is a common viral skin infection. The virus — aptly named the *Molluscum contagiosum* virus — causes small, raised, non-cancerous bumps to form on the outer layers of your skin. These bumps are typically painless and will resolve on their own, rarely leaving scars when untreated. How long the virus sticks around varies from person to person, but bumps can persist anywhere from two months to four years. Molluscum contagiosum spreads through direct contact with an infected person's lesions or through contact with a contaminated object, like a shared towel or piece of clothing. Medications and minor surgical procedures are available options, but treatment is not necessary in most cases. If you have a weakened immune system, however, the virus can be harder to eliminate. --- ## Understanding Molluscum Contagiosum ### What Does It Look Like? Recognizing the Symptoms If you or your child is exposed to the *Molluscum contagiosum* virus, symptoms may not appear for up to six months. Most people, though, develop signs of infection within two to seven weeks of exposure. The first thing you may notice is a small cluster of painless bumps, which can appear alone or in a patch of up to 20. These bumps are usually: - Very small, shiny, and smooth in appearance - Flesh-colored, white, or pink - Firm and dome-shaped with a small dimple in the center filled with a waxy core, measuring between 2 to 5 millimeters in diameter — roughly the size of a pinhead to a pencil eraser - Found anywhere on the body except the palms of your hands or the soles of your feet - Most commonly on the face, abdomen, torso, arms, and legs - In adults, also frequently found on the inner thighs, genitals, or abdomen If your immune system is compromised, your symptoms may be more severe. Lesions can grow as large as 15 millimeters in diameter — roughly the size of a dime — and tend to appear more often on the face. They are also typically more resistant to treatment. ---
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Care planMorning SicknessThe recommendations below are based in part on Joel M. Evans, M.D., OB/GYN's book and seminar series titled *"Achieving a Whole Pregnancy: Bringing Holism into Birth"* and his book titled *"The Whole Pregnancy Handbook — An Obstetrician's Guide to Integrating Conventional and Alternative Medicine Before, During, and After Pregnancy"* (a must-read for anyone trying to conceive or currently pregnant; available at most bookstores or on Amazon — published by Gotham Books). As noted throughout this protocol, **[Everyday Essentials Pregnancy](https://nutridyn.com/everyday-essentials-pregnancy)** was formulated by Joel M. Evans, M.D., OB/GYN — Assistant Clinical Professor, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine and College of Physicians and Surgeons of Columbia University, and author of *"The Whole Pregnancy Handbook."* Dr. Evans created Everyday Essentials Pregnancy because he was convinced that existing prenatal formulas — whether prescription or over-the-counter — were falling short on a number of nutrients essential for a healthy delivery and a healthy baby. ---
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Care planMotion SicknessMotion sickness happens when your brain gets confused by mixed signals coming from your eyes, ears, and body. All kinds of movement — riding in a car, flying in a plane, sailing on a boat, or even spinning on an amusement park ride — can leave you feeling nauseous, clammy, or downright sick to your stomach. Some people vomit. Whether you call it carsickness, seasickness, or airsickness, it's all the same thing: motion sickness. ## Understanding Motion Sickness ### Who Gets Motion Sickness? About one in three people experience motion sickness at some point in their lives. Women and children between the ages of two and 12 are most likely to be affected — but the truth is, it can happen to anyone. Certain factors can raise your risk of getting motion sickness: - A family history of motion sickness. - Hormonal birth control. - Inner ear disorders. - Menstrual periods. - Migraines. - Parkinson's disease. - Pregnancy. ### What Causes Motion Sickness? Your brain is constantly collecting signals from the motion-sensing parts of your body — your eyes, inner ears, muscles, and joints. When these signals don't match up, your brain gets caught in a kind of sensory crossfire, unsure whether you're sitting still or moving. That confusion is what makes you feel sick. Here's a classic example: while riding in a car, your: - Eyes watch trees blur past and register movement. - Inner ears sense that you're in motion. - Muscles and joints sense that your body is sitting still. - Brain detects a disconnect among these messages — and that's where the trouble begins. Many activities can set off motion sickness, including: - Amusement park rides and virtual reality experiences. - Reading while in motion. - Riding in a boat, car, bus, train, or plane. - Video games and movies. ### What Does Motion Sickness Feel Like? Motion sickness has a way of sneaking up on you. You can feel perfectly fine one moment and then, seemingly out of nowhere, notice one or more of these symptoms: - Cold sweats. - Dizziness. - Fatigue. - Headache. - Irritability. - Difficulty concentrating. - Increased saliva, nausea, and vomiting. - Pale skin. - Rapid breathing or gulping for air. ### How Is Motion Sickness Diagnosed? Your healthcare provider will ask you to describe your symptoms and what tends to trigger them. They may also do a brief physical exam and take a closer look at your eyes and ears. ### How Is Motion Sickness Treated Conventionally? There are several options — both for preventing motion sickness before it starts and for easing symptoms once they arrive. Standard medical treatments include: - **Antihistamines:** Best known for treating allergies, antihistamines can also prevent motion sickness and relieve symptoms. One important note: only the formulas that cause drowsiness are effective. Non-drowsy versions won't do the trick. - **Patches:** Scopolamine skin patches (Transderm Scop®) or oral pills can prevent nausea and vomiting. You apply the patch behind your ear at least four hours before you travel. After three days, remove the old patch and put on a fresh one. This medication may cause dry mouth and is approved for adults only. ### Can Motion Sickness Lead to Complications? Motion sickness rarely causes serious problems. In uncommon cases, vomiting can be persistent and hard to stop — and if that happens, excessive vomiting can lead to dehydration and low blood pressure (hypotension). ---
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Care planMouth / Lip ConditionsAngular stomatitis (also known as angular cheilitis, cheilosis, and perlèche) is recognized by redness, cracking, and flaking at the corners of the mouth. It is considered significant only when both corners are affected at the same time. **Research has connected the first appearance of angular cheilitis to nutritional deficiencies — particularly B vitamins (especially B2, or riboflavin) and iron** (low iron can lead to iron deficiency anemia), which may point to broader problems with nutrition or nutrient absorption. Other causes to rule out include poorly fitting dentures, syphilis, and herpes. **Cheilosis** (also called cheilitis) is a painful inflammation and cracking at the corners of the mouth. It can affect just one corner, but most often involves both sides. This condition is most common in people whose dentures fit poorly and fail to properly support the space between the upper and lower jaws. **A deficiency in Vitamin B1 (thiamin) can lead to tongue inflammation (glossitis). A deficiency in Vitamin B2 (ariboflavinosis) can cause glossitis, along with angular cheilitis, cheilosis, nerve damage in the limbs, and other symptoms. A deficiency in Vitamin B3 (pellagra) can also cause glossitis.** People who habitually irritate the corners of their mouth — by licking or rubbing those areas, for example — are also at greater risk for developing cheilosis. Moisture tends to collect in the skin folds at the corners of the mouth, creating the perfect conditions for yeast (*Candida*) infections to take hold. People living with health conditions such as anemia, diabetes, or a weakened immune system are especially vulnerable. ## Understanding Tongue Inflammation (Glossitis) **Glossitis** is the medical term for inflammation of the tongue. When it occurs, the tongue may swell, change color, and take on an unusual appearance. Glossitis can cause the small bumps on the tongue's surface — called papillae — to disappear. These papillae house thousands of tiny taste buds and play an important role in how you eat. When inflammation becomes severe enough to cause significant swelling and redness, it can be painful and may interfere with eating or speaking. ### What Triggers Tongue Inflammation? Several factors can lead to tongue inflammation, including: - **Allergic reactions to medications, foods, and other irritants** can aggravate both the papillae and the muscle tissue of the tongue. Common culprits include certain toothpastes and some blood pressure medications. - **Certain diseases** — Conditions that affect the immune system may attack the tongue's muscles and papillae. Herpes simplex — the virus responsible for cold sores and blisters around the mouth — can also contribute to tongue swelling and pain. - **Low iron and B12 levels** — Insufficient iron and B12 in the blood can trigger glossitis. Iron plays a key role in cell growth by helping the body produce red blood cells, which carry oxygen to organs, tissues, and muscles. When iron levels fall too low, levels of myoglobin — a protein in red blood cells that is essential for muscle health, including the tongue — may also drop. - **Mouth injuries** — Physical trauma to the mouth can affect the tongue's health. Cuts, burns on the tongue, or dental appliances like braces can all trigger inflammation. ---
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Care planMuscle Tear | Muscle StrainA **muscle tear**, also known as a **muscle strain**, happens when muscle fibers are overstretched or torn — usually from too much force, repetitive overuse, or an awkward movement. Muscle tears vary widely in severity: a mild injury (Grade I) involves only minor fiber damage and some soreness, while a severe tear (Grade III) means the muscle is partially or completely ruptured, often causing **sudden pain, swelling, bruising, and difficulty moving**. These injuries most commonly affect muscles that cross two joints — like the hamstrings, quadriceps, and calves — and typically heal best with a combination of **rest, physical therapy,** and **targeted nutritional support** to calm inflammation, rebuild tissue, and restore full function. When supporting **muscle tear healing** naturally, the goal is straightforward: reduce inflammation, give your body the raw materials it needs to repair damaged tissue, improve circulation to the injury site, and lay the groundwork for full regeneration. ---
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Care planMuscular DystrophyMuscular dystrophy is not a single disease — it is a group of inherited conditions, each caused by a distinct gene mutation, that share a common feature: progressive weakening and breakdown of the skeletal muscles that control movement. Understanding the specific type, its pattern of inheritance, which muscles it affects first, and how quickly it tends to progress is the foundation of informed, proactive care. ---
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Care planMyocardial InfarctionMost people survive a first heart attack and go on to live full, meaningful lives. With the right steps, you can be one of them.
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Care planMyocarditisMyocarditis is an inflammation of the heart muscle — the myocardium — that can weaken the heart's ability to pump blood effectively. It can cause chest pain, shortness of breath, and rapid or irregular heart rhythms (arrhythmias). One of the most common triggers of myocarditis is a viral infection, which prompts the immune system to mount an inflammatory response. In other cases, a drug reaction or an underlying inflammatory condition may be to blame. > 📝 **NOTE:** Myocarditis and pericarditis have been reported, especially in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). Myocarditis is inflammation of the heart muscle. Pericarditis is inflammation of the outer lining of the heart. When myocarditis becomes severe, the heart may no longer be able to meet the body's demands for blood. Clots can form inside the heart, raising the risk of stroke or heart attack. Treatment may involve medications, procedures, or surgery depending on the severity. ## Understanding Myocarditis ### Recognizing the Symptoms Many people in the early stages of myocarditis have no symptoms at all, or only mild ones that are easy to dismiss. Common signs of myocarditis include: - Chest pain - Fatigue - Swelling of the legs, ankles and feet - Rapid or irregular heartbeat (arrhythmias) - Shortness of breath, at rest or during activity - Light-headedness or feeling like you might faint - Flu-like symptoms such as headache, body aches, joint pain, fever or sore throat > ⚠️ **IMPORTANT NOTE:** In some cases, myocarditis symptoms can closely mimic those of a heart attack. If you are experiencing unexplained chest pain or sudden shortness of breath, seek emergency medical care immediately. ### Myocarditis in Children Children can develop myocarditis too, and their symptoms may look a little different. Watch for: - Breathing difficulties - Chest pain - Fainting - Fever - Rapid breathing - Rapid or irregular heart rhythms (arrhythmias) ### What Causes Myocarditis? - **Viral infections.** This can include the common cold, respiratory infections, hepatitis C and B, parvovirus, measles, mumps, the flu, fifth disease, HIV, herpes simplex virus, echoviruses, rubella and mononucleosis (Epstein-Barr virus). - **Bacterial infections.** This can include infections caused by *staphylococcus*, *streptococcus*, or tick-borne bacterium that cause Lyme disease. - **Autoimmune diseases**, including lupus or Lyme disease. - **Parasites**, such as Trypanosoma cruzi (which causes Chagas disease) and toxoplasma. Fungus can also cause myocarditis in people with weakened immune systems. Examples of fungi that have been associated with myocarditis include certain types of mold, candida, yeast infections and histoplasma. - **Exposure to environmental toxins or metal poisoning.** - **High levels of inflammation.** - **Adverse reactions to medications or recreational drugs**, including cocaine. Medications including certain antibiotics, sulfonamide drugs, anti-seizure medications and cancer medications have been associated with myocarditis. Adverse reactions to these drugs can cause hypersensitivity, which inflames the heart. - Rarely, certain types of cancer. - Rarely, infections caused by snake or spider bites. ### Key Takeaways About Myocarditis - Myocarditis is a disease marked by inflammation and damage of the heart muscle. - Symptoms don't always occur, but can include those similar to a heart attack such as chest pains, trouble breathing and heart palpitations. - Myocarditis can increase the risk for scar tissue developing on the heart, a heart attack, heart failure or stroke. - The most common causes of myocarditis are viral infections, autoimmune diseases, bacterial infections, drug or medication use, or, rarely, tick/insect bites. ---
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Care planMyofibrositisScar-like tissue that forms in your muscles and surrounding soft tissues can restrict normal movement. When soft tissues are torn from an injury — or when muscles are held in prolonged tension — your body responds by producing a thick, gel-like material that eventually hardens into collagen-based scar tissue. This is your body's well-intentioned but imperfect attempt to protect and stabilize an area it perceives as damaged. **Three important problems arise from this scar tissue formation:** 1. Scar tissue is more sensitive to pain than the healthy structural and contractile tissue it replaces. 2. Scar tissue is stiffer and less flexible, which limits how freely your joints can move. 3. Scar tissue is more brittle than healthy tissue, making it significantly more vulnerable to re-injury. This condition typically develops after a physical injury or from prolonged, repetitive overuse of your muscles. A classic example is postural strain — think of someone who leans over a desk day after day, placing constant, unrelenting tension on the muscles of the neck and upper back. Over time, those muscles and the nearby ligaments supporting the rib and spinal joints can become riddled with scar tissue adhesions. The good news: with the right treatment and thoughtful changes to your daily habits and workspace, the outlook is excellent. ### What to Watch For - Reduced range of motion or a "stiff" feeling in affected joints - Pain or tenderness when firm pressure is applied to the area - A gritty, rope-like texture felt in the ligaments or muscles - Localized muscle knots (also called trigger points) ---
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Care planMyositis**Myositis** is a broad term for inflammation of the muscles. It encompasses several distinct diseases, including dermatomyositis, inclusion body myositis (IBM), juvenile myositis, and polymyositis. These diseases are also collectively known as inflammatory myopathies. They share a common thread: inflammation within muscle tissue that leads to muscle damage. The trigger can be an injury, an infection, or an autoimmune disease — in which the body mistakenly attacks its own healthy tissue. Myositis refers to any condition that causes muscle inflammation. The most recognizable symptoms are weakness, swelling, and pain. Depending on the cause — which can range from infection or injury to autoimmune conditions and medication side effects — treatment approaches will differ. ## Understanding Myositis ### What Causes Myositis? Myositis can arise from any condition that triggers inflammation in the muscles. These causes generally fall into a few broad categories: - **Inflammatory conditions.** Conditions that drive widespread inflammation throughout the body can spill over into the muscles, causing myositis. Many of these are autoimmune conditions, where the immune system turns against the body's own tissues. Inflammatory conditions that can cause more severe forms of myositis include: - Dermatomyositis - Polymyositis - Inclusion body myositis Other inflammatory conditions tend to produce milder forms of myositis, including: - Lupus - Scleroderma - Rheumatoid arthritis Inflammatory conditions are often the most serious drivers of myositis and typically require long-term treatment strategies. - **Infection.** Viral infections are the most common infectious cause of myositis. Less commonly, bacteria, fungi, or other microorganisms may be responsible. These pathogens can invade muscle tissue directly or release substances that damage muscle fibers. Common cold and flu viruses, as well as HIV, are among the viruses known to cause myositis. - **Medications and drugs.** A surprisingly wide range of medications and substances can cause temporary muscle damage. Because inflammation within the muscle is not always detected, the resulting muscle problem may be labeled myopathy rather than myositis. Drugs that can cause myositis or myopathy include: - Statins - Colchicine - Plaquenil (hydroxychloroquine) - Alpha-interferon - Cocaine - Alcohol Muscle damage from a drug can appear shortly after starting it, or it may take months or even years to develop. In some cases, it results from an interaction between two medications taken together. Fortunately, severe drug-induced myositis is rare. - **Injury.** Intense physical exercise can leave muscles painful, swollen, and weak for hours or days afterward. Inflammation plays a role in these post-workout symptoms — which, technically speaking, qualifies as a form of myositis. The good news: myositis from exercise or injury almost always resolves fully with rest and recovery. - **Rhabdomyolysis.** Rhabdomyolysis occurs when muscle tissue breaks down rapidly. Symptoms include muscle pain, weakness, and swelling. In addition, urine may take on a dark brown or red color — a telltale warning sign that warrants prompt medical attention. ### Recognizing the Symptoms of Myositis The hallmark symptom of myositis is muscle weakness. This weakness may be obvious in daily life, or it may only be detectable through formal testing. Muscle pain (myalgias) may or may not accompany the weakness. In dermatomyositis, polymyositis, and other inflammatory forms of myositis, weakness tends to develop gradually — worsening over weeks or months. It typically affects large muscle groups, including the neck, shoulders, hips, and back, and usually involves both sides of the body equally. This progressive weakness can make everyday tasks unexpectedly difficult — increasing the risk of falls and making it hard to rise from a chair or get up after a fall. Additional symptoms that may accompany inflammatory myositis include: - Rash - Fatigue - Thickening of the skin on the hands - Difficulty swallowing - Difficulty breathing When a virus is responsible for myositis, most people will also notice classic signs of a viral illness — runny nose, fever, cough, sore throat, nausea, or diarrhea. Interestingly, these viral symptoms may clear up days or weeks before the muscle symptoms actually begin. While some people with myositis experience muscle pain, many do not. It is worth noting that most muscle pain is not caused by myositis at all, but rather by strain injuries or common illnesses like colds and flu. These everyday muscle aches are referred to as myalgias. ### How Is Myositis Diagnosed? A doctor may first suspect myositis based on a patient's reported muscle weakness or other telltale signs. To confirm the diagnosis, several tests may be used: - **Blood tests.** Elevated levels of muscle enzymes — such as creatine kinase — can signal muscle inflammation. Other blood tests look for abnormal antibodies that may point to an underlying autoimmune condition. - **MRI scan.** Using a powerful magnet and computer technology, an MRI produces detailed images of the muscles. It can help pinpoint areas of active myositis and track changes in muscle tissue over time. - **EMG (electromyography).** By inserting small needle electrodes into muscles, a doctor can measure how muscles respond to electrical nerve signals. An EMG can identify which muscles are weak or have been damaged by myositis. - **Muscle biopsy.** This is the most definitive test for diagnosing myositis. A doctor identifies an affected muscle, makes a small incision, and removes a tiny sample of muscle tissue for laboratory analysis. In most patients with myositis, a muscle biopsy provides the final, conclusive diagnosis. Because muscle weakness and pain are far more commonly caused by conditions other than myositis — and because the testing process is not always straightforward — reaching a confirmed diagnosis of myositis can take time and patience. ### Treating Myositis Treatment for myositis is tailored to its underlying cause. There is currently no cure for myositis. However, managing the disease effectively is essential — both to reduce muscle inflammation and to slow or prevent the progression of muscle weakness. When inflammatory conditions are driving myositis, treatment often involves medications that calm the immune system, including: - Prednisone - Azathioprine (Imuran) - Methotrexate When a virus is to blame, myositis typically resolves on its own without specific treatment. Bacterial myositis is uncommon but serious — requiring prompt antibiotic treatment to prevent life-threatening spread of infection. Although rhabdomyolysis is an uncommon complication of myositis, it can cause permanent kidney damage if not treated quickly. Patients with rhabdomyolysis are hospitalized and given large amounts of continuous intravenous fluids to protect the kidneys. When a medication is identified as the culprit, the most effective treatment is simply stopping that drug. **Sources:** - <https://www.webmd.com/a-to-z-guides/myositis-symptoms-treatments-prognosis#1> - Firestein, G. *Kelley's Textbook of Rheumatology*. W.B. Saunders Company, 2008. - Goldman, L. *Cecil Medicine*. Saunders, 2007. - Dalakas, M.C. *The Lancet*, 2003. - Dorph, C. *Journal of Rheumatology*, 2001. - Hansen, K.E. *Archives of Internal Medicine*, 2005. - Rider, L. *The Journal of the American Medical Association*, January 12, 2011. ---
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Care planNail / Toenail Fungus (Onychomycosis)Nail fungus is a surprisingly common condition that often starts as a small white or yellow spot beneath the tip of a fingernail or toenail. Left unchecked, the infection can burrow deeper — causing the nail to change color, grow thicker, and crumble at the edges. More than one nail can be affected at a time. If your case is mild and not causing you trouble, you may not need to do anything at all. But if nail fungus is painful or has caused your nails to thicken, a combination of self-care and medication can help. One important thing to know: even when treatment works, nail fungus has a frustrating tendency to return. Nail fungus goes by the medical name **onychomycosis** (on-ih-koh-my-KOH-sis). When fungus takes hold between your toes or on the skin of your feet, that condition is known as **athlete's foot** (tinea pedis). --- ## Understanding Nail Fungus ### What to Look For: Signs and Symptoms Nail fungus may be to blame if one or more of your nails are: - Thickened - Whitish to yellow-brown discoloration - Brittle, crumbly, or ragged - Distorted in shape - Darkened by debris collecting underneath the nail - Giving off a mildly unpleasant odor While nail fungus can affect the fingernails, it shows up far more often in the toenails. ### When It's Time to See a Doctor If home care hasn't made a dent and your nail is becoming more discolored, thickened, or misshapen, it's worth scheduling a visit with your doctor. And if you have diabetes and suspect you may have nail fungus, don't wait — see your doctor promptly. ### What Causes Nail Fungus? Fungal nail infections are triggered by various fungal organisms. The most frequent offender is a group of fungi called **dermatophytes**, though yeasts and molds can also infect nails. People of any age can develop a fungal nail infection, but older adults are more susceptible. As nails age, they tend to become dry and brittle — and those tiny cracks become open doors for fungi to slip through. Poor circulation to the feet and a weakened immune system can also raise your risk. Toenail fungus can originate from athlete's foot and spread from one nail to another. That said, picking up a fungal nail infection from another person is uncommon. ### Who Is Most at Risk? Several factors can make you more likely to develop nail fungus, including: - Being older, owing to reduced blood flow, more years of exposure to fungi, and slower-growing nails - Sweating heavily - Having a history of athlete's foot - Walking barefoot in damp communal areas, such as swimming pools, gyms, and shower rooms - Having a minor skin or nail injury or a skin condition, such as psoriasis - Having diabetes, circulation problems, or a weakened immune system ### Potential Complications: Why This Matters A serious nail fungal infection can be painful and may permanently damage the nail. In people with a weakened immune system — whether from medication, diabetes, or another condition — the infection can potentially spread beyond the feet and lead to more serious problems. If you have diabetes, you likely already know that blood flow and nerve function in your feet can be compromised. This also means you're at greater risk for a bacterial skin infection called **cellulitis**. In this context, even something that seems minor — like a nail fungal infection — can snowball into a bigger complication. If you have diabetes and think you might have nail fungus, please see your doctor. ### How to Protect Yourself: Prevention Tips These straightforward habits can help you avoid nail fungus in the first place — or prevent it from coming back after treatment: - Wash your hands and feet regularly. Wash your hands after touching an infected nail. Moisturize your nails after washing. - Trim nails straight across, smooth the edges with a file, and file down thickened areas. Disinfect your nail clippers after each use. - Wear sweat-absorbing socks or change your socks throughout the day. - Choose shoes made of materials that breathe. - Discard old shoes or treat them with disinfectants or antifungal powders. - Wear footwear in pool areas and locker rooms. - Choose a nail salon that uses sterilized manicure tools for each customer. - Give up nail polish and artificial nails. ### Getting a Diagnosis Your doctor will examine your nails closely. He or she may also collect a few nail clippings or scrape debris from under the nail and send the sample to a lab to pinpoint which type of fungus is responsible for the infection. It's worth noting that other conditions — psoriasis, for example — can look a lot like a fungal nail infection. Yeasts and bacteria can also infect the nails. Identifying the exact cause is key to choosing the most effective treatment. ---
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Care planNarcolepsy | CataplexyNarcolepsy is a sleep disorder marked by overwhelming daytime sleepiness and sudden, unavoidable episodes of falling asleep. It affects men and women equally, typically first appearing in the early teens to mid-twenties — though it can develop at any age. The American Sleep Association estimates that between 125,000 and 200,000 Americans live with narcolepsy, yet fewer than 50,000 are thought to be properly diagnosed and treated. ## Understanding Narcolepsy ### What Causes Narcolepsy? The root cause of narcolepsy has not yet been discovered. Genetics may play a role — if a family member has narcolepsy, your own risk appears to be slightly higher. Scientists have identified genes that regulate certain chemical messengers in the brain responsible for controlling when we fall asleep and wake up. In narcoleptic dogs and mice, genetic defects in this system lead to a shortage of a specific group of proteins called **hypocretins**. These same compounds are often dramatically reduced in people with narcolepsy. Hypocretins help stabilize REM sleep and ensure it happens at the right points in the sleep cycle. For reasons that are still not fully understood, the brain cells in an area called the **hypothalamus** — responsible for producing these important chemicals — are compromised in some people. This results in lower hypocretin levels in the fluid surrounding the brain and spinal cord, with the lowest levels seen in those who also experience cataplexy (sudden muscle weakness). Whether this is driven by a genetic flaw or triggered by outside factors like infection or an immune system misfiring is still being worked out. What does seem clear is that disruptions to this system lie at the heart of narcolepsy. Because many other medical conditions and certain medications can produce similar symptoms, a formal evaluation at a sleep lab is necessary to confirm a narcolepsy diagnosis. ### Recognizing the Symptoms The most common symptoms of narcolepsy are: 1. **Waves of intense drowsiness** every 3 to 4 hours during the day. You may feel an overwhelming urge to sleep, often followed by a brief, unplanned nap (sometimes called a sleep attack). - These episodes typically last about 15 minutes, though they can run longer. - They frequently happen after meals, but can also strike while driving, mid-conversation, or during other everyday activities. - You usually wake up feeling refreshed. 2. **Dream-like hallucinations** can occur in the hazy transition between sleep and wakefulness — vivid experiences involving sight, sound, and sometimes other senses. 3. **Sleep paralysis** is a temporary inability to move that can happen just as you wake up — or just as you are drifting off to sleep. 4. **Cataplexy** is a sudden loss of muscle control while you are fully awake, leaving you temporarily unable to move. It is often triggered by strong emotions like laughter or anger. - Most episodes last fewer than 30 seconds and may be so brief they go unnoticed. - The head may suddenly drop forward, the jaw may go slack, and the knees may buckle. - In more severe cases, a person may fall and remain temporarily paralyzed for up to several minutes. Not every person with narcolepsy experiences all four of these symptoms. Narcolepsy is believed to stem from a breakdown in the normal regulation of **Rapid-Eye Movement (REM) sleep** — the stage of sleep during which your eyes move rapidly beneath closed lids. In a typical night, sleep begins as the sun goes down and progresses through deepening stages of relaxation, slowing brain activity, and easing muscle tension (known as non-REM sleep), before transitioning into REM sleep — a phase defined by vivid dreaming, suppressed muscle activity, and a surge in brain activity. In most people, REM sleep accounts for roughly 25 percent of total sleep time and is when the most memorable dreams occur. The symptoms of narcolepsy closely mirror what normally happens during REM sleep — muscle limpness, inability to move, and dreaming. In people with narcolepsy, REM-like patterns can appear almost immediately upon falling asleep at night and intrude throughout the day as well. The defining symptom of narcolepsy is **excessive daytime sleepiness (EDS)**, which can cause a person to fall asleep without any warning. These sleep episodes can range from a few seconds to several minutes — a serious safety concern for anyone who drives or operates heavy equipment. EDS can also contribute to memory difficulties, trouble concentrating, fatigue, irritability, depression, and general exhaustion. Cataplexy — the sudden, involuntary loss of muscle tone often set off by strong emotions like surprise, laughter, or anger — may cause a person to drop objects they are holding or collapse entirely. Hallucinations while falling asleep or waking up can be intensely realistic and frightening, as can brief episodes of complete paralysis at the edges of sleep. This sleep paralysis typically lasts a few minutes and may or may not come with an awareness that it is happening. Some people also experience **automatic behavior** — continuing to talk and carry out routine tasks while essentially "running on autopilot," with no memory of doing so afterward. Up to eighty percent of people with narcolepsy experience this kind of automatic activity. Other features of narcolepsy can include restless nights, frequent limb movements during sleep, and even physically acting out dreams — biting, screaming, kicking, punching, or thrashing. For some, the daily challenges and social stigma of living with narcolepsy can erode motivation and contribute to depression. ### Approaches to Treatment There is currently no cure for narcolepsy. Treatment is focused on managing symptoms as effectively as possible. Making thoughtful lifestyle adjustments and developing strategies for coping with the emotional and practical demands of the condition can meaningfully improve your ability to function at work and in social settings. Helpful strategies include: - Choosing lighter or vegetarian meals during the day and avoiding heavy meals before important activities - Scheduling a brief nap (10 to 15 minutes) after meals whenever possible - Planning regular naps to stay ahead of daytime sleepiness and reduce the chance of sudden, unplanned sleep attacks - Letting teachers and supervisors know about your condition so that drowsiness is not mistaken for laziness at school or work According to Rubin Naiman, Ph.D., author and sleep specialist at the Arizona Center for Integrative Medicine, medications such as Provigil® help people with sleep disorders function more normally by masking the symptoms of sleepiness. They do not treat the underlying cause of the disorders. Nor do they address the mental-emotional-spiritual aspects of the basic human need to sleep and dream. While he acknowledges that medications may be necessary in acute cases of narcolepsy, Dr. Naiman suggests that people with the condition can work toward healthier sleep by optimizing general nutrition; eliminating alcohol, caffeine, and nicotine; exercising regularly; and napping routinely for 15–20 minutes as needed. Nutrients that may help manage narcolepsy include calcium and magnesium, choline, chromium picolinate, coenzyme Q10, omega-3 fatty acids, B vitamins, vitamin C complex (including bioflavonoids), and vitamins D and E. Some research suggests that the supplement 5-HTP may benefit people with narcolepsy by shortening the duration of cataplexy episodes and improving nighttime sleep quality. Food intolerances may also be connected to narcolepsy — an elimination diet is worth exploring. Wheat, dairy products, corn, and chocolate are the most commonly implicated foods. Dr. Naiman also recommends breathing exercises for stress management and encourages keeping a dream journal to better understand dreams and explore the psychological and spiritual dimensions of living with a sleep disorder. ### Key Nutrients for Narcolepsy and Cataplexy - **L-Tyrosine** — Plays an important role in thyroid function. Low levels have been linked to narcolepsy. *"Narcolepsy is a disorder characterized by the sudden urge to sleep. The biochemical etiology of this disorder is believed to be due to dopamine abnormalities. Since the precursor of dopamine is L-tyrosine, the administration of this amino acid may prove beneficial in the treatment of narcolepsy. Preliminary research apparently supports this hypothesis."* As part of a series of studies of the dopaminergic system in patients with various sleep disorders, eight narcoleptics were treated with oral tyrosine (average dose 100 mg/kg) in an open trial conducted in Bron, France. ***Within six months, all patients were free from daytime sleep attacks and episodes of cataplexy (sudden muscular weakness that is a distinctive part of the narcolepsy syndrome).*** The researchers concluded that their findings point to an abnormality in the dopaminergic system in narcolepsy, and that they are of real clinical significance — even in the absence of a control group. "Our impression, however, is that such a long-lasting placebo effect is unlikely and that tyrosine offers a valuable new approach to the management of narcolepsy." **References:** - *Medical Hypotheses*, Volume 33, Issue 4, December 1990, Pages 269–273. L-tyrosine in the treatment of narcolepsy. - *Lancet.* 1988 Dec 24–31;2(8626–8627):1458–9. Treatment of narcolepsy with L-tyrosine. > 🔶 **CAUTION:** Do not take tyrosine if you are taking an MAO inhibitor drug. - **L-5-Hydroxytryptophan (5-HTP)** — May shorten the duration of cataplexy episodes and improve nighttime sleep. 5-hydroxytryptophan (600 mg a day) or a placebo were administered during 4 weeks following a double-blind crossover design to 11 narcoleptic-cataplectic patients. Daily number of cataplectic and narcoleptic attacks did not vary. The 36-hour polygraphic recordings performed at the end of each treatment showed: a trend toward a decrease of the duration of daytime sleep and a significant increase of the duration of nighttime sleep. **Reference:** *Biomedicine.* 1977 Jul;27(5):200–3. Clinical and polygraphic effects of d.l. 5-HTP on narcolepsy-cataplexy. - **Calcium and Magnesium** — Essential for energy production and for keeping both the nervous system and muscles functioning well. - **Chromium Picolinate** — According to Dr. Andrew Weil, chromium helps boost energy and regulate sugar metabolism — both important for people managing narcolepsy. - **Coenzyme Q10** — According to Dr. Andrew Weil, Coenzyme Q10 supports healthy circulation to the brain, fuels mitochondrial energy production, and acts as a powerful antioxidant — all of which are important for people with narcolepsy. - **L-Glutamine** — According to Dr. Andrew Weil, L-glutamine supports mental performance. Often called "brain fuel," it crosses the blood-brain barrier freely and actively supports brain processes — making it particularly relevant for those with narcolepsy. - **Omega-3 Essential Fatty Acids** — According to Dr. Andrew Weil, omega-3 fatty acids protect cell membranes and support the nervous system. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — key omega-3s found in fish oils — are known to enhance brain function and memory, making them a valuable addition to the diet for anyone living with narcolepsy. - **Vitamin B Complex, Especially Vitamins B6, B12, and Folic Acid** — According to Dr. Andrew Weil, B vitamins rev up metabolism and are essential for sustaining energy levels and maintaining normal brain function — important considerations for people with narcolepsy. - **Vitamin C with Bioflavonoids** — According to Dr. Andrew Weil, vitamin C combined with the bioflavonoid complex supports energy levels and stimulates the body's production of interferon, helping to guard against free radical damage — benefits that matter for people with narcolepsy. - **Vitamin D** — Essential for calcium absorption and neurotransmitter balance. Narcolepsy with cataplexy (NC) is currently thought to be an autoimmune-mediated disorder in which environmental risk factors make a significant contribution to its development. It is proposed that vitamin D deficiency plays a role in autoimmune diseases. Research has found a higher frequency of vitamin D deficiency in NC. **Reference:** *PLoS One.* 2011;6(5):e20433. Published online 2011 May 25. doi: 10.1371/journal.pone.0020433. Low Vitamin D in Narcolepsy with Cataplexy. - **Vitamin E** — Supports healthy circulation and helps protect the heart and brain cells. ---
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Care planNatural ExpectorantsIf you're dealing with a wet, productive cough — the kind that brings up phlegm (mucus) — natural expectorants may offer real relief. These remedies work by thinning and loosening the mucus trapped in your lungs, making it easier to breathe and helping your cough actually clear things out. One important tip: when you cough up mucus, spit it out rather than swallowing it. While natural expectorants can ease your symptoms, they're not a cure — it's still important to identify and treat whatever is causing your cough in the first place. In the meantime, one of the simplest things you can do is drink plenty of fluids. Staying well-hydrated naturally helps thin the mucus in your lungs. ## Understanding Phlegm ### What Exactly Is Phlegm? Phlegm is a thick, sticky fluid produced deep in your chest. Your body makes it as a normal part of keeping your airways healthy — but when it's excessive, it can be a sign that something is off. When you're sick with a cold or flu and cough this fluid up, it's technically called sputum. Your body typically doesn't overproduce phlegm unless it's fighting something. One helpful clue? The color of your phlegm can actually tell you a lot about what's going on. **Use this phlegm color guide to help decode what your body might be telling you:** - **Green or Yellow Phlegm** — A classic signal that your immune system is actively fighting an infection. Conditions like bronchitis, pneumonia, sinusitis, and cystic fibrosis can all produce green or yellow phlegm — so pay attention to your other symptoms to help pinpoint the cause. - **White Phlegm** — Most commonly linked to viral bronchitis, gastroesophageal reflux disease (GERD), or congestive heart failure. - **Brown Phlegm** — Brown, rusty-colored phlegm typically points to old blood in the airways. It's most often caused by bacterial pneumonia or bacterial bronchitis. - **Red or Pink Phlegm** — Usually means there's fresh blood present. This can be associated with serious conditions including pneumonia, tuberculosis, congestive heart failure, pulmonary embolism, or in some cases, lung cancer — and warrants prompt medical attention. - **Black Phlegm** — Medically called melanoptysis, black phlegm is most often a sign that you've inhaled something dark, such as coal dust or kohl. It's commonly seen in smokers and can also result from pneumoconiosis (a lung disease caused by inhaled dust) or a fungal infection caused by a black yeast called *Exophiala dermatitidis*. - **Excessive Phlegm** — When phlegm is produced in unusually large amounts, the culprit is often an allergy or infection. Other possible triggers include dairy-heavy diets, chemotherapy, pregnancy, or candida (yeast) infections. ### How to Recognize Phlegm Buildup: Signs and Symptoms The symptoms that come along with phlegm buildup vary depending on the underlying cause, but there are some telltale signs that tend to show up across the board. The most common signs that you're dealing with excessive phlegm include: - Coughing up mucus and phlegm - A runny nose - Nasal congestion - A sinus headache - A sore, congested throat - Shortness of breath The good news: most cases of phlegm buildup stem from common infections like a cold or flu and tend to resolve on their own with the right support. ---
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Care planNeurogenesis> *"Neurogenesis, or the birth of new neuronal cells, was thought to occur only in developing organisms. **However, recent research has demonstrated that neurogenesis does indeed continue into and throughout adult life in both vertebrate and invertebrate organisms.**"* **Source:** <http://academics.wellesley.edu/Biology/Concepts/Html/neurogenesiswhat.html> According to a 2018 article published in the journal *Nutritional Neuroscience*: > *"In addition to surgical treatment, in peripheral nerve injuries, these nutrients also may play a role in preserving nerve function and health, as well as in the recovery of an injured nerve tissue (neurogenesis). **Omega 3 and omega 6 fatty acids, group B vitamins, antioxidants, several minerals, phenolic compounds, and alpha lipoic acid are thought to have impacts on the nervous system.** In addition to all of these, gut microbiota has effects on the nervous system, and some nutrient-related factors can also affect neurogenesis via gut microbiota."* > > **Reference:** *Nutritional Neuroscience.* Published online: 07 Dec 2018. New approach to peripheral nerve injury: nutritional therapy. <https://www.tandfonline.com/doi/abs/10.1080/1028415X.2018.1554322?needAccess=true&journalCode=ynns20> ---
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Care planNeurotransmitters**Neurotransmitters** are the brain's chemical messengers — and they do far more than most people realize. They carry signals between nerve cells (neurons) and virtually every other cell in your body, shaping everything from your mood and memory to your heartbeat and digestion. The process by which these messengers do their work is called neurotransmission, or synaptic transmission. Some neurotransmitters are "excitatory," meaning they encourage neurons to fire — sending electrical signals called action potentials that keep your brain and body humming. Others are "inhibitory," gently putting the brakes on neural activity to maintain balance. While neurotransmitters generally behave in predictable ways, their function can be disrupted by medications, disease, and interactions with other chemical signals in the body. ## Understanding Neurotransmitters ### How Do Neurotransmitters Work? Your neurons are constantly sending messages throughout your body — but here's the surprising part: they never actually touch each other. Instead, there's a tiny gap between each pair of nerve cells called a synapse. To bridge that gap and pass a message along, a neuron releases neurotransmitters that drift across the synapse to the next cell. Think of it like passing a note across an aisle — the message travels through open space and is received on the other side. ### What Neurotransmitters Do Neurotransmitters influence neurons in one of three ways: they can excite them, inhibit them, or modulate them. An excitatory neurotransmitter encourages a neuron to fire a signal (an action potential). An inhibitory one suppresses that firing. And a modulatory neurotransmitter — called a neuromodulator — acts more like a volume knob, tuning the activity of entire groups of neurons at once. **Excitatory neurotransmitters** raise the odds that a neuron will fire. Key examples include epinephrine (adrenaline) and norepinephrine (noradrenaline). **Inhibitory neurotransmitters** do the opposite — they lower the odds of firing, acting as a calming counterbalance. Key examples include serotonin and gamma-aminobutyric acid (GABA). **Modulatory neurotransmitters** — or neuromodulators — influence large numbers of neurons simultaneously and can even alter how other chemical messengers work. Through a process called neuromodulation, they fine-tune entire brain regions by regulating the levels of multiple neurotransmitter types throughout the nervous system. Neuromodulators are a specialized subtype of neurotransmitter, but they work quite differently. Rather than acting at a single, precise synapse, neuromodulators spread out across neural tissue in a process called "volume transmission" — essentially bathing a whole brain region in their influence and reshaping how its circuits function. This is very different from classic neurotransmission, which is more like a targeted, one-to-one conversation at a specific synapse. Another key distinction: neuromodulators act on different types of receptors than neurotransmitters do. Neurotransmitters target fast-acting "ionic" receptors that quickly convert chemical signals into electrical ones. Neuromodulators, on the other hand, act on slower G-protein receptors — of which there are three types — producing longer-lasting, more widespread effects. Importantly, neuromodulation doesn't simply excite or inhibit individual neurons the way classic neurotransmission does. Instead, it reshapes the properties of neurons and their connections, subtly but powerfully altering how they communicate with each other. **Some key neuromodulators include:** - **Noradrenaline (Noradrenergic System)** — Noradrenaline (also known as norepinephrine) regulates both brain cells and non-brain cells. It plays a rapid role in shaping cortical circuits and cellular energy use, and on a longer timescale, it influences inflammation and the brain's ability to rewire itself — a process called neuroplasticity. The brain's primary source of noradrenaline is a small but mighty region called the locus coeruleus. A growing body of evidence shows that this neuromodulator plays a critical role in learning, memory, and the brain's capacity to adapt — particularly through its influence on the hippocampus. - **Dopamine (Dopaminergic System)** — Dopamine is at the heart of how we seek reward, explore our environment, and make decisions. It plays a central role in motivation, curiosity, and many aspects of cognition. Variations in how the dopamine system functions appear to shape personality — influencing patterns of behavior, emotion, and thinking that differ from person to person. While researchers are still piecing together the full picture, dopamine has been linked to traits ranging from extraversion and aggression to intelligence and certain psychiatric tendencies. - **Serotonin (Serotonergic System)** — You might be surprised to learn that over 90% of your body's serotonin is actually made in your gut — where it helps regulate bowel function and signals fullness during meals. But serotonin is perhaps best known for its role in the brain, where it powerfully influences mood, anxiety, and overall sense of well-being. - **Acetylcholine (Cholinergic System)** — Acetylcholine (ACh) governs many of the body's automatic (autonomic) functions, and may also help the brain adapt to changes in the environment and metabolism. It influences body temperature regulation, sleep, appetite, and hormonal functions — including the release of insulin and glucagon from the pancreas. The hypothalamus, a brain region critical to maintaining the body's internal balance (homeostasis), is particularly sensitive to acetylcholine's influence — making ACh an important relay between the body's peripheral signals and the brain's regulatory centers. Acetylcholine also appears to play a role in the stress response: multiple studies have shown that stress triggers its release in specific brain regions. > 📝 **NOTE:** Some neurotransmitters, such as dopamine, depending on the receptors present, create both excitatory and inhibitory effects. ### What Are the 7 Major Neurotransmitters? Seven "small molecule" neurotransmitters do the lion's share of the work in your brain and nervous system: acetylcholine, dopamine, gamma-aminobutyric acid (GABA), glutamate, histamine, norepinephrine, and serotonin. ### Excitatory Neurotransmitters The best-understood excitatory neurotransmitters include: **Acetylcholine** Found throughout the nervous system, acetylcholine is a key excitatory messenger involved in many functions — including stimulating the muscles of the gastrointestinal system and those controlled by the autonomic (involuntary) nervous system. You may have heard of cosmetic Botox injections, used to smooth wrinkles by temporarily relaxing specific muscles. Botox works by blocking the release of acetylcholine from nearby neurons, essentially preventing the muscle from receiving the signal to contract. **Epinephrine** Better known as adrenaline, epinephrine is produced by the adrenal glands and released into the bloodstream when your body senses danger. It rapidly raises your heart rate, blood pressure, and blood sugar — priming you for action. This is the biochemical engine behind the fight-or-flight response. When you face a threatening situation, adrenaline helps your nervous and hormonal systems mobilize quickly so you can respond — whether that means standing your ground or making a fast exit. **Glutamate** Glutamate is the most abundant neurotransmitter in the central nervous system. As the brain's primary excitatory messenger, it works in balance with GABA — its inhibitory counterpart — to maintain a healthy equilibrium of neural activity. **Histamine** Best known for its role in allergic reactions, histamine is an excitatory neurotransmitter primarily involved in inflammation, widening of blood vessels (vasodilation), and regulating your immune system's response to foreign substances like allergens. **Dopamine** Dopamine is a dual-acting messenger — it can be both excitatory and inhibitory depending on which receptors it targets. It is most closely associated with the brain's reward system. Drugs such as cocaine, heroin, and alcohol temporarily flood the brain with dopamine, causing neurons to fire abnormally — leading to intoxication and impairment of consciousness and focus. Under normal conditions, however, dopamine release plays a key role in motivation and goal-directed behavior. ### Other Key Neurotransmitters **Norepinephrine** Also known as noradrenaline, norepinephrine is the principal neurotransmitter of the sympathetic nervous system — the branch responsible for your body's stress responses. It helps regulate heart rate, blood pressure, and liver function, among other vital processes. **Gamma-Aminobutyric Acid (GABA)** GABA is the brain's main inhibitory neurotransmitter — essentially the nervous system's natural "calm down" signal. Widely distributed throughout the brain, GABA counterbalances the effects of excitatory neurotransmitters and plays a major role in reducing excessive neural activity across the nervous system. **Serotonin** Serotonin is an inhibitory neurotransmitter deeply involved in regulating emotion and mood. It helps keep excitatory signals in check and plays an important role in sleep, carbohydrate cravings, digestion, and pain perception. ### Diseases and Conditions Linked to Neurotransmitter Imbalances Disruptions in neurotransmitter systems have been associated with a wide range of health conditions. - **Alzheimer's disease** has been linked to a lack of acetylcholine and glutamate in certain regions of the brain. - **Schizophrenia** has been linked to excessive amounts of dopamine in the mesolimbic pathway of the brain. - **Parkinson's disease** has been linked to too little dopamine in the brain's motor areas. - **Epilepsy and Huntington's disease** have been linked to lowered GABA in the brain. - **Mood disorders such as anxiety** have been linked to low levels of serotonin. - **Mood disorders such as manic depression, anxiety, and impaired sleep cycle** have been linked to noradrenaline (norepinephrine) and other neurotransmitters. **Sources:** - <https://www.healthline.com/health/excitatory-neurotransmitters#takeaway> - <https://www.news-medical.net/health/What-is-Neuromodulation.aspx> **References:** - Albert PR, et al. (2014). Serotonin-prefrontal cortical circuitry in anxiety and depression phenotypes: pivotal role of pre- and post-synaptic 5-HT1A receptor expression. DOI: 10.3389/fnbeh.2014.00199 - Briggs SW, et al. (2011). Altered GABA signaling in early life epilepsies. DOI: 10.1155/2011/527605 - Brish R, et al. (2014). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: Old fashioned, but still in vogue. DOI: 10.3389/fpsyt.2014.00047 - Exploring the link between dopamine and Parkinson's disease. (2017). blog.cedars-sinai.edu/exploring-the-link-between-dopamine-and-parkinsons-disease/ - Gaba stem cells (2015). <https://hdsa.org/hd-research/research-news-reports/gaba-stem-cells/> - Gottesmann, C. (2011). The involvement of noradrenaline in rapid eye movement sleep mentation. doi: 10.3389/fneur.2011.00081 - Iyengar I. (2018). GABA receptors in status epilepticus. epilepsy.com/article/2018/2/gaba-receptors-status-epilepticus - Kandimalla R, et al. (2018). Therapeutics of neurotransmitters in Alzheimer's disease. DOI: 10.3233/JAD-161118 - Kurita M. (2016). Noradrenaline plays a critical role in the switch to a manic episode and treatment of a depressive episode. DOI: 10.2147/NDT.S109835 - Lombard S, et al. (2015). Role of the nicotinic acetylcholine receptor in Alzheimer's disease pathology and treatment. DOI: 10.1016/j.neuropharm.2014.11.018 - Lin S, et al. (2014). Serotonin and mental disorders: A concise review on molecular neuroimaging evidence. DOI: 10.9758/cpn.2014.12.3.196 - Neurochemical substrates of rigidity and chorea in Huntington's disease. (n.d.). vivo.med.cornell.edu/display/pubid0027380104 - Wang R, et al. (2017). Role of glutamate and NMDA receptors in Alzheimer's disease [Abstract]. DOI: 10.3233/JAD-160763 - What are neurotransmitters? (2017). qbi.uq.edu.au/brain/brain-physiology/what-are-neurotransmitters - <http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780198523444.001.0001/acprof-9780198523444-chapter-5> - <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827581/> - <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466476/> - <http://weillcornellpainmedicine.com/health-library/neuromodulation> - <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548657/> - <https://www.quora.com/What-is-the-difference-between-neurotransmitters-and-neuromodulators> ---
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Care planOcular HypertensionOcular hypertension means the pressure inside your eyes — called **intraocular pressure (IOP)** — is higher than it should be. When left untreated, elevated eye pressure can lead to glaucoma and permanent vision loss in some people. That said, not everyone with ocular hypertension will experience eye damage — something your eye doctor can determine through a thorough eye exam and visual field testing. Researchers estimate that ocular hypertension occurs 10 to 15 times more often than primary open-angle glaucoma, the most prevalent form of glaucoma. According to the Ocular Hypertension Treatment Study, between 4.5 and 9.4 percent of Americans age 40 or older have ocular hypertension — putting them at greater risk of developing sight-threatening glaucoma. ### How Would You Know If You Have Ocular Hypertension? Here's the tricky part: you can't feel ocular hypertension. There are no obvious warning signs — no eye pain, no redness, nothing that would tip you off on your own. The only reliable way to detect it is during a comprehensive eye exam, where your eye care provider measures your IOP and compares it against healthy reference ranges. An eye pressure reading of **21 mmHg** (millimeters of mercury) or higher is generally considered a sign of ocular hypertension. Think of your eye like an inflated globe — the pressure inside keeps its shape and function. But when that pressure climbs too high or keeps rising over time, it pushes against the delicate optic nerve at the back of the eye. That sustained force can damage the nerve and lead to glaucoma. ### What Causes High Eye Pressure? The factors that cause or contribute to ocular hypertension are closely related to those behind glaucoma itself. These include: - **Too much fluid being produced inside the eye.** Your eye contains a clear fluid called aqueous humor, made by a structure behind the iris called the ciliary body. This fluid flows through the pupil, fills the front chamber of the eye (the space between the iris and cornea), and drains out through a filter-like structure called the **trabecular meshwork**. When the ciliary body produces more fluid than the eye can drain, pressure builds — leading to ocular hypertension. - **Fluid draining too slowly.** Even if production is normal, sluggish drainage throws off the delicate balance — and pressure rises as a result. Certain medications can also raise eye pressure as a side effect. Steroid medicines used for asthma and other conditions are a well-known example. Even steroid eye drops prescribed after LASIK or other vision correction surgeries can cause elevated pressure in susceptible individuals. If you've been prescribed any steroid medication, talk to your eye doctor about how often your IOP should be checked. - **Eye injury.** Trauma to the eye can disrupt the normal balance of fluid production and drainage, potentially causing ocular hypertension — sometimes months or even years after the injury occurred. Make sure to mention any past or recent eye injuries to your doctor during routine visits. - **Other eye conditions.** Ocular hypertension has been linked to several other eye conditions, including pseudoexfoliation syndrome, pigment dispersion syndrome, and corneal arcus. If you have any of these, your eye doctor may recommend more frequent monitoring of your eye pressure. Beyond specific conditions, certain personal characteristics also raise your risk. African-Americans, people over age 40, and those with a family history of ocular hypertension or glaucoma are at higher risk — though anyone can develop elevated eye pressure. Research also suggests that people with thinner-than-average central corneas may be at greater risk for both ocular hypertension and glaucoma. ### How Is Ocular Hypertension Treated? If your eye doctor finds that your eye pressure is elevated, they may prescribe eye drops to bring it down. Because these medications can sometimes cause side effects, some doctors prefer a watchful waiting approach — monitoring your IOP closely and stepping in only if signs of glaucoma begin to appear. If eye drops aren't effectively lowering your pressure, other options may be considered, including glaucoma surgery. At the very least, regular IOP monitoring at recommended intervals is essential to keep tabs on the condition and catch any changes early. **References:** - Effect of corneal arcus on central corneal thickness, intraocular pressure and primary open-angle glaucoma. *Archives of Ophthalmology.* November 2010. - Assessment of true intraocular pressure: the gap between theory and practical data. *Survey of Ophthalmology.* May–June 2008. - Management of ocular hypertension: a cost-effectiveness approach from the Ocular Hypertension Treatment Study. *American Journal of Ophthalmology.* June 2006. - The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. *Archives of Ophthalmology.* June 2002. - The distribution of intraocular pressures in the general population. *Survey of Ophthalmology.* November–December 1980. --- ## Understanding the Role of Oxidative Stress and Nutrition Because the factors that cause or contribute to ocular hypertension so closely mirror those behind glaucoma, it stands to reason that natural, lifestyle-based approaches may be similarly beneficial for both conditions. A growing body of research suggests that **oxidative stress** — the cumulative damage caused by harmful molecules called free radicals — may play an important role in glaucoma. When DNA in the trabecular meshwork (the eye's natural drainage system) is damaged by oxidative stress, fluid may not drain properly, causing pressure to rise. Free radicals generated inside the front of the eye can also escape into the back of the eye, where they interact with light and damage the retinal cells responsible for transmitting visual signals to the brain. Omega-3 fatty acids are well known for their role in heart and brain health, but they're also essential for the health of nerve tissue — including the retina. Research suggests that getting enough omega-3 fats in your diet may help influence eye pressure in a meaningful way. Resveratrol — a natural compound found in grapes, red wine, and certain berries — has shown promise in protecting the eye's drainage cells from the kinds of chronic oxidative stress linked to glaucoma. In a peer-reviewed study, resveratrol was associated with meaningful reductions in inflammatory markers, oxidative damage, and signs of age-related degeneration in trabecular meshwork cells. Researchers at the Duke Eye Center concluded that resveratrol — and similar compounds found in food — might help prevent the cellular changes that contribute to open-angle glaucoma, a leading cause of blindness. Quercetin — a flavonoid found naturally in apples, onions, and tea — has been shown to boost the levels of protective antioxidant proteins called peroxiredoxins in the trabecular meshwork. Eyes affected by glaucoma tend to have lower levels of these protective proteins, leaving them more vulnerable to oxidative damage. Quercetin appears to restore this protection by activating a key cellular defense pathway (Nrf2/NRF1), helping shield the eye against oxidative stress-related disease. **References:** - Kumar DM, Agarwal N. Oxidative stress in glaucoma: A burden of evidence. *J Glaucoma.* 2007;16:334–343. - Biscione F, Pignalberi C, Totteri A, et al. Cardiovascular effects of omega-3 free fatty acids. *Curr Vasc Pharmacol.* 2007;5:163–72. - Uauy R, Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. *Nutr Rev.* 2006;64:S24–33. <http://www.fiteyes.com/home/supplements-for-glaucoma> ---
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Care planOmega-3-6-9 Fatty Acids**Omega-3, omega-6, and omega-9 fatty acids are all essential dietary fats your body needs to thrive.** Each plays a unique and important role in your health — but the key is getting the right balance. When these fats fall out of proportion in your diet, it can quietly set the stage for a number of chronic diseases. ---
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Care planOsgood-Schlatter Disease**Osgood-Schlatter Disease** is a condition that causes pain in the knee and upper shin when tendons pull against the top of the shinbone. Sometimes called jumper's knee, this condition usually affects adolescents during growth spurts. ## Understanding Osgood-Schlatter Disease Osgood-Schlatter disease occurs when a tendon in the knee — called the **patellar tendon** — tugs against the top of the shinbone, causing pain in the knee and upper shin. Tendons are strong, fibrous bands of tissue that anchor muscles to bones. In Osgood-Schlatter disease, the patellar tendon pulls on an area of the shinbone where new bone is actively forming, known as the **growth plate**. This repeated pulling triggers pain and inflammation (swelling and irritation). Over time, a firm bump may develop just below the kneecap as the growth plate matures and hardens. Fortunately, most people with Osgood-Schlatter disease improve with rest, over-the-counter pain relievers, and time. Osgood-Schlatter disease is sometimes referred to as growing pains or jumper's knee. ### How Common Is It? Osgood-Schlatter disease is very common — in fact, it is the leading cause of knee pain in children and teenagers. ### Who Gets Osgood-Schlatter Disease? Osgood-Schlatter disease tends to develop in children and adolescents who are going through a growth spurt, typically around ages 11 to 14. Because the condition is often linked to specific activities and movements, it is especially common in adolescents who: - Play sports that involve a lot of jumping or deep knee bending, such as volleyball and basketball. - Have tight quadriceps (the large muscles at the front of the thigh). ### What Is the Patellar Tendon, and Why Does It Matter? The patellar tendon is a tough band of connective tissue in the knee that links the kneecap to the shinbone. It attaches just below the kneecap and runs down to the part of the shinbone where new bone is growing (the growth plate). Because of this precise attachment point, rapid growth during adolescence can place significant stress on this tendon — and that's where the pain begins. ### What Causes Osgood-Schlatter Disease? Osgood-Schlatter disease develops when repetitive sports activities place ongoing stress on the patellar tendon. Movements like running and jumping cause the leg muscles to repeatedly tug on the patellar tendon, which in turn pulls on the growth plate. Often described as growing pains, Osgood-Schlatter disease frequently emerges during growth spurts — periods when bones, muscles, and tendons are all rapidly changing and growing. These changes can amplify the stress placed on the patellar tendon and growth plate, making pain more likely. ### Symptoms The hallmark symptoms of Osgood-Schlatter disease are: - Swelling. - Tenderness. - Pain just below the kneecap. Pain typically builds gradually over time, though it can sometimes come on suddenly. It may be worse in one knee than the other, and it often intensifies with running, jumping, or climbing stairs. A firm, painful bump can also appear on the front of the knee just below the kneecap. This bump is new bone that forms where the tendon repeatedly pulls on the growth plate. While the pain will eventually resolve, the bump itself may persist into adulthood — though it is rarely bothersome. ### Diagnosis Doctors typically diagnose Osgood-Schlatter disease through a review of symptoms and a physical examination. Your doctor will take into account: - Your age (or your child's age). - What sports or activities may have contributed to the condition. Your doctor may also order X-rays to get a closer look at the kneecap and rule out other possible causes of pain, such as a fracture. If you are an adolescent experiencing pain just below your kneecap, Osgood-Schlatter disease could be the culprit — especially if you participate in sports that involve jumping or deep knee bending. A firm bump on the front of the knee just above the shin is another telltale sign of this condition. ### Conventional Treatment In most cases, Osgood-Schlatter disease can be managed at home with a combination of rest, ice, and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Depending on how severe the symptoms are, your child's doctor may recommend temporarily stepping back from the sports and activities that are aggravating the pain. Many children find meaningful relief by regularly stretching their quadriceps (thigh muscles), which helps ease tension on the patellar tendon. Some doctors also suggest a device called a patellar tendon strap — a thin brace that wraps around the knee just below the kneecap to reduce stress on the tendon. **Potential side effects of NSAIDs** (generally uncommon, and more likely with prolonged use): - Heartburn. - Stomach pain. - Dizziness. - Lightheadedness. - Headaches. - Stomach ulcers. - High blood pressure (hypertension). ### Complications Complications from Osgood-Schlatter disease are rare. When pain is severe, doctors may recommend cortisone injections to reduce inflammation and provide relief. In rare cases, pain can persist for years and may be particularly noticeable when kneeling. While surgery is very uncommon, it is an option for those with lasting, debilitating pain — doctors can surgically remove the bony growth that forms beneath the kneecap. ### What You Can Do at Home There are several steps you can take to ease the pain associated with Osgood-Schlatter disease: - **Rest:** Avoid activities and sports that require jumping, running, and bending. - **Ice:** Apply a cold compress to your knee to reduce swelling and relieve tenderness and pain. - **Medication:** Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) as directed by your doctor for pain relief. - **Stretching:** Stretch your quadriceps (thigh muscles) regularly to keep them flexible. Tight quadriceps can worsen the pain of Osgood-Schlatter disease. - **Physical therapy:** Your healthcare provider may recommend physical therapy to help manage symptoms. A physical therapist will guide you through targeted exercises designed specifically for your needs. ### Prevention While it isn't always possible to prevent Osgood-Schlatter disease, you may be able to lower your risk by: - Choosing sports (such as swimming) that are gentler on the knees. - Taking a break from a sport or activity at the first sign of knee pain. - Stretching your quadriceps and hamstrings (the large muscles of the upper leg) regularly to improve flexibility and reduce pressure on the patellar tendon. - Wearing supportive athletic shoes with good shock absorption. ### Long-Term Outlook The good news: most adolescents with Osgood-Schlatter disease recover fully with no lasting health effects. Children typically outgrow the condition as their bodies mature. The bony bump on the knee may remain into adulthood, but it is usually painless and does not interfere with daily life. ### When to Call Your Doctor If your child develops knee pain — particularly after running or playing sports — it's worth reaching out to your doctor. A proper evaluation is important to rule out other conditions that may be behind the pain and swelling. **Source:** <https://my.clevelandclinic.org/health/diseases/21171-osgood-schlatter-disease> **References:** - American Association of Orthopaedic Surgeons. Osgood-Schlatter Disease (Knee Pain). <https://orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain/> Accessed 11/7/2019. - Merck Manual. Osgood-Schlatter Disease. <https://www.merckmanuals.com/home/children-s-health-issues/bone-disorders-in-children/osgood-schlatter-disease> Accessed 11/7/2019. - American Academy of Pediatrics. Knee Pain and Osgood-Schlatter Disease. <https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Knee-Pain-and-Osgood-Schlatter-Disease.aspx> Accessed 11/7/2019. ---
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Care planOsteoarthritisOsteoarthritis (OA) is the most common form of arthritis — and one of the leading causes of pain and disability worldwide. At its core, OA is a joint disease driven by the gradual breakdown of cartilage, the firm yet springy tissue that acts as a cushion between the bones at your joints. When cartilage is healthy, it allows bones to glide smoothly over one another and absorbs the forces generated by everyday movement. In OA, that cartilage progressively breaks down and wears away. Without this protective buffer, bones begin to rub directly against each other — causing pain, swelling, and stiffness that can significantly affect quality of life. OA can also limit how far and freely you can move the affected joint. The joints most commonly involved are the hands, knees, hips, and spine. OA affects men and women in nearly equal numbers. More than 20 million people in the United States live with this condition, and symptoms most commonly begin to appear when people are in their fifties and sixties. ### How Do You Know If It Might Be OA? Common Signs and Symptoms: - Joint pain — often described as a deep, aching sensation — that worsens with activity and improves with rest (in severe cases, pain may be constant) - Stiffness in the morning or after sitting or resting for more than 15 minutes - Joint swelling - Joints that feel warm to the touch - A crunching, clicking, or crackling sensation when you move the joint (called crepitation) - Reduced range of motion — difficulty fully bending or straightening a joint - Muscle weakness around affected joints - Bony knobs or lumps near joints that cause visible deformity (such as Heberden's nodes — small bumps that appear at the outermost joints of the fingers) ### What Causes OA? In most cases, there is no single identifiable cause of OA. It is primarily a disease of aging — the cumulative result of years of wear on your joints. That said, a variety of factors can contribute to its development, including metabolic, genetic, chemical, nutritional, and mechanical influences. ### Who Is Most at Risk? Key Risk Factors for OA: - Increasing age - Genetic predisposition (a family history of OA) - Obesity (excess body weight places greater stress on weight-bearing joints) - Prior joint injury - A history of inflammatory joint disease - Metabolic or hormonal disorders (such as hemochromatosis and acromegaly) - Bone and joint disorders present at birth - Repetitive, high-stress joint use — common in certain occupations and sports such as baseball, ballet dancing, and construction work - Crystal deposits within joints ### How Is OA Diagnosed? There is no single test that can definitively diagnose OA. Instead, your doctor will typically use a combination of approaches to confirm the diagnosis and rule out other possible causes. A physical examination may reveal limited range of motion, a grating sensation when the joint moves, joint swelling, and tenderness. X-rays of the affected joints can show a narrowing of the joint space, and in more advanced cases, erosion of bone ends and the development of bone spurs. ### Can OA Be Prevented? Steps You Can Take While OA cannot always be prevented, the following measures may help reduce your risk of developing it: - Protecting injured joints from further damage - Staying physically active with regular exercise - Maintaining a healthy weight - Avoiding excessive repetitive joint motions when possible - Supporting your body with proper nutrition ### How Is OA Treated? A Comprehensive Approach The overarching goals of OA treatment are to relieve pain, maintain or improve joint mobility, strengthen the muscles and structures supporting your joints, and minimize the long-term impact of the disease on your daily life. The best treatment plan will depend on which joints are affected. A combination of conventional medical treatment and complementary and alternative medicine (CAM) approaches is often the most effective strategy. Lifestyle interventions — especially exercise — along with many alternative therapies are growing in popularity and are increasingly recognized as safe and effective tools in managing OA. Notably, several natural remedies have been shown to be at least as effective as conventional medications for symptom relief, and some may even help slow the progression of the disease. Americans spend more on natural remedies for OA than for any other medical condition. In 1997, researchers conducted surveys and found that between 26% and 100% of patients with painful conditions affecting muscles, tendons, joints, and bones had tried some form of complementary or alternative medicine. **Some of the most promising complementary approaches for managing OA include:** - Reducing physical stress on affected joints (through weight loss and improved posture) - Lifestyle modifications — particularly regular exercise - Targeted supplements, including S-adenosylmethionine (SAMe), glucosamine, chondroitin, MSM, Green Lipped Mussel, Type II Collagen complex, and antioxidants - Anti-inflammatory herbs, including ginger, turmeric, boswellia, black pepper, devil's claw, white willow bark, and capsaicin (cream) - Acupuncture - Chiropractic care - Physical therapy and magnet therapy - Yoga - Tai chi ---
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Care planOsteoporosis## Understanding Bone Loss ### What Is Low Bone Density? Low bone density means your bones are thinner than they should be — but not quite thin enough to be diagnosed as osteoporosis. Think of it like a warning sign: because you're starting with less bone than ideal, you have less of a "cushion" to lose before fractures become a real concern. People with low bone density are more likely to break a bone than those with normal bone density. ### What Is Osteoporosis? Osteoporosis is a disease that makes your bones fragile and far more likely to break. It's the most common bone disease in the world, and it dramatically raises your risk of fractures. In fact, about half of all women over the age of 50 will break a hip, wrist, or vertebra (a bone in the spine) at some point in their lives. Here's something most people don't realize: bone is living tissue. Your body is constantly breaking down old bone and building new bone to replace it — your entire skeleton is essentially renewed about every 10 years. Osteoporosis develops when this process falls out of balance: either the body isn't building enough new bone, it's breaking down too much existing bone, or both. ### What Causes Bone Loss? The single most important factor in osteoporosis risk is genetics — meaning the tendency can run in families and be passed down through generations. Beyond genetics, bone loss is heavily influenced by nutrition. Your body needs a steady supply of specific nutrients to build and maintain strong bone tissue. Calcium is one of the most critical minerals for bone formation. But if your diet is lacking in calcium, vitamin D, and other key bone-building nutrients — or if your digestive system isn't absorbing them efficiently (a condition called hydrochloric acid deficiency) — your bones can gradually become brittle and more prone to fractures. ### Major Risk Factors: - Family history of osteoporosis - Low stomach acid (hydrochloric acid deficiency) - Low intake of vitamins and minerals - Late onset of menstruation or absence of periods (amenorrhea) - Caucasian, Asian, or other non-Black ethnic background - Slender build, being underweight, or having low muscle mass - Early menopause or prolonged absence of menstrual cycles - Long-term use of corticosteroids, antacids, or diuretics ### Minor Risk Factors: - Chronic emotional stress - Excessive dieting - Very high fiber intake - Cigarette smoking - Sedentary lifestyle - Prolonged bed rest or immobilization - Excessive consumption of soda, alcohol, caffeine, or salt - A diet high in phosphates, phytates, oxalates, or fat ### Other Common Causes of Bone Loss: - Extended periods of bed rest - Certain underlying medical conditions - Long-term use of certain medications (including corticosteroids, antacids, and diuretics) ---
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Care planPain / Inflammation**Inflammation** is one of the body's most powerful tools—essential for fighting infection, protecting tissues, and driving healing. But like many powerful things, it can cause serious harm when it goes wrong. When inflammation becomes chronic or fails to resolve, it quietly smolders in the background, contributing to a wide range of serious illnesses, including heart disease, diabetes, arthritis, autoimmune disorders, and neurodegenerative conditions. This state of **persistent, low-grade inflammation** can be triggered by modern diets, environmental toxins, chronic stress, hidden infections, and nutritional deficiencies. Decades of research now confirm that **what we eat and how well-nourished we are** profoundly shapes how inflammation behaves in our bodies. Diets rich in colorful vegetables, omega-3 fatty acids, and plant-based compounds help the body resolve inflammation naturally, while processed foods, excess sugar, and unhealthy fats keep inflammatory signals switched on. Functional medicine takes a deeper look—identifying and removing underlying triggers like gut imbalances, hidden infections, or food sensitivities—and works to restore immune balance using nutrition, lifestyle changes, and targeted supplementation. --- ## Understanding Inflammation and Pain ### The Four Main Types of Pain — and What They Mean for You **Pain** is your body's distress signal—its way of telling you that something is off. But not all pain works the same way, and understanding **the four main types of pain** is the first step toward finding the right solution: - **Nociceptive Pain** — This is the most familiar kind of pain, caused by direct injury or damage to muscles, joints, skin, or bones. Think of arthritis flares, muscle strains, or recovery from surgery. It tends to feel sharp or achy, and it typically improves as the injured tissue heals. - **Inflammatory Pain** — This type of pain is driven by an overactive immune system that triggers abnormal inflammation in tissues and joints. Conditions like gout, rheumatoid arthritis, and inflammatory bowel disease fall into this category. Calming the immune response and supporting the energy-producing structures inside your cells are central to recovery. - **Neuropathic Pain** — When nerves themselves are damaged or irritated, the result is often a distinctive burning, tingling, or shooting sensation. Common culprits include diabetes, viral infections like shingles, or nerve compression. Because poor cellular energy production and oxidative stress play a central role, therapies that support nerve repair—such as alpha-lipoic acid, acetyl-L-carnitine, and B vitamins—are often particularly helpful. - **Functional (Centralized) Pain** — In this type of pain, the brain and spinal cord's pain-signaling pathways become hypersensitive, producing real and significant pain even without obvious tissue damage. **Fibromyalgia** and **irritable bowel syndrome (IBS)** are classic examples. Stress, disrupted gut-brain communication, and impaired cellular energy production all play important roles, making mind-body therapies, quality sleep, and mitochondrial support especially valuable. ### Acute vs. Chronic Pain: What's the Difference? - **Acute pain** is short-lived and has a clear cause—surgery, an injury, a burn—and it typically fades as the underlying problem heals. - **Chronic pain** lasts longer than six months and may persist long after the original injury has healed. It affects more than **50 million adults** in the U.S. and often involves an interconnected cycle of inflammation, oxidative stress, impaired cellular energy production, and an oversensitized nervous system. Chronic pain also tends to bring unwanted companions: **fatigue, poor sleep, anxiety, and depression**—all of which feed the flames of inflammation, making pain worse. Functional medicine targets this vicious cycle by restoring cellular energy, improving the body's ability to detoxify, rebalancing the gut microbiome, and optimizing key nutrients like vitamin D, magnesium, omega-3 fatty acids, CoQ10, and antioxidants. ### How Functional Medicine Approaches Chronic Pain Rather than simply masking symptoms, functional medicine focuses on **finding and addressing root causes** while restoring balance to the whole body. Key strategies include: - **Anti-inflammatory nutrition:** Mediterranean-style or elimination diets rich in omega-3s, polyphenols, and antioxidants. - **Cellular energy support:** Nutrients like CoQ10, alpha-lipoic acid, acetyl-L-carnitine, magnesium, and B vitamins help cells produce energy more efficiently and defend against oxidative damage. - **Gut and immune restoration:** Probiotics (e.g., *L. rhamnosus GG*, *B. longum*), prebiotics, and gut-healing nutrients (L-glutamine, zinc carnosine) help dial down systemic inflammation. - **Lifestyle therapy:** Regular movement, stress reduction, restorative sleep, and gentle detoxification all promote healing and long-term resilience. **The bottom line:** Inflammation and pain are deeply intertwined, shaped by the health of your immune system, your cells' energy factories, and your gut. By identifying triggers, supporting cellular repair, and addressing inflammation through nutrition and lifestyle, functional medicine offers an evidence-based, non-opioid path toward lasting pain relief and a better quality of life. **Source:** <https://www.healthline.com/health/types-of-pain#other-considerations> ---
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Care planPancreatic Exocrine Insufficiency (PEI) / Exocrine Pancreatic Insufficiency (EPI)> *"Pancreatic exocrine insufficiency (PEI) can be defined as a reduction in pancreatic enzyme activity in the intestinal lumen to a level that is below the threshold required to maintain normal digestion."* > > *"Pancreatic enzyme replacement therapy is administered in the form of enteric-coated minimicrospheres during meals. The dose should be in proportion to the fat content of the meal, usually 40–50,000 lipase units per main meal, and half the dose is required for a snack."* > > **Reference:** <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831207/> **Pancreatic Exocrine Insufficiency (PEI) / Exocrine Pancreatic Insufficiency (EPI) is a condition in which your body doesn't produce enough pancreatic enzymes to properly break down the food you eat.** When this happens, nutrients like fats, proteins, and carbohydrates pass through your digestive system without being fully absorbed — a process called maldigestion. The good news: once diagnosed, EPI is a manageable condition. With the right treatment plan — centered on pancreatic enzyme replacement therapy (PERT) — most people are able to live well. **Source:** <https://www.identifyepi.com/what-is-epi> ## Understanding Pancreatic Exocrine Insufficiency (EPI / PEI) **To understand EPI/PEI, it helps to first understand what the pancreas actually does.** Tucked in the center of the abdomen, this hard-working organ has 2 critical jobs: - **Endocrine function** — produces insulin, the hormone that helps your body process the sugars you eat - **Exocrine function** — produces digestive enzymes that break down food so your body can absorb it In EPI/PEI, it's the exocrine function that goes wrong. Your pancreas simply doesn't make enough of the enzymes needed to break down what you eat. The result: uncomfortable digestive symptoms, and a body that struggles to get the nutrition it needs from food. **The exocrine pancreas produces 3 key digestive enzymes:** - **Lipase** — breaks down fats - **Protease** — breaks down proteins - **Amylase** — breaks down carbohydrates --- ### What Causes Pancreatic Exocrine Insufficiency (PEI)? The pancreas is an essential part of your digestive system. When EPI/PEI is present, a shortage of digestive enzymes means food moves through your intestines in a largely undigested state — and your body misses out on the nutrients it needs. **In adults, chronic pancreatitis is the leading cause of EPI/PEI.** Up to 8 in 10 adults with this condition develop EPI. Pancreatitis causes ongoing inflammation and swelling in the pancreas, and over time, that chronic inflammation can permanently damage the cells responsible for making digestive enzymes. **Other conditions that can cause EPI/PEI in adults include:** - Celiac disease - Diabetes - Inflammatory bowel disease (IBD) - Pancreatic cancer - Surgery on the digestive tract, including weight loss surgery ### What Causes Exocrine Pancreatic Insufficiency (EPI) in Children? **In infants and children, cystic fibrosis is the number one cause of EPI.** Cystic fibrosis is an inherited condition that causes thick mucus to build up in the lungs — making breathing difficult — and in the pancreas, where it blocks digestive enzymes from ever reaching the small intestine. Nearly 9 in 10 infants born with cystic fibrosis develop EPI/PEI within their first year of life, and those who don't are still at risk of developing it later in childhood or adulthood. Another inherited condition, Shwachman-Diamond syndrome (SDS), is also a known cause of EPI/PEI in children. In SDS, the enzyme-producing portion of the pancreas simply doesn't function properly. ### What Does Exocrine Pancreatic Insufficiency (EPI) Feel Like? Recognizing the Symptoms One of the hallmarks of EPI/PEI is difficulty absorbing fats from food. This tends to cause a range of uncomfortable digestive symptoms, including: - Abdominal pain, gas, and bloating - Constipation - Diarrhea - Fatty stools (pale, oily, foul-smelling stools that float) - Unexplained weight loss, or failure to thrive in infants and children ### How Is Pancreatic Exocrine Insufficiency (PEI) / Exocrine Pancreatic Insufficiency (EPI) Diagnosed? Because many digestive conditions share similar symptoms, diagnosing EPI often requires specific testing. If you have an underlying condition that affects the pancreas, your healthcare provider may already be watching for signs of EPI/PEI. One or more of the following tests may be recommended: - **Fecal elastase test (FE-1)** — checks your stool for the presence of elastase, an enzyme that helps digest proteins. Low or absent elastase levels can point to EPI. - **Fecal fat test** — measures how much fat is present in your stool. Elevated fat levels may indicate that your body isn't absorbing fat properly — a hallmark of EPI/PEI. - **Secretin pancreatic function test** — evaluates how your pancreas responds to secretin, a hormone that normally triggers digestive enzyme release. Secretin is given through an intravenous (IV) line, and your provider uses endoscopic ultrasound to collect and analyze the resulting fluid for enzyme activity. - A **CT scan**, abdominal ultrasound, or other imaging studies may also be ordered to look for structural problems in the pancreas that could be contributing to EPI/PEI. ### What Are the Complications of Pancreatic Exocrine Insufficiency (PEI) / Exocrine Pancreatic Insufficiency (EPI)? When the body can't adequately absorb fats, proteins, and carbohydrates from food — a condition called malabsorption — the downstream effects extend well beyond digestion. Your body depends on these nutrients to fuel energy and keep organs functioning. Left unaddressed, malabsorption can lead to malnutrition. **Warning signs of malnutrition include:** - Dry skin, brittle nails, and hair loss - Depression - Edema (swelling in body tissues) - Fatigue or dizziness - Feeling cold all the time - Irritability - Difficulty with memory and concentration - Muscle loss ### How Is Pancreatic Exocrine Insufficiency (PEI) / Exocrine Pancreatic Insufficiency (EPI) Managed and Treated? EPI is a lifelong condition, but it is treatable. The goal of treatment is to give your body the nutrients it needs to stay healthy and function well. A comprehensive management plan typically includes: - **Pancreatic enzyme replacement therapy (PERT):** A prescription medication that replaces the digestive enzymes your pancreas isn't producing in sufficient amounts. Taken with meals, PERT helps your body break down and absorb the nutrients in food. - **A high-calorie, high-fat diet:** Adequate calorie and fat intake is essential — dietary fat plays a key role in helping your body absorb nutrients. Working with a registered dietitian can help you build an eating plan that meets your needs. - **Vitamin supplementation:** Because EPI/PEI impairs the absorption of fat-soluble vitamins, your provider may prescribe vitamins A, D, E, and K to help maintain healthy nutrient levels. **Sources:** - <https://www.identifyepi.com/what-is-epi> - <https://my.clevelandclinic.org/health/diseases/21577-exocrine-pancreatic-insufficiency-epi> ---
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Care planPancreatitisPancreatitis means inflammation of the pancreas — a large, vital gland tucked behind your stomach, nestled close to the duodenum (the first stretch of your small intestine). Think of the pancreas as your body's digestive command center: it produces powerful digestive juices, called enzymes, and sends them through a small channel called the pancreatic duct into your small intestine. There, those enzymes team up with bile — a digestive fluid made in the liver and stored in the gallbladder — to break down the food you eat. The pancreas also releases two important hormones, insulin and glucagon, directly into your bloodstream, which help your body manage blood sugar (glucose) for energy. Under normal circumstances, those digestive enzymes stay dormant until they reach the small intestine, where they're needed. But when the pancreas becomes inflamed, those enzymes activate too early — inside the pancreas itself — and begin attacking and damaging the very tissues that created them. Pancreatitis comes in two forms: acute (sudden) and chronic (long-lasting). Both forms are serious and can lead to significant complications. In severe cases, bleeding, infection, and permanent tissue damage may occur. For context, the gallbladder and the network of ducts that carry bile and digestive enzymes from the liver, gallbladder, and pancreas to the small intestine are collectively known as the **biliary system** — a term you may encounter as you learn more about this condition. It's worth noting that both forms of pancreatitis occur more often in men than in women. --- ## Understanding Pancreatitis ### What Is Acute Pancreatitis? Acute pancreatitis is a sudden-onset inflammation of the pancreas that, with proper treatment, typically resolves within a few days — though it can sometimes become a life-threatening emergency with serious complications. Each year, about 210,000 people in the United States are hospitalized with acute pancreatitis. The most common culprit is gallstones — small, hardened deposits of bile that can trigger inflammation in the pancreas as they travel through the common bile duct. Heavy alcohol use is another leading cause. In fact, acute pancreatitis can strike within hours to 2 days after drinking. Other, less common triggers include abdominal injury, certain medications, infections, tumors, and inherited abnormalities of the pancreas. ### Recognizing the Symptoms of Acute Pancreatitis Acute pancreatitis typically announces itself with pain in the upper abdomen — pain that can come on gradually or strike suddenly, and that often radiates through to the back. At first, the pain might be mild and worsen after eating. But it frequently becomes severe, persistent, and can last for several days. Someone experiencing acute pancreatitis usually looks and feels seriously ill and needs prompt medical attention. Other symptoms may include: - A swollen and tender abdomen, along with nausea and vomiting - Fever - A rapid pulse In severe cases, acute pancreatitis can cause dangerous dehydration and dangerously low blood pressure. The heart, lungs, or kidneys may begin to fail. If bleeding occurs within the pancreas, the situation can escalate to shock — and in the worst cases, death. ### How Is Acute Pancreatitis Diagnosed? When evaluating a patient, your doctor will take a careful medical history and perform a physical exam, then order blood tests to help confirm the diagnosis. In acute pancreatitis, the blood typically shows at least 3 times the normal levels of amylase and lipase — two digestive enzymes produced by the pancreas. Other blood chemistry values (such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate) may also be temporarily abnormal but usually return to normal once the condition improves. Because the pancreas sits deep in the abdomen, diagnosing acute pancreatitis can be challenging. Your doctor will likely order one or more of the following imaging tests: - **Abdominal ultrasound.** Sound waves are sent toward the pancreas through a handheld device that a technician glides over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture — called a sonogram — on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off them, showing their location. - **Computerized tomography (CT) scan.** The CT scan is a noninvasive x-ray that produces three-dimensional pictures of parts of the body. The person lies on a table that slides into a donut-shaped machine. The test may show gallstones and the extent of damage to the pancreas. - **Endoscopic ultrasound (EUS).** After spraying a solution to numb the patient's throat, the doctor inserts an endoscope — a thin, flexible, lighted tube — down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts. - **Magnetic resonance cholangiopancreatography (MRCP).** MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube for the test. The technician injects dye into the patient's veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts. ### Possible Complications of Acute Pancreatitis When gallstones are the underlying cause of acute pancreatitis, they — along with the gallbladder — typically need to be surgically removed. If pancreatitis is mild, this surgery (called a **cholecystectomy**) may take place during the same hospital stay. In more severe cases, gallstones may first be cleared using a specialized procedure called therapeutic **endoscopic retrograde cholangiopancreatography (ERCP)**, which allows doctors to view and treat the pancreatic and bile ducts directly. In these situations, cholecystectomy is usually delayed by a month or more to allow full recovery. If an infection develops, ERCP or surgery may be needed to drain the infected area, also called an abscess. Exploratory surgery may also be necessary to find the source of any bleeding, to rule out conditions that resemble pancreatitis, or to remove severely damaged pancreatic tissue. **Pseudocysts** — accumulations of fluid and tissue debris — that may develop in the pancreas can be drained using ERCP or EUS. If pseudocysts are left untreated, enzymes and toxins can enter the bloodstream and affect the heart, lungs, kidneys, or other organs. Acute pancreatitis can sometimes cause kidney failure, requiring blood-cleansing treatments called dialysis or, in some cases, a kidney transplant. In rare cases, acute pancreatitis can cause breathing problems. A dangerous drop in oxygen levels — a condition called **hypoxia** — can develop, where the body's cells and tissues are deprived of the oxygen they need. Doctors treat this by providing supplemental oxygen, though some patients may temporarily require a respirator (breathing machine) to support their lungs. **Reference:** Russo MW, Wei JT, Thiny MT, et al. Digestive and liver disease statistics, 2004. *Gastroenterology.* 2004;126:1448–1453. --- ## What Is Chronic Pancreatitis? Chronic pancreatitis is a form of pancreatic inflammation that doesn't resolve on its own — instead, it persists and progressively worsens, ultimately causing permanent damage. Like acute pancreatitis, it occurs when digestive enzymes prematurely activate and attack the pancreas and surrounding tissues, triggering recurring bouts of pain. Chronic pancreatitis most commonly develops in adults between the ages of 30 and 40. By far the most common cause is long-term, heavy alcohol use. Chronic pancreatitis can also be set in motion by a single severe acute attack that injures the pancreatic duct. That damage triggers ongoing inflammation, which over time leads to scarring — and the gradual, irreversible destruction of the pancreas. ### Other Causes of Chronic Pancreatitis - Inherited (hereditary) disorders of the pancreas - Cystic fibrosis — the most common inherited disorder leading to chronic pancreatitis - Hypercalcemia — high levels of calcium in the blood - Hyperlipidemia or hypertriglyceridemia — abnormally high levels of fats in the blood - Certain medications - Certain autoimmune conditions - Unknown causes Hereditary pancreatitis deserves special mention: it can appear in people younger than 30, though it may go undiagnosed for years. It typically causes recurring episodes of abdominal pain and diarrhea lasting several days, gradually progressing toward chronic pancreatitis. A diagnosis of hereditary pancreatitis is likely if the person has two or more family members with pancreatitis in more than one generation. ### Recognizing the Symptoms of Chronic Pancreatitis Most people with chronic pancreatitis experience upper abdominal pain, though some have no pain at all. The pain may radiate to the back, worsen with eating or drinking, and become constant and debilitating over time. In some cases, the pain actually diminishes as the disease advances — often because the pancreas has lost the ability to produce digestive enzymes altogether. Other symptoms include: - Nausea - Vomiting - Weight loss - Diarrhea - Oily stools One of the hallmarks of chronic pancreatitis is unexplained weight loss — even in people with a healthy appetite and normal eating habits. This happens because the damaged pancreas can no longer produce enough digestive enzymes to properly break down food, so nutrients aren't absorbed as they should be. Over time, this poor digestion leads to malnutrition, largely from fat passing through the gut unabsorbed and appearing in the stool. ### How Is Chronic Pancreatitis Diagnosed? Chronic pancreatitis can be tricky to distinguish from acute pancreatitis, since the symptoms often overlap. As with acute pancreatitis, diagnosis begins with a thorough medical history and physical exam. Blood tests can help determine whether the pancreas is still producing adequate levels of digestive enzymes — though in some cases, enzyme levels appear normal even when chronic pancreatitis is present. As the disease advances and complications like malabsorption and diabetes emerge, your doctor may order blood, urine, and stool tests to help confirm the diagnosis and track its progression. Imaging also plays an important role. After reviewing x-rays of the abdomen, your doctor will likely use one or more of the same tests used for acute pancreatitis — abdominal ultrasound, CT scan, EUS, and MRCP. ---
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Care planParathyroid DisordersMost people have four tiny, pea-sized glands called parathyroid glands nestled against the thyroid gland in the neck. Despite their similar names, the thyroid and parathyroid glands are completely different organs with different jobs. The parathyroid glands produce **parathyroid hormone (PTH)**, which acts like a thermostat — constantly fine-tuning your body's balance of calcium and phosphorus. When the parathyroid glands produce too much or too little PTH, this delicate balance breaks down. Too much PTH causes a condition called **hyperparathyroidism**, which drives calcium levels in the blood too high. In most cases, a noncancerous (benign) growth on one of the parathyroid glands is the culprit, though sometimes one or more glands simply become enlarged and overactive. True parathyroid cancer is exceedingly rare. Too little PTH leads to a condition called **hypoparathyroidism**, which causes blood calcium to drop and phosphorus levels to rise. This can result from injury to the glands, other hormonal disorders, or genetic conditions. Treatment focuses on restoring the proper calcium-phosphorus balance. --- ## Understanding Hypoparathyroidism Your four parathyroid glands sit close to each lobe of your thyroid gland, and they serve a critical purpose: producing the hormone that keeps calcium levels in your blood within a healthy range — calcium that your bones, teeth, nerves, and clotting system all depend on. Hypoparathyroidism is a rare condition in which these glands fall short. Either they don't make enough PTH, they produce a form of PTH that the body can't use effectively, or the kidneys and bones simply don't respond to the PTH that is made. The result is low blood calcium and high blood phosphate — a combination that can cause a surprising range of symptoms. Hypoparathyroidism may be inherited or acquired; the most common acquired causes are parathyroid surgery, cancer, or trauma to the neck. ### Recognizing the Signs and Symptoms Hypoparathyroidism can cause a wide variety of symptoms, many of which stem directly from low blood calcium levels: - Muscle spasms or cramping, most often in the hands or feet - Seizures (convulsions) - Cataracts (clouding of the eye's lens) - Hair loss - Dry skin or brittle, malformed nails - Anxiety - Unusual sensations such as numbness, tingling, or burning — especially around the mouth and fingertips - Candidiasis (a yeast infection caused by *Candida albicans*) in cases linked to autoimmune polyglandular syndrome, type I In children, hypoparathyroidism may also cause: - Poor tooth development - Vomiting - Headaches - Intellectual or developmental difficulties ### What Triggers Hypoparathyroidism? Hypoparathyroidism can develop from several different causes, including: - Parathyroid glands that are underdeveloped at birth - Medical treatments that damage the glands (such as radiation to the thyroid, certain medications, or thyroid/parathyroid surgery) - An underlying medical condition, including cancer, neck trauma, Wilson's disease (excess copper buildup in tissues), iron overload in tissues, or chronically low magnesium levels ### Who Is Most Likely to Develop Hypoparathyroidism? Certain factors can increase your risk of developing hypoparathyroidism: - A family history or genetic predisposition - Use of medications that suppress parathyroid activity, such as asparagine, doxorubicin, cytosine arabinoside, cimetidine, or products containing aluminum - Prior surgery on or removal of the parathyroid glands - Extensive radiation to — or surgical removal of — the thyroid gland ### How Is Hypoparathyroidism Treated? Managing hypoparathyroidism is typically a lifelong commitment. Most people require ongoing dietary and/or supplemental calcium and vitamin D to keep their calcium and mineral levels in a healthy range. During a sudden or severe episode (the "acute phase"), calcium may be given directly into a vein (intravenously). Diuretics — medications that influence how the kidneys handle fluids — may also be prescribed at that time to prevent too much calcium from being lost in the urine, and to reduce how much calcium and vitamin D supplementation is needed overall. --- ## Understanding Hyperparathyroidism Your four parathyroid glands sit just behind the two lobes of the thyroid gland, and their job is to produce the hormone that keeps calcium and phosphate levels — minerals your bones, teeth, and countless bodily functions depend on — within a healthy range. In **primary hyperparathyroidism**, the parathyroid glands go into overdrive, producing too much PTH. This excess hormone then drives blood calcium levels too high — a condition with potentially far-reaching effects throughout the body. ### Recognizing the Signs and Symptoms > *"At least 50% of patients with primary hyperparathyroidism have no symptoms, and approximately 1% of cases go undiagnosed. The vast majority of cases occur in people with no family history of the disorder. Only about 5% of cases can be linked to an inherited problem. Familial multiple endocrine neoplasia type 1 is a rare, inherited syndrome that affects the parathyroids as well as the pancreas and the pituitary gland. Another rare genetic disorder, familial hypocalciuric hypercalcemia, is sometimes confused with typical hyperparathyroidism. Each accounts for about 2% of primary hyperparathyroidism cases."* > > **Source:** NIH: National Institute of Diabetes and Digestive and Kidney Diseases When symptoms do occur, they are generally caused by persistently elevated calcium levels and may include: - Joint pain - Bone loss leading to osteoporosis - Muscle weakness - Abdominal discomfort - Heartburn - Nausea and vomiting - Constipation - Lack of appetite - Ulcers - Pancreatitis (inflammation of the pancreas) - Kidney stones - Excessive thirst - Excessive urination - Depression - Anxiety - Memory loss - Excessive drowsiness ### What Causes Hyperparathyroidism? Primary hyperparathyroidism may develop as a result of one of the following conditions: - Single or multiple benign tumors in the parathyroid glands - Parathyroid hyperplasia (excessive growth of normal parathyroid cells) - Parathyroid malignancies (rare) - Certain endocrine disorders, such as type I and II multiple endocrine neoplasia (MEN) syndrome - Diet soft drinks, due to their high phosphate content, are a precipitating factor for calcium loss — this is considered "Nutritionally-Induced Secondary Hyperparathyroidism" **"Nutritionally-Induced Secondary Hyperparathyroidism"** is diet/lifestyle-induced hyperparathyroidism. The high phosphorus content in the diet induces a "secondary hyperparathyroidism," which mobilizes calcium from hard tissue. > *"**Lifestyle factors** like alcohol consumption and a high phosphorus intake can displace calcium or increase its urinary excretion. Soft drinks, due to their high phosphate content, are a precipitating factor for calcium loss leading to osteoporosis. Smoking, carbonated drinks, caffeine (which leaches minerals from the body), and antacids (which impair mineral digestion and absorption) all increase the risk of osteoporosis."* > > **Reference:** Nguyen TV, et al. Lifestyle factors and bone density: Implications for osteoporosis prevention. *J. Bone Res.* 1994;9(9):1339. > *"**Soft drink consumption may have adverse effects on bone mineral density (BMD),** but studies have shown mixed results. In addition to displacing healthier beverages, colas contain caffeine and phosphoric acid (H3PO4), which may adversely affect bone...Intake of cola, but not of other carbonated soft drinks, is associated with low BMD in women."* > > **Reference:** Tucker KL, et al. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. *Am J Clin Nutr*. 2006;84:936–942. > *"**Long-term consumption of caffeinated and uncaffeinated soft drinks appears to have bone catabolic effects in boys and girls.** This effect is mainly mediated by the negative association with total protein intake and is not primarily based on milk displacement."* > > **Reference:** Libuda L, et al. Association between long-term consumption of soft drinks and variables of bone modeling and remodeling in a sample of healthy German children and adolescents. *Am J Clin Nutr.* 2008;88:1670–1677. ### Who Is Most Likely to Develop Hyperparathyroidism? Certain factors can raise your risk of developing primary hyperparathyroidism: - Age: risk increases as you get older, though children can also be affected - Sex: the condition affects twice as many women as men - Inherited endocrine conditions (such as MEN syndromes) ---
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Care planParesthesiaIf you've ever felt like your skin was crawling, or noticed unexplained numbness or itching, you've likely experienced paresthesia — and you're far from alone. Nearly everyone has had a brush with paresthesia at some point. That classic "pins and needles" sensation when your arm or leg "falls asleep" is one of the most recognizable examples. It typically happens when you've accidentally put pressure on a nerve. Once you shift position and relieve that pressure, the sensation fades. This kind of paresthesia is fleeting and goes away on its own. However, if the sensation lingers, it may be a signal that something else is going on beneath the surface — something worth discussing with your doctor. ## Understanding Paresthesia ### What Does Paresthesia Feel Like? Paresthesia can show up anywhere in the body, but it most commonly affects the: - Hands - Arms - Legs - Feet **Paresthesia can be temporary or chronic.** The symptoms can include feelings of: - Numbness - Weakness - Tingling - Burning - Cold **When paresthesia becomes chronic**, it can produce a stabbing pain and may cause clumsiness in the affected limb. When it occurs in the legs or feet, even walking can become a challenge. If paresthesia symptoms persist or begin to interfere with your daily life, it's time to see your doctor. These sensations can sometimes be a window into a deeper medical condition that deserves attention and treatment. ### What Causes Paresthesia? The root cause of paresthesia isn't always easy to pin down. Temporary cases are often the result of pressure on a nerve or a brief interruption in circulation — like when you doze off on your hand or sit cross-legged for too long. **When paresthesia is chronic, it may point to nerve damage. The two most common forms of nerve damage linked to paresthesia are radiculopathy and neuropathy.** **Radiculopathy: When Nerve Roots Are Under Pressure** Radiculopathy occurs when nerve roots become compressed, irritated, or inflamed. This can happen when you have: - A herniated disk that presses on a nerve - A narrowing of the canal that transmits the nerve from your spinal cord to your extremity - Any mass that compresses the nerve as it exits the spinal column When radiculopathy affects the lower back, it's called lumbar radiculopathy — and it can cause paresthesia in the leg or foot. In more severe cases, the sciatic nerve (a large nerve originating in the lower spinal cord) can become compressed, leading to leg weakness. Cervical radiculopathy, on the other hand, involves the nerves that supply sensation and strength to your arms. If you have cervical radiculopathy, you may experience: - Chronic neck pain - Paresthesia of the upper extremities - Arm weakness - Hand weakness **Neuropathy: When Nerves Are Chronically Damaged** Neuropathy results from long-term nerve damage. The single most common cause is hyperglycemia — that is, persistently high blood sugar. Other possible causes of neuropathy include: - Trauma - Repetitive movement injuries - Autoimmune diseases, such as rheumatoid arthritis - Neurological diseases, such as MS - Kidney diseases - Liver diseases - Stroke - Tumors in the brain or near nerves - Bone marrow or connective tissue disorders - Hypothyroidism - Deficiencies in vitamin B-1, B-6, B-12, E, or niacin - Infections, such as Lyme disease, shingles, or HIV - Certain medications, such as chemotherapy drugs - Exposure to toxic substances, such as chemicals or heavy metals Left unaddressed, nerve damage can ultimately lead to permanent numbness or even paralysis. ### Who Is at Risk for Paresthesia? Temporary paresthesia can happen to anyone. The risk of radiculopathy, however, rises with age. You may also be more vulnerable if you: - Perform repetitive movements that repeatedly compress your nerves, such as typing, playing an instrument, or playing a sport such as tennis - Drink heavily and eat a poor diet that leads to vitamin deficiencies, specifically vitamin B-12 and folate - Have type 1 or 2 diabetes - Have an autoimmune condition - Have a neurological condition, such as MS ### How Is Paresthesia Diagnosed? If you're experiencing persistent paresthesia with no clear explanation, make an appointment with your doctor. Come prepared to share your full medical history, including any activities that involve repetitive movement. Bring a list of all medications — both over-the-counter and prescription — that you currently take. Your doctor will take your known health conditions into account when forming a diagnosis. If you have diabetes, for example, they'll want to determine whether nerve damage — or neuropathy — has developed. Expect a thorough physical exam, which will likely include a neurological evaluation. Blood work and other laboratory tests, such as a spinal tap, may be used to rule out certain conditions. If your doctor suspects a problem with your neck or spine, imaging studies — such as X-rays, CT scans, or MRI scans — may be recommended. Depending on the findings, you may be referred to a specialist such as a neurologist, orthopedist, or endocrinologist. ### How Is Paresthesia Treated? Treatment is guided by the underlying cause. In some cases, simply removing the trigger is enough — for example, a repetitive movement injury may respond well to lifestyle modifications or physical therapy. When paresthesia stems from an underlying disease, treating that condition can go a long way toward easing the nerve-related symptoms. Whether your symptoms improve will depend on your individual situation. Some forms of nerve damage, unfortunately, are irreversible. ### What Can You Expect Long-Term? Temporary paresthesia usually clears up within a few minutes. If those strange sensations keep coming back — or simply won't go away — you may be dealing with chronic paresthesia. When symptoms are severe, they can meaningfully disrupt your daily life. That's precisely why identifying the underlying cause matters so much. Don't hesitate to seek a second opinion or ask for a specialist referral if you feel you need one. How long chronic paresthesia lasts and how severe it becomes depends largely on the cause. In many cases, treating the root condition brings real relief. Always keep your doctor informed if your current treatment isn't working — there are often adjustments that can be made. ### Can Paresthesia Be Prevented? Not always. You can't exactly control the position you drift into while sleeping, for instance. That said, there are practical steps you can take to reduce how often paresthesia occurs or how intense it feels. For example, wearing wrist splints at night may help relieve nerve compression in the hand and reduce nighttime symptoms. Here are some helpful habits for reducing your risk of chronic paresthesia: - Avoid repetitive movement if possible. - Rest often if you need to perform repetitive movements. - Get up and move around as often as possible if you have to sit for long periods. If you live with diabetes or another chronic condition, diligent monitoring and disease management are among the best tools you have for keeping paresthesia at bay. **Sources:** - <https://www.healthline.com/health/paresthesia#prevention> - Acute radiculopathies. (n.d.) <https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/acute_radiculopathies_134,11/> - Mayo Clinic Staff. (2014, December 2). Peripheral neuropathy: Causes. <https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/causes/con-20019948> - NINDS paresthesia information page. (2015, September 11). <https://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm> - Numbness (paresthesia and neuropathy). (2012, January 3). <https://www.mpkb.org/home/symptoms/neurological/paresthesia> - Peripheral Neuropathy Fact Sheet [Fact sheet]. (2016, March 9). <https://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm> ---
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Care planParkinson's DiseaseParkinson's disease is a chronic, slowly progressive disorder of the central nervous system (brain and spinal cord). It is defined by three core features: slowness of intentional movement, tremors that occur at rest, and stiffness of the muscles. *Dorland's Medical Dictionary* describes the Parkinsonian complex as "neurologic disorders characterized by hypokinesia, tremors, and muscular rigidity. It typically occurs late in life, although juvenile forms have been described." Parkinson's disease is diagnosed based on a patient's medical history and a physical examination. A doctor examining someone with Parkinson's may notice a mask-like, expressionless face; a characteristic shuffling, hurried walk; overall slowness of movement (bradykinesia); muscle weakness; poor balance; and certain neurological reflex signs. Patients themselves often report excessive sweating and leg cramps, and may also experience changes in their speech, memory difficulties, and mild depression. The disease and its symptoms arise from an accelerated loss of dopamine — a chemical messenger in the brain — from a region called the substantia nigra. It is worth noting that some loss of dopamine occurs naturally with aging in everyone. However, Parkinson's symptoms do not typically emerge until dopamine production has fallen below 80% of normal. There is currently no cure for Parkinson's disease, and conventional medical treatment focuses on managing symptoms rather than stopping the disease. Medications are aimed at boosting dopamine levels in the brain, while other drugs are used to manage the side effects of those primary treatments. A class of drugs called monoamine oxidase B inhibitors — such as selegiline — has also shown some benefit. Surgery has been attempted as a treatment option: a procedure called a pallidotomy — which involves surgically targeting a specific region of the brain called the pallidum — has been in use since the 1940s. It can provide symptom relief, but carries serious risks including blindness and stroke. An implantable brain pacemaker (deep brain stimulator) has also been used in an effort to reduce severe tremors. Most people are middle-aged or older when their symptoms first appear, and the disease progresses extremely slowly. In most cases, Parkinson's is not inherited and does not run in families — it appears to arise spontaneously. Although Parkinson's disease is recognized worldwide and its signs are often clear enough to diagnose, the underlying cause remains unknown and the biological mechanisms are still not fully understood. In Parkinson's disease, there is typically a loss of cells in specific pigment-containing regions of the brain — including the substantia nigra and the locus ceruleus — along with a drop in dopamine levels along the pathways connecting the substantia nigra to two other brain structures involved in movement control: the caudate nucleus and the putamen. The disease typically begins on one side of the body, but eventually becomes symmetrical as it progresses. Its onset is subtle and slow, and many people live for years without significant disability. Interestingly, after World War I, a widespread outbreak of a specific type of brain inflammation (encephalitis) left many survivors with symptoms virtually identical to Parkinson's — because the same brain cells affected by that infection are the ones that deteriorate in Parkinson's disease. This is considered one of the known causes of Parkinson's-like illness, though the term "Parkinsonism" is generally reserved for the idiopathic (unknown-cause) form of the disease. ---
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Care planPeriodic Limb Movement DisorderPeriodic Limb Movement Disorder (PLMD) is a sleep condition characterized by repetitive cramping or jerking of the legs during sleep. It is unique among movement disorders in that it occurs exclusively during sleep — which is why it is sometimes called periodic leg (or limb) movements during sleep. The word "periodic" captures the essence of these movements: they are repetitive and rhythmic, occurring like clockwork roughly every 20–40 seconds. Because these movements so often fragment and disrupt sleep, PLMD is also classified as a sleep disorder — and its consequences can extend well into the daytime, causing significant sleepiness. PLMD frequently overlaps with other sleep disorders. It is most commonly associated with restless legs syndrome, though the two are distinct conditions. Restless legs syndrome involves unusual, often uncomfortable sensations in the legs — and sometimes the arms — while a person is awake, paired with an almost irresistible urge to move the limbs to find relief. Notably, at least 80% of people with restless legs syndrome also have PLMD, but having PLMD does not mean you have restless legs syndrome. When PLMD was first described in the 1950s, it went by the name nocturnal myoclonus — "nocturnal" meaning night, and "myoclonus" referring to the rapid, rhythmic muscle contractions seen in conditions like seizures. However, the movements of PLMD are not true myoclonus, and that original label has since been retired. PLMD can affect people of any age, though — like many sleep disorders — it becomes more common as we move into middle age and beyond. ### What Causes Periodic Limb Movement Disorder? It is worth knowing upfront: persistent poor sleep and daytime sleepiness are not a normal part of aging. PLMD is classified as either primary or secondary. **Secondary PLMD** arises from an identifiable underlying medical condition. **Primary PLMD**, by contrast, has no known cause — though it has been linked to abnormalities in how the nervous system regulates signals traveling from the brain to the limbs. The precise nature of those abnormalities remains unclear. **Secondary PLMD has many potential causes, listed below. Notably, many of these overlap with the known causes of restless legs syndrome (RLS):** - Diabetes mellitus - Iron deficiency - Spinal cord tumor - Spinal cord injury - Sleep apnea syndrome — A breathing disorder that repeatedly disrupts sleep, causing daytime sleepiness and a range of other health consequences - Narcolepsy — A sleep disorder marked by overwhelming, uncontrollable sleepiness during waking hours - Uremia — A dangerous buildup of waste products in the blood resulting from poor kidney function - Anemia — An abnormally low level of hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body - Certain medications — Including neuroleptics and other antidopaminergic agents such as Haldol, dopaminergic agents such as Sinemet (despite the fact that Sinemet is often a treatment for PLMD), or tricyclic antidepressants such as amitriptyline (Elavil) - Withdrawal from sedative medications such as barbiturates or benzodiazepines (such as Valium) ### Recognizing the Symptoms of Periodic Limb Movement Disorder Somewhat counterintuitively, the most common complaints among people with PLMD are not about leg movements at all — they are about poor sleep and daytime fatigue. In fact, many people with PLMD have no idea their legs are moving during the night until a bed partner brings it to their attention. When movements do occur, they may involve one or both legs. - Typically, the knee, ankle, and big toe joints all flex as part of each movement. - The movements range widely in intensity — from subtle twitches to forceful kicking and thrashing. - Each movement lasts about 2 seconds, making them considerably slower than the rapid jerks seen in myoclonus. - The movements are rhythmic and predictable, repeating every 20–40 seconds throughout the night. ### How Is PLMD Diagnosed? For most people with PLMD, poor sleep and daytime sleepiness are the most disruptive symptoms — and many never connect those symptoms to what is happening in their legs overnight. Because disrupted sleep has so many potential causes, your healthcare provider will likely ask you a thorough set of questions to get to the bottom of things. Those questions will cover your current and past medical history, your family's health history, the medications you take, your work and travel history, and your daily habits and lifestyle. A detailed physical examination will also be performed to look for any underlying conditions that might be responsible for your sleep troubles. There is no single lab test or imaging study that can definitively diagnose PLMD. However, several tests can uncover underlying causes — such as anemia, nutritional deficiencies, or metabolic disorders — that may be driving your symptoms. - Blood tests may be ordered to assess your blood cell counts and hemoglobin levels, basic organ function, blood chemistry, and thyroid hormone levels. You may also be screened for certain infections that could be contributing to secondary PLMD. - A urine sample may be collected to check for traces of substances that can interfere with sleep. - Polysomnography (an overnight sleep study) is the only definitive way to confirm a PLMD diagnosis. During the study, your leg movements are recorded and measured while you sleep in a monitored lab setting. At any point during your evaluation, your healthcare provider may refer you to a neurologist — a specialist in disorders of the nervous system — to help rule out other neurological conditions and confirm the PLMD diagnosis. ### Treatment Options for Periodic Limb Movement Disorder Treatment cannot cure PLMD, but it can meaningfully reduce symptoms and improve quality of life. **Medical Treatment** The goal of treatment is to either reduce the frequency of limb movements or help you sleep through them when they occur. **Medications** It is important to note that many of the medications used to treat PLMD are the same ones used to manage restless legs syndrome. - **Benzodiazepines:** These medications suppress muscle contractions and also act as sedatives, helping you sleep through movements. Clonazepam (Klonopin), in particular, has been shown to reduce the total number of periodic limb movements per hour and is probably the most widely used drug to treat PLMD. - **Dopaminergic agents:** These drugs boost levels of dopamine — a key brain chemical involved in controlling muscle movement. They are effective for some people but not others. Widely used examples are a levodopa/carbidopa combination (Sinemet) and pergolide (Permax). - **Anticonvulsant agents:** Originally developed to treat seizures, these medications can also reduce muscle contractions in some people with PLMD. The most widely used anticonvulsant in PLMD is gabapentin (Neurontin). - **GABA agonists:** These agents work by blocking certain nerve signals that trigger muscle contractions, promoting muscle relaxation. The most widely used of these agents in PLMD is baclofen (Lioresal). ### Prevention Stay on top of your health by seeing your healthcare provider regularly for ongoing management of any medical or mental health conditions. ### What to Expect Over Time **Primary PLMD** may be a long-term, chronic condition. Many people experience periods of improved sleep, but relapses are common over time. **Secondary PLMD** may resolve entirely once the underlying cause is identified and effectively treated. **Source:** <https://www.webmd.com/sleep-disorders/periodic-limb-movement-disorder#1> ---
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Care planPeriodontal Disease**Periodontitis, also known as gum disease,** is a serious infection of the gums that damages the soft tissues supporting your teeth and — if left untreated — can destroy the underlying bone. This can cause teeth to become loose or fall out entirely. Periodontitis is surprisingly common, yet largely preventable. It almost always stems from poor oral hygiene habits. Something as simple as brushing at least twice a day, flossing daily, and keeping up with regular dental visits can dramatically improve both your treatment outcomes and your ability to prevent this disease in the first place. --- ## Understanding Periodontitis ### What Does Periodontitis Look and Feel Like? Healthy gums are firm, pale pink, and hug your teeth snugly. When periodontitis develops, you may notice some of the following warning signs: - Swollen or puffy gums - Bright red, dusky red, or purplish gums - Gums that feel tender when touched - Gums that bleed easily - Pink-tinged toothbrush after brushing - Spitting out blood when brushing or flossing your teeth - Bad breath - Pus between your teeth and gums - Loose teeth or loss of teeth - Painful chewing - New spaces developing between your teeth - Gums that pull away from your teeth (recede), making your teeth look longer than normal - A change in the way your teeth fit together when you bite ### When Should You See a Dentist? Stick to your dentist's recommended schedule for routine checkups. If any of the symptoms above catch your attention, call your dentist promptly — don't wait. The earlier you seek care, the greater your chances of reversing the damage caused by periodontitis. ### What Causes Periodontitis? In most cases, periodontitis begins with plaque — a sticky, bacteria-laden film that coats your teeth. When left unchecked, here is how plaque can quietly progress into full-blown gum disease: - **Plaque forms on your teeth** when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth twice a day and flossing once a day removes plaque, but plaque re-forms quickly. - **Plaque can harden under your gumline into tartar (calculus)** if it stays on your teeth. Tartar is more difficult to remove and it's filled with bacteria. The longer plaque and tartar remain on your teeth, the more damage they can do. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it. - **Plaque can cause gingivitis,** the mildest form of gum disease. Gingivitis is irritation and inflammation of the part of your gum tissue around the base of your teeth (gingiva). Gingivitis can be reversed with professional treatment and good home oral care. - **Ongoing gum inflammation can cause periodontitis,** eventually causing pockets to develop between your gums and teeth that fill with plaque, tartar, and bacteria. In time, these pockets become deeper, filling with more bacteria. If not treated, these deep infections cause a loss of tissue and bone, and ultimately you may lose one or more teeth. Also, ongoing chronic inflammation can put a strain on your immune system. ### Who Is at Risk? A number of factors can raise your chances of developing periodontitis, including: - Gingivitis - Poor oral health habits - Smoking or chewing tobacco - Hormonal changes, such as those related to pregnancy or menopause - Recreational drug use, such as smoking marijuana or vaping - Obesity - Inadequate nutrition, including vitamin C deficiency - Genetics - Certain medications that cause dry mouth or gum changes - Conditions that cause decreased immunity, such as leukemia, HIV/AIDS, and cancer treatment - Certain diseases, such as diabetes, rheumatoid arthritis, and Crohn's disease ### What Happens If It Goes Untreated? Beyond tooth loss, periodontitis can have consequences that reach far beyond your mouth. The bacteria responsible for the infection can enter your bloodstream through your gum tissue, potentially affecting other organs and body systems. Periodontitis has been linked to respiratory disease, rheumatoid arthritis, coronary artery disease, and difficulty managing blood sugar in diabetes. ### How to Protect Yourself The most powerful defense against periodontitis is a consistent, lifelong oral hygiene routine — ideally one that you start early and never abandon. **Good oral hygiene.** That means brushing your teeth for two minutes at least twice daily — in the morning and before going to bed — and flossing at least once a day. Flossing before you brush allows you to clean away the loosened food particles and bacteria. Good oral hygiene prevents the development of an environment around your teeth that is favorable to specific bacteria that cause periodontal disease. **Regular dental visits.** See your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain medications, or smoking — you may need professional cleaning more often. **Source:** <https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473> **References:** - Overview of periodontal disease. Merck Manual Professional Version. <https://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/overview-of-periodontal-disease>. Accessed Sept. 26, 2019. - Gum disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research. <https://www.nidcr.nih.gov/health-info/gum-disease/more-info#>. Accessed Sept. 26, 2019. - Caton JG, et al. A new classification scheme for periodontal and peri-implant diseases and conditions — Introduction and key changes from the 1999 classification. *Journal of Clinical Periodontology.* 2018; doi:10.1111/jcpe.12935. - Periodontal (gum) disease. National Institute of Dental and Craniofacial Research. <https://catalog.nidcr.nih.gov/OrderPublications/#10>. Accessed Sept. 26, 2019. - Periodontal disease. Centers for Disease Control and Prevention. <https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html>. Accessed Sept. 26, 2019. - AskMayoExpert. Periodontal disease. Mayo Clinic; 2019. - Smiley CJ, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. *Journal of the American Dental Association.* 2015; doi:10.1016/j.adaj.2015.01.026. - Papapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. *Journal of Periodontology.* 2018; doi:10.1002/JPER.17-0721. - Slots J. Periodontitis: Facts, fallacies and the future. *Periodontology 2000.* 2017; doi:10.1111/prd.12221. - Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. *International Journal of Health Sciences.* 2017; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/>. Accessed Sept. 30, 2019. - Graziani F, et al. Nonsurgical and surgical treatment of periodontitis: How many options for one disease? *Periodontology 2000.* 2017; doi:10.1111/prd.12201. - Salinas TJ (expert opinion). Mayo Clinic. Jan. 14, 2020. - Ramoa CP, et al. Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral health care. *Journal of Periodontal Research.* 2017; doi:10.1111/jre.12458. - Gu Z, et al. Marijuana-derived cannabinoids trigger a CB2/PI3K axis of suppression of the innate response to oral pathogens. *Frontiers in Immunology.* 2019; doi:10.3389/fimmu.2019.02288. - Isik Andrikopoulos G, et al. Electronic nicotine delivery systems (ENDS) and their relevance in oral health. *Toxics.* 2019; doi:10.3390/toxics7040061. ---
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Care planPeripheral Artery Disease (PAD)Peripheral Artery Disease (PAD) occurs when the blood vessels outside your heart become dangerously narrowed. **The root cause of PAD is atherosclerosis — a process in which plaque, a sticky mixture of fat and cholesterol, gradually builds up along the walls of arteries that deliver blood to your arms and legs.** As plaque accumulates, arteries narrow or become blocked entirely, reducing or completely cutting off blood flow — most often to the legs. When your legs don't receive enough blood, they may ache or go numb. In severe cases, tissue can die from lack of circulation. Left untreated, this can ultimately lead to amputation of a foot or leg. **Having PAD also significantly raises your risk of heart attack, stroke, and transient ischemic attack (a "mini-stroke").** The encouraging news: in many cases, you can slow, stop, or even begin to reverse plaque buildup by making changes to your diet, increasing physical activity, and actively working to lower high cholesterol and blood pressure. According to the latest American Heart Association data, approximately eight million people in the United States are living with PAD — including 12–20% of adults over age 60. Even more striking, a large number of cases remain undiagnosed, pushing the true estimated burden of PAD as high as 12–14 million Americans. At the biological level, three key processes drive the formation of atherosclerotic plaque — the hallmark of PAD: inflammation, dysfunction of the cells lining your blood vessels (called endothelial cells), and disrupted production of nitric oxide, a molecule your body uses to keep blood vessels relaxed and open. Simply put, PAD is a circulatory problem: your limbs don't receive enough blood because the arteries supplying them have become too narrow. **People with PAD are also at heightened risk for coronary heart disease, and PAD frequently occurs alongside type 2 diabetes.** Most researchers believe atherosclerosis begins with damage to the endothelium — the delicate inner lining of your arteries. High blood pressure, elevated LDL ("bad") cholesterol, abnormally high levels of homocysteine (an amino acid your body naturally produces), tobacco smoke, diabetes, the hormonal shifts of menopause, and certain infections are all believed to injure the endothelium. Once damaged, this lining becomes far more vulnerable to deposits of fats, cholesterol, cellular debris, calcium, and other substances that embed in the artery wall. Over time, this buildup thickens the wall substantially — shrinking the artery's inner diameter, reducing blood flow, and dramatically cutting the oxygen supply to your tissues. Blood clots can also form on top of these deposits, potentially blocking the artery altogether and cutting off blood supply entirely. Importantly, many people who develop atherosclerosis don't have the "classic" risk factors like smoking or high blood pressure — which suggests that other contributors, such as inflammation triggered by infection or autoimmune disease, may also play a meaningful role. ### What Is Claudication? Claudication is muscle pain caused by insufficient blood flow during physical activity. It most commonly shows up as leg pain or cramping that begins after walking a certain distance or at a certain pace — and how quickly it sets in depends on the severity of your condition. The hallmark of this symptom is that it is intermittent: it comes on with movement and eases with rest. As the condition progresses, however, the pain may begin to appear even at rest. Claudication is technically a symptom, not a disease in itself — and its most common underlying cause is peripheral artery disease, in which narrowed arteries limit blood flow to the limbs. ### How Are PAD and Claudication Connected? Claudication happens when a working muscle simply isn't receiving enough blood to meet its demands. In PAD, the artery that normally supplies that muscle has become narrowed. At rest, enough blood can still squeeze through to keep the muscle satisfied. But when you walk or exercise, your muscles need significantly more blood — and a narrowed artery may not be able to deliver it. ### Risk Factors - Male sex - Declining estrogen levels following menopause - Older age - High blood pressure - High LDL ("bad") cholesterol and/or high triglycerides - Elevated homocysteine levels - Low HDL ("good") cholesterol - Family history of atherosclerosis (which may reflect shared lifestyle habits as much as genetics) - Cigarette smoking and regular exposure to secondhand smoke - Diabetes mellitus - Insulin resistance - Excess body weight, particularly around the abdomen - A sedentary, low-activity lifestyle - Diets high in saturated fat and trans fatty acids - Chronic stress - Depression --- ## Understanding Arteriosclerosis and Atherosclerosis The terms arteriosclerosis and atherosclerosis are often used interchangeably — but they actually refer to distinct conditions. **Arteriosclerosis** is a broad term describing what happens when the arteries — the vessels that carry oxygen-rich blood from your heart to the rest of your body — become thick and stiff, sometimes reducing blood flow to vital organs and tissues. Healthy arteries are naturally flexible and elastic, but over time their walls can harden. You may know this by its common name: "hardening of the arteries." **Atherosclerosis** is a specific form of arteriosclerosis. **It refers to the buildup of fats, cholesterol, and other substances within the artery walls** — a deposit collectively called plaque. As plaque accumulates, arteries narrow and blood flow is restricted. Plaque can also rupture suddenly, triggering a blood clot that may completely block the artery. Although we most often think of atherosclerosis as a heart condition, it can affect arteries throughout the entire body. The positive news is that atherosclerosis is treatable — and healthy lifestyle choices can go a long way toward preventing it from developing in the first place. ### Symptoms to Watch For In its early stages, atherosclerosis typically produces no noticeable symptoms. Symptoms generally don't appear until an artery has narrowed or become so blocked that it can no longer adequately supply blood to the tissues it serves. In some cases, a blood clot forms abruptly and completely cuts off flow — potentially triggering a heart attack or stroke. When symptoms do occur, they depend on which arteries are affected: - **Arteries of the heart:** You may experience chest pain or a sensation of pressure, known as angina. - **Arteries leading to the brain:** Sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, temporary vision loss in one eye, or facial drooping may occur. These are warning signs of a transient ischemic attack (TIA), or "mini-stroke." An untreated TIA can progress to a full stroke. - **Arteries of the arms and legs:** You may develop symptoms of peripheral artery disease, such as leg pain when walking (claudication) or a noticeable drop in blood pressure in an affected limb. - **Arteries leading to the kidneys:** Atherosclerosis in this area can contribute to high blood pressure or kidney failure. ### How Atherosclerosis Is Treated Because atherosclerosis often produces no symptoms until a serious event — like chest pain or a heart attack — occurs, prevention through lifestyle is the most powerful tool available. Achieving and maintaining a healthy weight, lowering blood pressure and cholesterol, exercising regularly, quitting smoking, and managing stress are all essential strategies. Once a complication has occurred, surgical procedures or other interventions may be needed to remove plaque from blocked arteries or to reroute blood flow around an obstruction. Heart-healthy diets that lower cholesterol, reduce blood pressure, and support a healthy body weight — such as the Mediterranean Diet — are a cornerstone of atherosclerosis treatment. The Mediterranean Diet emphasizes whole grains, fresh fruits and vegetables, fish, olive oil, and moderate daily wine consumption. Unlike standard low-fat diets, the Mediterranean Diet is not low in all fats — it is low in saturated fat while being rich in heart-healthy monounsaturated fatty acids. In a long-term study of 423 patients who had suffered a heart attack, those who followed a Mediterranean-style eating pattern had a 50% to 70% lower risk of recurrent heart disease compared to a control group that received no special dietary guidance. **Stop Smoking.** Cigarette smoking acutely raises heart rate and arterial blood pressure, which can disrupt normal arterial blood flow patterns. Using non-invasive ultrasound technology, researchers have demonstrated that smoking increases the stiffness of artery walls and alters how blood moves through them — changes that help explain why smoking is such a powerful driver of atherosclerosis. > 📝 **NOTE: Beet Juice Tied to Reduced Post-PCI Restenosis.** Late lumen loss (LLL) after percutaneous interventions (PCI) can be reduced significantly by oral ingestion of beet juice, according to a phase 2 randomized trial. ([Cardio Flow](https://nutridyn.com/dynamic-cardio-flow)) The study grew out of relatively recent evidence that ingestion of nitrate-rich foods, such as beets, can trigger noncanonical pathways for nitric oxide generation, sometimes referred to as the nitrate-nitrite-nitric oxide sequence. Dr. Rathod cited experimental evidence associating this pathway with the traditional benefits of NO generation, such as anti-inflammatory and antithrombotic effects. - **Percutaneous coronary intervention (PCI)** is the general name for procedures that open up blocked coronary arteries, blood vessels that supply oxygen via blood to your heart muscles — such as balloon angioplasty, laser angioplasty, rotational atherectomy, angioplasty with a stent, and Impella-supported PCI. - **Late lumen loss (LLL)** is an efficacy measure based on the minimal lumen diameter assessed by serial coronary angiography. Optical coherence tomography is a high-resolution imaging technique that provides microscopic information on the stent and adjacent neointima, potentially useful to assess surrogates of device safety. - **Reduced Post-PCI Restenosis** can be defined as a reduction in the luminal diameter of more than 50%. It had a high incidence rate of 25–50% in patients having undergone balloon angioplasty, with the vast majority of patients requiring revascularisation within 6 months. **In-stent restenosis (ISR)** is the narrowing of a stented coronary artery lesion. The mean time from percutaneous coronary intervention (PCI) to ISR was 12 months with drug-eluting stents (DES) and 6 months with bare metal stents (BMS). ISR typically presents as recurrent angina. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms-causes/syc-20350557> - <https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569> - <https://www.mayoclinic.org/diseases-conditions/claudication/symptoms-causes/syc-20370952> - <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323487/> - <https://pubmed.ncbi.nlm.nih.gov/28582205/> - <https://pubmed.ncbi.nlm.nih.gov/27998900/> - <https://www.tctmd.com/news/beeting-stent-restenosis-dietary-nitrate-may-improve-outcomes> ---
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Care planPeripheral Nerve DisordersYour peripheral nerves are the ones that live outside your brain and spinal cord — they form a vast communication network that carries messages between your brain and every other part of your body. When peripheral nerves are damaged or diseased, it's a bit like static on a telephone line: the signals get distorted, delayed, or cut off entirely. There are more than 100 types of peripheral nerve disorders, and they can affect a single nerve or many at once. Some arise as complications of other conditions, like diabetes. Others, like Guillain-Barré syndrome, follow a viral infection. Some result from nerves being squeezed or compressed — as in carpal tunnel syndrome or thoracic outlet syndrome. In conditions like complex regional pain syndrome or brachial plexus injuries, nerve damage follows physical trauma. And in some people, peripheral nerve disorders are present from birth. ### What Does It Feel Like? Common Symptoms Symptoms often begin subtly and gradually worsen over time. They may include: - Numbness - Pain - Burning or tingling - Muscle weakness - Unusual sensitivity to touch Treatment focuses on addressing whatever underlying condition is driving the nerve damage, reducing pain, and managing symptoms to protect your quality of life. **Source:** NIH: National Institute of Neurological Disorders and Stroke ---
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Care planPernicious AnemiaAnemia is a medical condition in which your blood doesn't have enough normal, healthy red blood cells. **Pernicious anemia is one specific cause of vitamin B-12 deficiency anemia. It is believed to be primarily driven by an autoimmune process — meaning your own immune system mistakenly prevents your stomach from producing a critical protein called intrinsic factor.** Intrinsic factor is essential for absorbing the vitamin B-12 you eat into your small intestine. Vitamin B-12 itself is an indispensable nutrient that your body relies on to produce and maintain healthy, properly functioning red blood cells. Pernicious anemia is uncommon, affecting about 0.1 percent of the general population and roughly 1.9 percent of adults over the age of 60, according to a [2012 study](https://doi.org/10.2147/JBM.S25620) in the *Journal of Blood Medicine*. That said, up to 50 percent of all vitamin B-12 deficiency anemia in adults is actually caused by pernicious anemia. The name "pernicious" reflects a dark historical reality — before effective treatments existed, this condition was often fatal. Today, however, pernicious anemia is very manageable, typically treated with vitamin B-12 injections or, in some cases, high-dose oral supplements. Left untreated, though, vitamin B-12 deficiency from any cause can lead to serious, lasting complications. --- ## Understanding Pernicious Anemia ### Recognizing the Symptoms Pernicious anemia tends to develop slowly and quietly. Many people gradually adapt to feeling unwell, which can make the symptoms easy to overlook or dismiss. Common symptoms include: - Fatigue - Weakness - Headaches - Chest pain - Weight loss - Pale skin In more severe or long-standing cases of vitamin B-12 deficiency — including that caused by pernicious anemia — neurological symptoms may emerge. These can include: - An unsteady gait - Peripheral neuropathy, which is numbness in the arms and legs - Muscle weakness - Depression - Memory loss - Dementia Additional symptoms that can accompany vitamin B-12 deficiency, including from pernicious anemia, include: - Nausea and vomiting - Confusion - Constipation - Loss of appetite - Heartburn --- ### What Causes Vitamin B-12 Deficiency Anemia? **Not getting enough vitamin B-12 through your diet** People with anemia have too few normal red blood cells (RBCs). Since vitamin B-12 is essential for making RBCs, your body needs a steady, adequate supply. Vitamin B-12 is found in: - Meat - Poultry - Shellfish - Eggs - Dairy products - Fortified soy, nut, and rice milks - Nutritional supplements **Lack of intrinsic factor in the body** Beyond diet, your body also depends on a protein called intrinsic factor (IF) to actually absorb vitamin B-12. IF is made by specialized cells in your stomach lining called parietal cells. Once you consume vitamin B-12, it travels to your stomach where IF latches onto it. Together, they are then absorbed in the final segment of your small intestine. In most cases of pernicious anemia, the immune system mistakenly attacks and destroys these parietal cells — the very cells responsible for making IF. When those cells are gone, your stomach can no longer produce IF, and your small intestine loses the ability to absorb dietary vitamin B-12 — whether from food or supplements. **Conditions affecting the small intestine** Certain diseases of the small intestine can independently cause vitamin B-12 deficiency. These include conditions like celiac disease, Crohn's disease, or HIV. Surgical removal of the ileum — the final section of the small intestine — can also result in vitamin B-12 deficiency. Disruptions to the normal balance of bacteria in the small intestine may also contribute. Antibiotics, for example, can deplete the beneficial bacteria needed for healthy intestinal absorption. Conversely, an overgrowth of bacteria in the small intestine can interfere with absorption and similarly lead to vitamin B-12 deficiency. **How pernicious anemia differs from other causes of vitamin B-12 deficiency anemia** > 📝 **NOTE:** Other vitamin B-12 deficiencies, such as that caused by poor dietary intake, are often confused with pernicious anemia. **Pernicious anemia is primarily understood to be an autoimmune disorder that damages the parietal cells lining the stomach.** The result is a failure to produce intrinsic factor and, therefore, poor vitamin B-12 absorption. **Pernicious anemia may also have a hereditary component, meaning it can run in families.** Some children are even born with a genetic defect that prevents them from making intrinsic factor altogether. Both pernicious anemia and anemia caused by small intestinal malabsorption can be treated with intramuscular B-12 injections administered by your physician. High-dose oral vitamin B-12 supplementation may also be an effective alternative for some individuals with pernicious anemia. **When vitamin B-12 deficiency anemia occurs in someone whose body can still absorb B-12 normally, oral supplementation and dietary changes may be all that's needed.** --- ### Who Is at Risk for Pernicious Anemia? Certain people are more predisposed to developing pernicious anemia than others. Risk factors include: - Having a family history of the disease - Being of Northern European or Scandinavian descent - Having type 1 diabetes mellitus, an autoimmune condition, or certain intestinal diseases such as Crohn's disease - Having had part of your stomach removed - Being 60 years or older - Risk of developing pernicious anemia also increases with age --- ### How Is Pernicious Anemia Diagnosed? Diagnosing pernicious anemia typically requires a series of blood tests. Your doctor will likely order: - **Complete blood count.** This test screens for anemia broadly by evaluating key markers such as hemoglobin and hematocrit levels. - **Vitamin B-12 level.** If vitamin B-12 deficiency is suspected as the cause of your anemia, your doctor can measure your vitamin B-12 level with a blood test. A lower than normal result confirms a deficiency. - **Intrinsic factor and parietal cell antibodies.** Your blood is tested for antibodies directed against intrinsic factor and the stomach's parietal cells. In a well-functioning immune system, antibodies serve as defenders — they identify and flag bacteria or viruses for destruction. In an autoimmune disease like pernicious anemia, that system goes awry. The immune system loses its ability to distinguish between foreign invaders and healthy tissue, and begins destroying the very stomach cells responsible for making intrinsic factor. --- ### How Is Pernicious Anemia Treated? Treatment for pernicious anemia involves a two-part approach: first correcting the vitamin B-12 deficiency, then maintaining healthy levels over time. Treatment typically consists of: - Vitamin B-12 injections that are followed closely over time - Following the blood level of vitamin B-12 over the course of therapy - Making adjustments accordingly in vitamin B-12 dosing Vitamin B-12 injections may be given daily or weekly until levels return to normal or near-normal. During the first few weeks of treatment, your doctor may advise you to limit strenuous physical activity. Once your vitamin B-12 levels stabilize, you may only need monthly injections. Some patients learn to self-administer these at home — or have a family member help — reducing the need for frequent doctor visits. **Once your B-12 level is restored, your doctor may suggest transitioning to oral B-12 supplements in place of injections.** However, if your intrinsic factor deficiency is significant enough to impair intestinal absorption of vitamin B-12, injections may remain your primary — and necessary — long-term treatment. --- ### Potential Complications Your doctor will likely recommend long-term follow-up care to catch and address any serious effects of pernicious anemia before they progress. One particularly important concern is gastric cancer, which your doctor can screen for at regular visits through physical examination, imaging, and biopsies when appropriate. Other potential complications of pernicious anemia include: - Peripheral nerve damage - Digestive tract problems - Memory problems, confusion, or other neurological symptoms - Heart problems These complications most often arise from long-standing, poorly managed pernicious anemia — and in some cases, they can become permanent. --- ### Living with Pernicious Anemia: What to Expect Most people with pernicious anemia will require lifelong treatment and monitoring to protect their long-term health and prevent damage to vital body systems. If you think you may be experiencing symptoms of pernicious anemia, don't wait — speak with your doctor. Early diagnosis, timely treatment, and consistent follow-up are the keys to staying ahead of this condition and avoiding complications down the road. **Source:** <https://www.healthline.com/health/pernicious-anemia#outlook> **References:** - Andres E, et al. (2012). Optimal management of pernicious anemia. *Journal of Blood Medicine.* doi: 10.2147/JBM.S25620 - Anemia, pernicious. (n.d.). <https://rarediseases.org/rare-diseases/anemia-pernicious/> - Cattan D. (2011). Pernicious anemia: What are the actual diagnosis criteria? *World Journal of Gastroenterology.* doi: 10.3748/wjg.v17.i4.543 - Lahner E, et al. (2009). Pernicious anemia: New insights from a gastroenterological point of view. *World Journal of Gastroenterology.* doi: 10.3748/wjg.15.5121 - Mayo Clinic Staff. (2019). Vitamin deficiency anemia. <https://www.mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/symptoms-causes/syc-20355025> - Pernicious anemia. (n.d.). <https://www.nhlbi.nih.gov/health-topics/pernicious-anemia> - Vitamin B-12: Fact sheet for professionals. (2020). <https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/> - Vitamin B-12 deficiency: What is it? (2019). <https://www.health.harvard.edu/a_to_z/vitamin-b12-deficiency-a-to-z> ---
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Care planPeyronie's DiseasePeyronie's disease is defined by the formation of a plaque — a firm, flat scar — that develops inside the penis. This scar tissue takes hold within a tough, fibrous sleeve called the **tunica albuginea**, which wraps around the erectile tissue like a protective sheath. It begins as a small area of localized inflammation that gradually hardens into scar tissue over time. This plaque has nothing to do with the arterial plaque associated with heart disease. Peyronie's disease exists on a spectrum from mild to severe. Some men notice symptoms gradually; others wake up one day and find them already present. In more serious cases, the hardened plaque stiffens the penis, causing pain and a noticeable curve or arc during erection. The pain often fades with time, but the bend itself frequently persists — and that can make sexual intercourse difficult or impossible. The ripple effects on a couple's intimacy and a man's self-confidence can be profound. In a small number of men with milder disease, the inflammation resolves on its own without lasting pain or curvature. The plaque is entirely benign — not cancerous, not a tumor. Peyronie's disease is not contagious and is not caused by any infectious agent. Where the plaque forms determines the direction of the bend: a plaque on the top of the shaft — the most common location — pulls the penis upward during erection, while one on the underside causes a downward curve. When plaques form on both sides, the penis may indent and shorten. In some men, the combination of pain, curvature, and emotional distress makes sexual intercourse simply not possible. Estimates of how common Peyronie's disease is vary widely — anywhere from less than 1 percent to 23 percent of men. A well-conducted study in Germany found it in 3.2 percent of men between the ages of 30 and 80. Though it is most common in middle-aged men, younger and older men are not immune. About 30 percent of men with Peyronie's disease also develop hardened tissue elsewhere in the body — most notably in the hand, a condition known as **Dupuytren's contracture**. The fact that Peyronie's disease sometimes runs in families suggests that genetics may play a role in who is vulnerable. The disease was first formally described by French surgeon François de la Peyronie in 1743, though it appeared in medical writings as early as 1687. Early physicians categorized it as a form of impotence — what we now call **erectile dysfunction (ED)**. Peyronie's disease can indeed be associated with ED, which is the inability to achieve or maintain an erection firm enough for intercourse. That said, experts today recognize that ED is just one of several possible features of this disease — and one that doesn't affect every man who has it. **References:** 1. Wessells H, Joyce GF, Wise M, Wilt TJ. Erectile dysfunction and Peyronie's disease. In: Litwin MS, Saigal CS, editors. *Urologic Diseases in America.* U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Printing Office, 2007; NIH Publication No. 07–5512:483–530. 2. Sommer F, Schwarzer U, Wassmer G, Bloch W, Braun M, Klotz T, Engelmann U. Epidemiology of Peyronie's disease. *International Journal of Impotence Research.* 2002;14:379–383. --- ## Understanding Peyronie's Disease ### How Does Peyronie's Disease Develop? The leading theory is that Peyronie's disease begins with physical trauma — a bump, bend, or awkward moment during sex — that causes a small amount of bleeding deep within the penis. Running the length of the penis are two expandable chambers called the **corpora cavernosa**. A band of connective tissue called the septum runs between these chambers and anchors to the tunica albuginea at both the top and bottom. When the penis is struck or forcefully bent, the point where the septum attaches to the tunica albuginea can be overstretched, tearing the tunica and rupturing tiny blood vessels in the process. As we age, the tissue near these attachment points naturally loses some of its elasticity, which makes injury more likely. The septum itself can also sustain damage, leading to the development of tough, fibrous tissue — a process called **fibrosis**. The tunica albuginea is made up of multiple layers with very limited blood flow between them. This means that once inflammation sets in, it can remain trapped between those layers for months. Over time, the inflamed cells release substances that drive excessive scar formation and erode the tissue's flexibility. This slow, chronic process eventually produces a hardened plaque — one characterized by dense scar tissue, calcium deposits, patchy loss of elasticity, and a visible deformity of the penis. What makes Peyronie's disease puzzling is that trauma alone doesn't explain everything. Most cases develop gradually and without any obvious injury. Trauma also doesn't explain why some cases get better on their own, or why a closely related condition — Dupuytren's contracture of the hand — doesn't seem to follow significant trauma either. Some researchers believe Peyronie's disease may have an autoimmune component — meaning the body's own immune system may mistakenly target penile tissue. ### How Is Peyronie's Disease Diagnosed? In most cases, a doctor can diagnose Peyronie's disease through a straightforward physical exam. The plaque is often detectable by touch when the penis is soft. A complete evaluation, however, typically requires an examination during erection to get a true picture of the curvature and its severity. The erection may be induced by injecting medication directly into the penis or through self-stimulation. Some men can avoid in-office assessment by bringing a digital photo taken at home during a natural erection. The workup may also include an ultrasound of the penis to precisely locate the plaque and check for calcium deposits. If there are concerns about erectile dysfunction, ultrasound can also be used to assess blood flow into and out of the penis. ### How Is Peyronie's Disease Treated? Most men seek help for Peyronie's disease because of painful erections, a noticeable curve, or trouble with intercourse. Because the exact cause and progression of the disease are not fully understood, treatment is largely based on what seems to work for individual patients rather than on one universally proven approach. The overarching goal is to restore and maintain the ability to have comfortable, satisfying intercourse. For some men, simply learning about the disease and understanding its natural course is enough. No non-surgical treatment has been shown to be universally effective, and surgery is generally reserved for men with long-standing, stable disease whose curvature is severe enough to prevent intercourse. Because Peyronie's disease follows a different course in every man — and because some men improve on their own without any treatment — most medical experts recommend waiting at least 1 year before considering surgery. During that waiting period, many men are open to trying treatments that, while not definitively proven, may offer some benefit. ### Medical Treatments Small studies have found that men with Peyronie's disease who took oral vitamin E reported improvements — but no rigorous, controlled trials have confirmed its effectiveness. Similar mixed results have been seen with aminobenzoate potassium (Potaba). Other oral medications that have been tried include colchicine, tamoxifen, and pentoxifylline — again, without controlled studies to firmly establish their benefit. Researchers have also explored injecting agents directly into the plaque. Verapamil and interferon alpha-2b appear to reduce penile curvature. Collagenase, another injectable option, was still in clinical trials at the time of this writing, with results pending. Steroid injections such as cortisone have fallen out of favor due to side effects, including the breakdown and death of healthy surrounding tissue. Another technique — iontophoresis — uses a gentle, painless electrical current to drive verapamil or another agent through the skin and into the plaque without a needle. Radiation therapy — directing high-energy beams at the plaque — has also been used. Like some of the injectable treatments, radiation may reduce pain, but it does not appear to shrink or dissolve the plaque itself, and it carries the risk of causing erectile dysfunction. The wide variety of treatments being tried reflects the reality that no single proven solution yet exists — though growing insights into how wounds heal may one day lead to more targeted and effective therapies. ### Surgery Three surgical approaches have shown meaningful success in treating Peyronie's disease. The first involves removing or cutting out the plaque and filling in the gap with a patch — which may be a piece of skin, a vein, or a material derived from animal tissue. This approach can straighten the penis and may recover some of the length lost to Peyronie's disease, though some men experience penile numbness or reduced erectile function afterward. The second approach, called **plication**, works differently: instead of removing the plaque, the surgeon removes or folds a small section of the tunica albuginea on the opposite side of the penis from the plaque — essentially balancing out the curvature. This method carries a lower risk of numbness or erectile dysfunction but cannot restore lost length or girth. The third option is the placement of a penile implant to restore rigidity. In some cases, the implant alone will straighten the penis sufficiently. When it doesn't, the implant can be combined with one of the other two procedures for a more complete result. Surgery generally produces good outcomes. However, because complications are possible — and because some effects of Peyronie's disease, such as shortening of the penis, are typically not fully corrected by surgery — most doctors reserve these procedures for the small subset of men whose curvature is severe enough to make intercourse impossible. ---
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Care planPinworm InfectionPinworms (genus *Enterobius*) — called threadworms in the United Kingdom and Australia, or seatworms elsewhere — are tiny parasitic worms that live in the human intestine. Despite sounding alarming, they are among the most common and manageable parasitic infections in the world. In fact, pinworm infection is the most common intestinal worm infection in the United States. These worms are thin and white, measuring about 1/4 to 1/2 inch (about 5 to 13 millimeters) in length — roughly the size of a staple. While an infected person sleeps, female pinworms quietly crawl out and lay thousands of microscopic eggs in the folds of skin around the anus. Most people who are infected never even know it — they have no symptoms at all. When symptoms do appear, they typically include anal itching and disrupted sleep. Pinworm infections are most common in school-age children, and the microscopic eggs spread easily from child to child and throughout households. Fortunately, treatment is straightforward: oral medications that eliminate the worms, combined with thorough washing of bedding, clothing, and underwear. For the best outcome, the entire family should be treated together. ### What Are the Symptoms? Many people with pinworms have no symptoms at all. When symptoms do occur, they may include: - Itching around the anal or vaginal area - Trouble sleeping, irritability, and restlessness - On-and-off abdominal pain and nausea If you or your child has unexplained nighttime itching or restless sleep, pinworms may be worth considering. ### What Causes a Pinworm Infection? Pinworm infections begin when microscopic eggs are accidentally swallowed. These eggs can hitch a ride to your mouth on contaminated food, drinks, or fingers. Once swallowed, the eggs hatch in the intestines and develop into adult worms within a few weeks. Female pinworms then migrate to the anal area to lay their eggs — which is what triggers the characteristic itching. When the area is scratched, eggs cling to the fingers and lodge under the fingernails. From there, they can transfer to toys, bedding, or other surfaces — and eventually to other people's mouths. Pinworm eggs are remarkably resilient: they can survive on surfaces for two to three weeks. You can pick up an infection simply by touching a contaminated surface and then touching your mouth. ### Who Is Most at Risk? Certain factors make pinworm infections more likely: - **Being a young child.** Pinworm infections most commonly affect children between the ages of 5 and 14. The microscopic eggs spread easily to family members, caregivers, and other children at school or childcare settings. - **Living in close quarters.** People living in group settings or institutions face a higher risk of pinworm infections. - **Living in a temperate climate.** While pinworms exist worldwide, they are more common in non-tropical climates. ### Can Pinworms Cause Serious Problems? The good news is that typical pinworm infections do not cause serious complications. In rare cases, however, heavy infestations may lead to: - **Genital infection in females.** In women and girls, the parasite can travel from the anal area into the vagina, uterus, fallopian tubes, and the surrounding pelvic region. This can cause conditions such as vaginal inflammation (vaginitis) or inflammation of the uterine lining (endometritis). - **Weight loss.** When large numbers of adult pinworms are living in the intestines, they can cause abdominal discomfort and compete for enough nutrients to result in weight loss. ### Testing & Diagnosis A doctor can confirm a pinworm infection by identifying the worms or their eggs under a microscope. You can help your doctor make the diagnosis at home using a simple "tape test." As soon as the person you suspect may be infected wakes up — before using the toilet, bathing, or getting dressed — press the sticky side of a piece of clear tape against the skin around the anus. The eggs will stick to the tape. For the most reliable results, repeat the tape test on three consecutive mornings, and then bring all three samples to your doctor. Your doctor will examine the tape under a microscope to check for pinworm eggs. ### Prevention: Breaking the Cycle The following steps can help prevent pinworm eggs from spreading — and reduce the risk of reinfection: - **Wash in the morning.** Since pinworms lay their eggs at night, washing the anal area each morning can significantly reduce the number of eggs on the body. Showering is preferable to bathing to avoid potential recontamination in bath water. - **Change underwear and bed linens daily.** Changing these items every day helps physically remove eggs before they can spread. - **Wash everything in hot water.** Bedsheets, nightclothes, underwear, washcloths, and towels should all be laundered in hot water to kill pinworm eggs. - **Resist the urge to scratch.** Scratching spreads eggs. Keep your child's fingernails trimmed short to minimize egg accumulation, and discourage nail biting. - **Clean toilet seats daily.** Wiping down toilet seats each day helps remove eggs that may have been deposited there. - **Wash hands thoroughly and often.** Wash hands carefully after bowel movements or diaper changes, and always before eating. This single step dramatically reduces the risk of spreading infection. > 📝 **NOTE:** The most common prescription anti-parasite medications for pinworms are Mebendazole and Albendazole (Albenza). Mild gastrointestinal side effects can occur during treatment. It is also common to need at least two rounds of medication to fully eliminate the infection. ---
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Care planPlantar FasciitisThe plantar fascia is a tough band of tissue — similar to a tendon — that runs along the entire bottom of your foot, connecting your heel to the bones at the ball of your foot. Think of it like a rubber band that creates the natural curve of your arch: a shorter band means a higher arch, while a longer band produces a flatter foot. A cushion of fat sits underneath your heel, acting as a natural shock absorber with every step you take. When the plantar fascia becomes damaged or irritated, it's one of the most common culprits behind heel pain. ## Understanding Plantar Fasciitis ### Why Does Your Heel Hurt? As we age, the plantar fascia gradually loses its elasticity — it stops behaving like a flexible rubber band and starts acting more like a stiff rope. At the same time, the fatty cushion under the heel thins out, making it less effective at absorbing the impact of walking. Together, these changes put extra stress on the plantar fascia, causing it to swell, develop small tears, or bruise. In fact, you may actually be able to see bruising or swelling on your heel. **Additional factors that raise your risk of developing plantar fasciitis include:** - Overweight and obesity - Diabetes - Spending most of the day on your feet - Becoming very active in a short period of time - Being flat-footed or having a high arch ### What's Really Driving the Modern Foot Pain Epidemic? The striking rise in foot and ankle injuries we are witnessing today is likely driven by the following factors: **Fitness —** Fitness has become a veritable religion amongst Baby Boomers who are much more physically active than their parents were. The increased stress and pounding on the feet, in the name of improved fitness and weight loss, has caused an increase in foot and ankle injuries and repetitive-stress related disorders. **Degenerative Disorders —** We are seeing an increase in degenerative disorders such as arthritis, neuropathies, peripheral vascular diseases, and chronic inflammation in its many forms. There are many contributing factors to problems like these, but one of the most important is the increased toxic load modern man is exposed to through poor diet and environmental influences. Exposure to poisonous compounds in our diet and environment lead to increased free radical formation (also known as oxidative stress), a weakened immune system, and may ultimately lead to the expression of genes that set the stage for degenerative illness. When the body is under constant assault this way, it becomes very difficult for it to repair itself efficiently. **Man-Made Surfaces —** Another important factor is the surfaces we walk around on. In mankind's infinite wisdom, we have covered the Earth with concrete and asphalt, created homes with hardwood floors or tile, and designed shoes that crowd the foot and hamper proper foot function. The end result is that the "ground reactive force" placed on the foot — the impact the foot must absorb during usual walking — is way beyond the physiologic capabilities inherent in its structure. The foot and ankle complex is a miracle of design and function, and if left to function on natural surfaces, would not be subjected to these abnormal stresses, which ultimately lead to pathology and pain. Our modern way of life does little to support our feet and much to damage them. ### Inflammation: The Fork in the Road Between Healing and Chronic Pain **One of the most common foot maladies people suffer from is plantar fasciitis.** This condition arises when undue stress is placed on the ligament in your foot that supports your arch — the plantar fascia. When that ligament is overworked, it leads to the classic symptoms of heel and arch pain which worsens when you get up to walk after periods of rest. Two million Americans suffer from plantar fasciitis every year, and 10 percent of the population will experience it in their lifetime. It has become recognized as one of the most chronic and, often times, most difficult foot problems to treat. When your plantar fascia is stressed — whether from improper exercise, a congenitally short ligament causing a "cavus deformity" or extremely high arch, or a tight calf muscle complex pulling it in the opposite direction — the cells in the ligament become more metabolically active and cellular damage occurs. When this happens, the immune system is recruited to help detoxify the cells and repair the injured ones via a cascading pathway known as **primary inflammation**. When this pathway is operating efficiently and is able to properly handle the extent of the injury, you will have no symptoms or they will be minor — some slight pain and swelling that diminishes rapidly within a few days as your injured ligament is repaired. When the stress placed on your foot exceeds what this pathway can manage, your immune system employs a different set of chemical responses: **chronic inflammation**. Chronic inflammation is designed to protect your tissues when they are under extreme stress, but when left unchecked it actually creates further damage and produces profound pain, swelling, heat, and other symptoms. The impact that inflammation has on the body is one of the most profound discoveries in modern medicine. Chronic inflammation can contribute to a host of chronic illnesses — from heart disease to diabetes and more. It is also the driving force in plantar fasciitis. Understanding inflammation this way is a fundamental shift away from the way most conventional podiatrists understand and treat plantar fasciitis. The most common treatment is cortisone, a powerful steroid that blocks ALL inflammation. While it relieves immediate symptoms, it ultimately inhibits the body's inherent mechanisms for healing itself. Cortisone is also "fibrolytic" — it can weaken fibrous tissue, including your plantar fascia — which is the last thing you want when you are trying to heal and strengthen your ligaments. ### Functional Influences: How You Use Your Foot Matters Perhaps few podiatrists take an integrative approach to foot problems like plantar fasciitis. Like most people, doctors typically think of the foot as somehow separate from the rest of the body — they focus on treating only the foot and don't look at the other physiological systems or diet and lifestyle factors that go into creating these problems in the first place. But your foot is connected to the rest of your body. If you want to heal your foot, you need to treat your whole body. Common problems that contribute to plantar fasciitis include: - Structural deformities - Repetitive stress injury - Muscular dysfunction - Positional deformities - Abnormal muscle sequencing - Improper or excessive exercise - Secondary muscular compensations You need to identify and address which of these issues is leading to problems with your plantar fascia. The treatment will depend on exactly what you are doing to injure your foot. Additional common interventions include: - Stretching exercises - Therapeutic exercises - Orthotic therapy - Yoga - Physical therapy The goal is to correct these biomechanical problems to the degree possible. Once this is accomplished, we can focus on healing the inflamed and injured tissue without fear of continued stress and injury. ---
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Care planPolycystic Kidney DiseaseHealthy kidneys act like a sophisticated filtration system — constantly cleaning your blood by removing waste products and extra fluid, which then leave your body as urine. **Chronic kidney disease (CKD)** is a condition in which the kidneys gradually lose their ability to do that job. When CKD reaches an advanced stage, dangerous amounts of fluid, electrolytes, and toxins can accumulate in your body with nowhere to go. In its early stages, CKD often causes no noticeable signs or symptoms. In fact, you may not realize anything is wrong until your kidney function has already been significantly compromised. Treatment for CKD is focused on slowing further damage to the kidneys — most often by getting the underlying cause under control. Left unchecked, CKD can advance to end-stage kidney failure, which is life-threatening without dialysis (a machine that filters your blood) or a kidney transplant. ## Understanding Chronic Kidney Disease ### Warning Signs Because CKD tends to develop slowly, warning signs usually emerge gradually as kidney function declines. Symptoms to watch for include: - Nausea - Vomiting - Loss of appetite - Fatigue and weakness - Sleep problems - Changes in how much you urinate - Decreased mental sharpness - Muscle twitches and cramps - Swelling of feet and ankles - Persistent itching - Chest pain, if fluid builds up around the lining of the heart - Shortness of breath, if fluid builds up in the lungs - High blood pressure (hypertension) that's difficult to control It's worth knowing that many of these symptoms are nonspecific — meaning they can also be caused by a wide range of other conditions. Making matters more complicated, the kidneys are remarkably resilient organs that can quietly compensate for lost function, which is why warning signs may not surface until serious, irreversible damage has already taken place. ### What Causes CKD? CKD develops when a disease or condition interferes with normal kidney function and causes damage that worsens over months or years. Common culprits include: - Type 1 or type 2 diabetes - High blood pressure - Glomerulonephritis, an inflammation of the kidney's filtering units (glomeruli) - Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures - Polycystic kidney disease - Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones, and some cancers - Vesicoureteral reflux, a condition that causes urine to back up into your kidneys - Recurrent kidney infection, also called pyelonephritis ### Who Is at Risk? Certain factors can raise your chances of developing CKD: - Diabetes - High blood pressure - Heart and blood vessel (cardiovascular) disease - Smoking - Obesity - Being African-American, Native American, or Asian-American - Family history of kidney disease - Abnormal kidney structure - Older age ### Potential Complications CKD doesn't stay confined to the kidneys — it can ripple outward and affect nearly every system in the body. Possible complications include: - Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema) - A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening - Heart and blood vessel (cardiovascular) disease - Weak bones and an increased risk of bone fractures - Anemia - Decreased sex drive, erectile dysfunction, or reduced fertility - Damage to your central nervous system, which can cause difficulty concentrating, personality changes, or seizures - Decreased immune response, which makes you more vulnerable to infection - Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium) - Pregnancy complications that carry risks for the mother and the developing fetus - Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival ### How to Protect Your Kidneys There are practical steps you can take to lower your risk of developing kidney disease: - **Follow instructions on over-the-counter medications.** When using nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others), and acetaminophen (Tylenol, others), follow the instructions on the package. Taking too many pain relievers could lead to kidney damage and generally should be avoided if you have kidney disease. Ask your doctor whether these drugs are safe for you. - **Maintain a healthy weight.** If you're at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk with your doctor about strategies for healthy weight loss. Often this involves increasing daily physical activity and reducing calories. - **Don't smoke.** Cigarette smoking can damage your kidneys and make existing kidney damage worse. If you're a smoker, talk to your doctor about strategies for quitting. Support groups, counseling, and medications can all help you to stop. - **Manage your medical conditions with your doctor's help.** If you have diseases or conditions that increase your risk of kidney disease, work with your doctor to control them. Ask your doctor about tests to look for signs of kidney damage. ---
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Care planPolycystic Ovary Syndrome (PCOS) | Ovarian CystsA cyst is a fluid-filled sac — and when one forms on an ovary, it's usually nothing to worry about. In most cases, ovarian cysts are harmless and disappear on their own. They're incredibly common; most women will have one at some point in their lives. Cysts are rarely cancerous in women under 50. They can sometimes cause discomfort, but often you won't even know one is there — many women discover a cyst during a routine pelvic exam. If you're in your childbearing years or past menopause, have no symptoms, and have a simple fluid-filled cyst, one completely reasonable option is to keep an eye on it over time rather than rushing into treatment. ## Understanding Ovarian Cysts ### Simple (Non-Polycystic) Ovarian Cysts Many of these cysts cause no symptoms at all. When they do cause symptoms, you might notice a sense of pressure, fullness, or heaviness in your lower abdomen, or discomfort when the area is pressed. Sudden, sharp pain is less typical and may point to a more urgent situation — such as a ruptured cyst, bleeding into the cyst, or the ovary twisting on itself (called ovarian torsion). Some women also experience spotting around ovulation or irregular bleeding between periods. Diagnostic workup may include: an endometrial biopsy (for women over 35); or a laparoscopic procedure for a closer look. ### Polycystic Ovarian Cysts Women with this type of cyst typically go through normal sexual development, but may notice excess hair growth (especially on the face), weight gain, irregular or absent periods, difficulty getting pregnant, and ovaries that are enlarged and dotted with multiple small cysts. Lab findings may show: elevated LH (luteinizing hormone) with normal FSH (follicle-stimulating hormone); high testosterone; elevated urine 17-ketosteroids; elevated androstenedione; and, in women over 35, an endometrial biopsy may be recommended. Luteal cysts may also be present. > ⚠️ **IMPORTANT NOTE:** Metabolic Syndrome — a cluster of conditions that raise the risk of heart disease and diabetes — is frequently seen alongside polycystic ovary syndrome. One of the more significant health conditions linked to ovarian cysts is polycystic ovarian syndrome (PCOS). Women with PCOS tend to have higher-than-normal levels of male hormones, irregular or absent periods, and small cysts on their ovaries. **Source:** [National Women's Health Information Center](https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome) ---
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Care planPolymyalgia RheumaticaPolymyalgia rheumatica is a condition that causes pain and stiffness in the muscles of your neck, shoulders, and hips. It is far more common in women than men, and almost always affects people over the age of 50. The hallmark symptom is stiffness after periods of rest. Other symptoms can include fever, weakness, and unintentional weight loss. For some people, the condition seems to appear overnight; for others, it develops gradually over time. Polymyalgia rheumatica sometimes occurs alongside a condition called giant cell arteritis — a form of blood vessel inflammation (vasculitis) in which the temporal arteries, which carry blood to your head and brain, become inflamed or damaged. You may also hear it referred to as cranial arteritis or temporal arteritis. Symptoms of giant cell arteritis include headaches and blurred vision. Doctors commonly prescribe a corticosteroid medication called prednisone to treat both conditions. Polymyalgia rheumatica generally responds well to treatment. Even without treatment, it tends to resolve on its own after a year or more — though leaving giant cell arteritis untreated carries a small but real risk of blindness or stroke. Temporal arteritis is an autoimmune disease in which your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body — become inflamed. It most commonly affects the large and medium-sized temporal arteries that run along both sides of your head. Under a microscope, the cells of these inflamed arteries appear unusually large, which is how temporal arteritis earned its other name: giant cell arteritis. This swelling slows blood flow through the affected arteries, giving rise to symptoms such as headaches and pain in your face and joints. When left untreated, the narrowing of these arteries can eventually lead to vision problems and permanent blindness. **Source:** *NIH: National Institute of Arthritis and Musculoskeletal and Skin Disease* --- ## Understanding Polymyalgia Rheumatica and Giant Cell Arteritis ### Who Gets Polymyalgia Rheumatica? - Women develop polymyalgia rheumatica more often than men. - It most often appears in women over the age of 50. - Giant cell arteritis affects both men and women who are over the age of 50. - Some people who develop giant cell arteritis also have polymyalgia rheumatica. - Polymyalgia rheumatica predominantly affects Caucasian women over the age of 50. Giant cell arteritis affects both men and women, usually over 50 years of age, who may or may not have polymyalgia rheumatica. ### What Causes These Conditions? The exact cause of polymyalgia rheumatica remains unknown, and there is no single definitive test to diagnose it. Your doctor will piece together the picture using your medical history, your symptoms, and a physical examination. Certain laboratory tests that look for signs of inflammation can help support the diagnosis. Temporal arteritis, giant cell arteritis, and cranial arteritis all refer to the same underlying process: one or more arteries becoming inflamed, swollen, and tender. Temporal arteritis most often affects arteries in the head — particularly the temporal arteries, which branch off from a major blood vessel in the neck called the carotid artery. That said, the condition can involve almost any medium-to-large artery anywhere in the body. The cause remains unclear, but researchers believe it is partly driven by a misfiring immune response. The condition has also been linked to severe infections and the use of high-dose antibiotics. Giant cell arteritis may develop alongside or shortly after polymyalgia rheumatica. It is almost exclusively seen in people over age 50, though rare cases in younger individuals have been reported. It is uncommon in people of African descent, and there is some evidence suggesting it can run in families. ### How Exercise Can Help Ease Stiffness and Pain Beyond medications, dietary changes, and nutritional support, incorporating moderate exercise into your routine can be a powerful tool for managing the stiffness and pain of this condition. Regular physical activity not only supports your overall health, but also helps maintain flexibility and build muscle strength — both of which help protect your joints over time. Activities like walking, bicycling, swimming, and certain types of gentle weight-bearing exercise are well-suited for people living with polymyalgia rheumatica (PMR). It is worth knowing that a lack of physical activity can contribute to bone loss and cause muscles to shrink and weaken over time. A physical therapist can create a customized exercise program tailored to your specific needs and limitations. > 📝 **NOTE:** Before starting an exercise program, always consult your physician. ### What to Expect Over Time PMR typically lasts 2–3 years. It may then go away for reasons unknown. However, some persons may have a longer course of PMR; a few have PMR for less than a year. Prednisone is used to suppress the inflammation and treat the symptoms but does not cure the illness (Matsen 2002). With treatment, most patients with PMR or giant cell arteritis do not have lasting disability. However, in giant cell arteritis, if one or both eyes develop blindness before treatment becomes effective, the blindness may be permanent. ### Putting It All Together The number of inflammatory-related diseases that could be successfully treated with cytokine-lowering therapy is staggering. Dietary supplements such as fish oil, DHEA, vitamin D, and vitamin K possess specific mechanisms of suppressing inflammatory cytokines. Those who continue to suffer from PMR or giant cell arteritis despite taking physician-recommended drugs, modifying diet, and using inflammation-suppressing supplements should initiate aggressive therapy. An inexpensive C-reactive protein (high-sensitivity) blood test (CRP-hs) can help reveal if you have systemic inflammation. If your CRP protein level is over 1.3 mg/L, this is an indication that you have an inflammatory reaction occurring in your body. Those with elevated CRP-hs levels (and who have a disease associated with chronic inflammation) should consider a nutritional support program designed to suppress pro-inflammatory cytokines. A CRP blood test may be done through your physician. Give attention to a healthy lifestyle. Participate in at least 30 minutes of some type of weight-bearing exercise (exercise involving swimming, bicycling, walking, or running) daily. Walking is probably more appropriate for persons with PMR. Maintain a healthy diet, including whole foods such as fruits and vegetables; cold water fish; probiotic cultures from food or supplements; limited refined sugar, caffeine, and alcohol; and plenty of water. Eat slowly and chew food well. Because systemic inflammation is an underlying driver of both PMR and giant cell arteritis, taking steps to interrupt the body's multiple inflammatory pathways makes good sense. Medications prescribed for PMR are often effective, but can carry significant side effects. Certain nutrients can help shield the body from some of the adverse effects of corticosteroid or NSAID drugs. Below, you will find the nutritional supplements that together form a comprehensive strategy for reducing the inflammation and pain of PMR and giant cell arteritis. ---
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Care planPost-Cancer Nutritional SupportWhy does what you eat and breathe matter so much when it comes to cancer? Because the foods you consume, the nutrients your body receives, the toxins you're exposed to, and how well your body clears those toxins are considered among the most important drivers of cancer development — and among the most powerful tools for prevention. According to the National Academy of Sciences, **at least 60% of all cancers in women and at least 40% of all cancers in men may be due to dietary and nutritional factors.** It has been estimated that **more than two-thirds of human cancers could be prevented through appropriate lifestyle modification.** Richard Doll and Richard Peto have reported that 10–70% (average 35%) of human cancer mortality is attributable to diet. According to Samuel Epstein, M.D., Professor of Occupational and Environmental Medicine at the University of Illinois School of Public Health: > *"Many cancer-causing pesticides and industrial chemicals found in the environment end up in the food we consume, the water we drink, and the air that we breathe, and tend to accumulate in fatty tissues, whether in fish, cattle, fowl, or people."* The good news? Diet, key nutrients, plant-based compounds, and a well-functioning detoxification system are also our strongest defenses against cancer — and they are factors largely within your control. **References:** - Doll R, Peto R. The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today. *J Natl Cancer Inst.* 1981;66:1191–1308. - Manson MM. Cancer prevention: The potential for diet to modulate molecular signalling. *Trends Mol Med.* 2003;9:11–18. - Manson MM et al. Blocking and suppressing mechanisms of chemoprevention by dietary constituents. *Toxicol Lett.* 2000;112–113:499–505. ---
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Care planPost-ColonoscopyA **colonoscopy** is a common screening procedure, typically performed under light sedation given by a nurse or deeper sedation provided by an anesthesiologist. It's used to look for potential problems inside the colon — things like polyps or colorectal cancer — before they become serious. During a colonoscopy, your doctor guides a long, flexible tube called a colonoscope into your rectum. A tiny camera at the tip of the tube lets the doctor see the full length of your colon in real time. If anything looks abnormal — like a polyp or unusual tissue — it can often be removed or sampled right then and there, during the same procedure. **What you eat and drink after your colonoscopy matters more than you might think. The preparation you went through beforehand is dehydrating, so restoring fluids and electrolytes to your body is essential.** (Consider **[Hydrate](https://nutridyn.com/dynamic-hydrate-2041)** — 1 scoop in 8 oz of water twice daily or as needed.) For the rest of the day of your procedure and the day after, plan to drink plenty of fluids and stick to soft, gentle foods that are easy on your digestive system and won't irritate your colon. Most people only need to follow these precautions for one day, but everyone recovers a little differently. If your stomach isn't ready to handle your usual diet right away, simply stay with soft and liquid-based foods for an extra day or two — there's no rush. **Research shows that the bowel-cleansing preparation used before a colonoscopy can have a lasting impact on the balance and health of your gut microbiome — the community of beneficial bacteria living in your digestive tract. In fact, approximately 20% of people experience uncomfortable abdominal symptoms after a colonoscopy, which may be linked to this disruption. Taking probiotics and prebiotics after your procedure may help restore a healthy, balanced gut microbiome.** (See research articles below.) **Sources:** - <https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569> - <https://www.healthline.com/health/what-to-eat-after-colonoscopy> - <https://pubmed.ncbi.nlm.nih.gov/27015015/> - <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483960/#:~:text=Other%20factors%2C%20including%20genetics%3B%20the,factors%20(2%E2%80%936).> ---
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Care planPosterior Vitreous Detachment (PVD)The human eye is a remarkable and complex organ. It's made up of several key parts, including: - **the lens,** the clear structure sitting just behind the iris - **the cornea,** the eye's protective outer surface - **the retina,** the light-sensing tissue that lines the back of the eye - **the vitreous body,** a clear, gel-like substance that fills the space between the lens and the retina **Microscopic fibers connect the vitreous body to the retina. Posterior vitreous detachment (PVD) happens when the vitreous shrinks and gradually pulls away from the retina.** PVD is very common and is a natural part of aging. It does not lead to vision loss, and in most cases, no treatment is needed. ## Understanding Posterior Vitreous Detachment ### What Causes PVD? The most common cause of PVD is simply getting older. As you age, the vitreous gel begins to shrink and become more watery — but the space it occupies between your lens and retina stays the same size. This mismatch makes it easier for the vitreous to pull away from the retina over time. The more the gel shrinks or condenses, the more likely it is to detach from the retina. Most people experience PVD after age 60, though it can occur earlier. It is less common in people under the age of 40. **Factors that may increase your risk of developing PVD at an earlier age include:** - Cataracts - Prior eye surgery - Diabetes - An eye injury - Nearsightedness PVD often affects both eyes. If you experience a vitreous detachment in one eye, there is a good chance you may eventually experience one in the other eye as well. --- ### What Are the Symptoms of PVD? PVD does not cause pain or permanent vision loss, but it can produce some noticeable visual symptoms, including: - **Flashes.** Brief flashes of light — similar to "seeing stars" after bumping your head — that can last a few seconds or minutes. These tend to become less frequent or stop altogether once the detachment is complete. - **Floaters.** Drifting specks, dots, or cobweb-like shadows in your field of vision. These typically appear during the first few weeks of PVD and are most noticeable when looking at a bright, light-colored background — like a white wall or an overcast sky. - **Cobweb effect.** As the vitreous separates from the retina, you may begin to see the outer edge of the gel, creating the sensation of looking through a cobweb. This is temporary and typically resolves once the detachment is complete. --- ### How Is PVD Diagnosed? Even though PVD is common, it is important to see a doctor promptly if you suddenly notice new floaters or flashes. These symptoms can be caused by PVD — but they can also signal a more serious condition, such as a retinal detachment. Your doctor will likely want to perform a diagnostic test to determine what is going on. A dilated eye examination is the standard way to confirm PVD, a retinal detachment, or another eye condition. During this exam, your eye doctor places special drops in your eyes to widen your pupils, allowing a thorough view of the back of your eye — including the retina, the macula, and the optic nerve. The examination takes about 30 minutes. It may take a few hours for the dilation to fully wear off, so bring a pair of sunglasses to your appointment, as your eyes will be more sensitive to light afterward. ### Are There Other Tests? In some cases, additional testing may be needed to confirm the diagnosis. If your vitreous gel is exceptionally clear, a detachment can be difficult to see directly. In these situations, your doctor may use optical coherence tomography (OCT) or an ocular ultrasound to get a clearer picture. OCT uses light waves to create a detailed, three-dimensional image of your eye, while an ocular ultrasound uses high-frequency sound waves to produce a similar picture. --- ### How Is PVD Treated? In most cases, PVD does not require any treatment. Complete detachment typically takes no longer than three months. If floaters persist after the detachment is complete, talk with your doctor about your options. Floaters and flashes usually improve within 3 months, but your doctor will likely recommend a follow-up dilated eye exam 3 months after your diagnosis to make sure no new damage has occurred to your retina. If floaters remain bothersome after several months, your doctor may discuss options such as using a laser to reduce their size or surgically removing the vitreous gel to clear them. If a retinal tear is found, it can typically be repaired with laser surgery or cryopexy, a procedure that uses freezing to seal the tear. Further treatment may be needed if any of the following complications arise: - **Persistent floaters.** If you have a large number of floaters or are having trouble seeing clearly, your doctor may recommend a vitrectomy — an outpatient procedure in which some or all of the vitreous gel is removed from the eye. - **Retinal tears.** If the vitreous fibers pull too forcefully on the retina, the underlying tissue can tear. If fluid seeps beneath the retina through the tear, a retinal detachment can occur. Left untreated, this can lead to vision loss. Both retinal tears and detachments can be repaired with surgery. - **Macular holes.** These occur when the vitreous is firmly attached to the retina as it pulls away, creating a small hole in the macula. Macular holes can cause distorted or blurry central vision. Some close on their own, but surgery is available for those that do not. Some eye doctors recommend avoiding high-impact exercise during the first six weeks after PVD begins. During this time, the vitreous may not have fully detached from the retina, and the risk of a retinal detachment may be higher. --- ### When Should You See a Doctor? As a general rule, contact your doctor right away if you notice any sudden change in your vision — especially a new onset of flashes or floaters. These could be signs of PVD, retinal detachment, or another eye condition that requires prompt attention. --- ### The Bottom Line PVD is a common, age-related eye condition that usually does not require treatment. That said, do not try to diagnose yourself if you notice eye or vision changes. The symptoms of PVD can look very similar to those of more serious eye disorders, so it is always best to see an eye doctor for a proper evaluation and diagnosis. Be sure to schedule a routine eye exam every year. Regular check-ups are one of the best ways to catch and address eye and vision problems early — before they have a chance to progress. **Sources:** - <https://www.healthline.com/health/eye-health/posterior-vitreous-detachment#takeaway> - <https://www.webmd.com/eye-health/posterior-vitreous-detachment-facts> - <https://www.rnib.org.uk/eye-health/eye-conditions/posterior-vitreous-detachment> ---
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Care planPostpartum DepressionPostpartum depression (PPD) is a form of depression that can develop after having a baby. It can begin at any point during your baby's first year of life, but it most commonly appears within the first 3 weeks after giving birth. If you have postpartum depression, you may feel overwhelming sadness, hopelessness, or guilt — and you might struggle with the desire to bond with or care for your baby. Importantly, PPD doesn't only happen with a first baby. You can develop it even if you never experienced it after a previous pregnancy. ## Understanding Postpartum Depression ### Why Does Postpartum Depression Happen? There are several known contributors, including: - **Hormonal shifts.** Hormone levels rise significantly during pregnancy and then drop sharply after delivery. This sudden change can trigger depression in some women. (If you've ever felt moody or emotional in the days before your period, you already know firsthand how powerfully hormones can affect your mood.) - **Personal or family history of depression.** If you've experienced depression before — or if it runs in your family — your risk of developing postpartum depression is higher. - **Life stress and lack of support.** An unplanned pregnancy, a partner or family who isn't involved in caring for the baby, financial hardship, substance use issues, or other major stressors can all increase your risk of depression as a new mother. - **Being very young** and feeling unprepared — emotionally, practically, or financially — to care for a baby also raises your risk. ### Recognizing the Signs Every woman's experience is different, but these are some of the most common symptoms to be aware of: - Persistent sadness, hopelessness, or despair - Feeling unable to care for your baby or manage everyday tasks - Frequent crying, sometimes without a clear reason - Difficulty feeling emotionally close to or bonded with your baby - Loss of interest in food, sex, self-care, or activities you once enjoyed - Sleeping too much - Difficulty concentrating, learning new things, or remembering ### Getting a Diagnosis and Finding the Right Treatment Only a doctor can officially diagnose postpartum depression — but if you suspect you may have it, don't wait. Make an appointment as soon as possible. The good news is that effective treatments exist that can help you feel like yourself again. **Medication.** Your doctor may recommend antidepressants, which work by helping to rebalance certain brain chemicals associated with depression. Most are considered safe to take while breastfeeding. Your doctor may also discuss brexanolone (Zulresso), a newer medication that is a synthetic form of the hormone allopregnanolone and is specifically designed to treat postpartum depression. Be sure to let your doctor know if you are nursing. **Counseling.** Working with a psychologist or therapist can be enormously helpful. You'll learn to identify negative thought patterns and develop healthier ways to respond to them. Therapy can also be a safe space to explore past relationships or stressors — and to work through them so they have less power over your life today. ### What Else Can Help? Alongside professional treatment, there are everyday steps you can take to support your own recovery and well-being: - Eat a nutritious diet with adequate, clean protein - Move your body every day with some form of exercise - Make space for at least one enjoyable activity each day - Set small, achievable goals for yourself - Prioritize rest and relaxation - Lean on people who love and support you **Source:** <https://www.webmd.com/depression/postpartum-depression/understanding-postpartum-depression-basics#1> ---
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Care planPost-Stroke Nutritional SupportWith all types of strokes, one or more areas of the brain can be damaged. Depending on which area is affected, a person may lose the ability to move one side of the body, the ability to speak, or a number of other functions. The damage may be temporary or permanent, and function may be partially or completely lost. A person's long-term outlook depends on how much of the brain was damaged, how quickly treatment begins, and a number of other factors. ---
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Care planPost-Traumatic Stress Disorder (PTSD)Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after living through or witnessing a shocking, terrifying, or life-threatening event. It is completely natural to feel frightened both during and after a traumatic experience. Fear sets off a cascade of rapid changes in the body designed to help protect you from danger — the well-known "fight-or-flight" response. Nearly everyone goes through a range of emotional and physical reactions following trauma, and most people heal naturally over time. Those whose symptoms persist and interfere with daily life may be diagnosed with PTSD. People living with PTSD often feel on edge or afraid even when no real danger is present. ## Understanding PTSD ### Recognizing the Signs and Symptoms While many — but not all — people who experience trauma have short-term symptoms, most do not go on to develop lasting (chronic) PTSD. Not every case of PTSD stems from a life-threatening event; the sudden, unexpected death of a loved one, for example, can also trigger the condition. Symptoms typically appear within 3 months of the traumatic event, though in some cases they may not surface for years. To qualify as PTSD, symptoms must persist for more than a month and be severe enough to disrupt relationships or work. Recovery looks different for everyone — some people improve within 6 months, while others struggle with symptoms for much longer, and in some cases the condition becomes chronic. PTSD is diagnosed by a mental health professional with experience in trauma-related conditions, such as a psychiatrist or psychologist. To be diagnosed with PTSD, an adult must experience all of the following for at least 1 month: - At least one re-experiencing symptom - At least one avoidance symptom - At least two arousal and reactivity symptoms - At least two cognition and mood symptoms **Re-experiencing symptoms include:** - Flashbacks — reliving the trauma over and over, often accompanied by physical sensations like a racing heart or sweating - Disturbing or frightening dreams - Intrusive, frightening thoughts Re-experiencing symptoms can disrupt everyday life and may be set off by a person's own thoughts and feelings, or by words, objects, or situations that serve as reminders of the traumatic event. **Avoidance symptoms include:** - Staying away from places, events, or objects that are reminders of the traumatic experience - Avoiding thoughts or feelings connected to the traumatic event Reminders of the trauma can set off avoidance symptoms, sometimes causing significant changes to a person's daily routines. For example, someone involved in a serious car accident may begin avoiding driving or even riding in a car. **Arousal and reactivity symptoms include:** - Being easily startled - Feeling tense or constantly "on edge" - Difficulty sleeping - Angry outbursts Unlike other PTSD symptoms, arousal symptoms tend to be persistent rather than triggered by specific reminders. They can make a person feel chronically stressed and irritable, and interfere with basic daily activities like sleeping, eating, and concentrating. **Cognition and mood symptoms include:** - Difficulty remembering important details of the traumatic event - Persistent negative thoughts about oneself or the world - Distorted feelings such as guilt or self-blame - Loss of interest in activities that were once enjoyable Cognition and mood symptoms may appear or intensify after the traumatic event and are not caused by injury or substance use. They can make a person feel detached or cut off from friends and family. It is normal to experience some of these symptoms for a few weeks after a traumatic event. When symptoms last longer than a month, significantly impair daily functioning, and cannot be attributed to substance use, a medical condition, or anything other than the traumatic event itself, PTSD may be the cause. Some people with PTSD have no symptoms at all for weeks or even months after the trauma. PTSD also commonly occurs alongside depression, substance use disorders, or other anxiety conditions. ### Do Children Experience PTSD Differently Than Adults? Children and teenagers can have intense reactions to trauma, but their symptoms may look quite different from those seen in adults. In very young children (under 6 years old), symptoms can include: - Bedwetting after having already been toilet-trained - Forgetting how to speak or losing the ability to talk - Re-enacting the frightening event during play - Becoming unusually clingy with a parent or trusted adult Older children and teenagers are more likely to show symptoms that resemble those seen in adults. They may also display disruptive, disrespectful, or destructive behaviors. Some older children and teens carry feelings of guilt about being unable to prevent injury or loss, and some may harbor thoughts of revenge. ### Who Is at Risk? PTSD can affect anyone at any age — combat veterans, children, and people who have survived physical or sexual assault, abuse, accidents, natural disasters, or other traumatic events. According to the National Center for PTSD, approximately 7 or 8 out of every 100 people will develop PTSD at some point in their lives. Women are more likely than men to develop PTSD, and genetics may play a role in individual susceptibility. It is worth noting that not everyone with PTSD directly experienced the traumatic event. Some people develop the condition after a close friend or family member is harmed or endangered. The sudden, unexpected death of a loved one can also lead to PTSD. ### Why Do Some People Develop PTSD and Others Do Not? It is important to understand that most people who live through a dangerous or traumatic event do not develop PTSD. Whether or not a person develops PTSD depends on many interacting factors. Some of these are "risk factors" — things that make PTSD more likely — while others are "resilience factors" — things that may help protect against it. Factors that may increase the risk of developing PTSD include: - Living through dangerous events or traumas - Being physically injured - Witnessing another person being hurt, or seeing a dead body - A history of childhood trauma - Experiencing intense horror, helplessness, or fear during the event - Having little or no social support in the aftermath - Facing additional stressors after the event, such as the loss of a loved one, pain or injury, or loss of a job or home - A personal history of mental illness or substance use Factors that may support healing and recovery after trauma include: - Reaching out to trusted friends and family for support - Connecting with a support group after the traumatic event - Feeling confident and positive about one's own actions in the face of danger - Having a healthy coping strategy — a constructive way to work through the experience and find meaning in it - Being able to act and respond effectively even when feeling afraid Researchers continue to investigate these and other risk and resilience factors, including the roles of genetics and brain biology. With continued advances in research, it may one day be possible to predict who is at greatest risk for PTSD — and to prevent it. ### Treatment Options The primary treatments for PTSD are medications, psychotherapy ("talk therapy"), or a combination of both. Because PTSD affects everyone differently, what works well for one person may not work as well for another. It is important for anyone with PTSD to work with a mental health provider who has specific experience treating trauma. Some people may need to explore more than one treatment approach before finding the right fit. If someone with PTSD is also navigating an ongoing traumatic situation — such as an abusive relationship — both issues need to be addressed together. Other conditions that often accompany PTSD include panic disorder, depression, substance use, and thoughts of self-harm. **Medications** The most thoroughly studied medications for PTSD are antidepressants, which can help manage symptoms such as sadness, worry, anger, and emotional numbness. Other medications may be useful for targeting specific PTSD symptoms, including sleep disturbances and nightmares. You and your doctor can work together to find the most effective medication or combination of medications, as well as the right dosage. Check the U.S. Food and Drug Administration website for the latest information on patient medication guides, warnings, or newly approved medications. **Psychotherapy** Psychotherapy — often called "talk therapy" — involves working with a trained mental health professional to address and treat a mental health condition. It can take place one-on-one or in a group setting. Talk therapy for PTSD typically lasts 6 to 12 weeks, though it may continue longer. Research consistently shows that support from family and friends plays an important role in recovery. Several types of psychotherapy can be helpful for people with PTSD. Some focus directly on PTSD symptoms, while others address broader challenges in relationships, family dynamics, or the workplace. A therapist may blend different approaches depending on what a person needs most. The most effective psychotherapy approaches share several key elements: education about PTSD symptoms, skills to identify what triggers those symptoms, and practical tools to manage them. One especially well-supported form of treatment is cognitive behavioral therapy (CBT), which can include: - **Exposure therapy.** This helps people gradually confront and work through their fear in a safe, controlled way. By carefully revisiting the traumatic experience — through imagination, writing, or even returning to the place where it occurred — the therapist helps a person with PTSD process and cope with their feelings over time. - **Cognitive restructuring.** This helps people reframe how they think about the traumatic event. Sometimes memories of trauma become distorted, and people may carry guilt or shame over things that were not their fault. A therapist guides people with PTSD toward a more accurate and compassionate understanding of what happened. Other forms of therapy can also be beneficial. People with PTSD are encouraged to discuss all available treatment options with their provider. Ultimately, the goal of treatment is to equip individuals with the skills to manage their symptoms and to help them re-engage with the activities and relationships they valued before PTSD. ### How Talk Therapy Helps People Overcome PTSD Talk therapies work by teaching people healthier, more empowered ways to respond to the distressing events that trigger PTSD symptoms. Depending on the approach, therapy may: - Provide education about trauma and how it affects the mind and body - Build relaxation and anger-management skills - Offer practical guidance on improving sleep, nutrition, and physical activity - Help people recognize and work through feelings of guilt, shame, and other emotions tied to the traumatic event - Support people in gradually facing — rather than avoiding — the reminders of their trauma **Source:** <https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd> ---
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Care planPostural Orthostatic Tachycardia Syndrome (POTS)**Postural Orthostatic Tachycardia Syndrome (POTS)** is a circulation disorder that affects blood flow. POTS causes symptoms — most commonly lightheadedness, fainting, and a sudden, uncomfortable racing heartbeat — that are triggered by standing up from a lying position and that typically improve when you sit or lie back down. POTS involves two key parts of your nervous system: the **autonomic nervous system** (which automatically controls vital body functions like breathing and heart rate) and the **sympathetic nervous system** (which triggers your body's "fight or flight" response). POTS is a type of **orthostatic intolerance** — a condition in which symptoms appear when you stand up from a lying or reclining position, and often ease when you sit or lie back down. Normally, your heart rate and blood pressure work in tandem to keep blood moving steadily throughout your body, regardless of how you're positioned. In people with POTS, this teamwork breaks down — the blood vessels and heart can't coordinate properly, making it impossible to keep blood pressure stable. No two cases of POTS are exactly alike. Symptoms may come and go over the course of years. For most people, a combination of dietary changes, medications, and physical activity leads to meaningful improvement in quality of life. Symptoms may also improve significantly if an underlying cause is identified and treated. ## Understanding POTS ### The Most Common Forms of POTS - **Neuropathic POTS:** Damage to the peripheral nerves (the nerves that supply your blood vessels) leads to weakened blood vessel muscles, particularly in the legs and core. - **Hyperadrenergic POTS:** The sympathetic ("fight or flight") nervous system becomes overactive. - **Low blood volume POTS:** A reduced amount of blood circulating through the body can trigger POTS. The symptoms of low blood volume can overlap with those of neuropathic and hyperadrenergic POTS. ### Who Is Most Likely to Develop POTS? The majority of people with POTS are women between the ages of 13 and 50. An estimated 1 to 3 million Americans are living with POTS. - POTS can develop after a viral illness, serious infection, medical illness, pregnancy, or a physical trauma such as a head injury. It may also emerge following a significant illness — especially one that required hospitalization or prolonged bed rest. - POTS may develop in people who have recently had mononucleosis ("mono"). - Certain autoimmune conditions — such as Sjögren's syndrome and celiac disease — may increase your risk of developing POTS. Sjögren's syndrome can be evaluated through blood tests, a dry eye test, a lip biopsy, and a consultation with a rheumatologist. Celiac disease can be assessed through blood tests, a gastroenterology consultation, and, if necessary, biopsies of the small intestine. ### What Does POTS Feel Like? Recognizing the Symptoms POTS symptoms can be deeply uncomfortable and even frightening. Most people with POTS experience two or more of the symptoms listed below — though not everyone will have all of them. - High blood pressure / low blood pressure - High / low heart rate; racing heart rate - Chest pain - Dizziness or lightheadedness, especially when standing up, standing in one place for a long time, or walking long distances - Fainting or near-fainting - Exhaustion and fatigue - Abdominal pain, bloating, and nausea - Difficulty regulating body temperature (feeling too hot or too cold) - A nervous or jittery feeling - Forgetfulness and difficulty concentrating (commonly called "brain fog") - Blurred vision - Headaches and body pain or achiness (sometimes resembling flu-like symptoms); neck pain - Trouble falling or staying asleep, chest pain and racing heart rate during sleep, and excessive sweating - Shakiness or tremors, especially during adrenaline surges - Discoloration of the feet and hands - Difficulty exercising (exercise intolerance) - Excessive sweating or, conversely, an inability to sweat - Diarrhea and/or constipation ### How Is POTS Diagnosed? POTS can be challenging to diagnose because its many symptoms can mimic other conditions and tend to accumulate gradually over time. Before receiving a POTS diagnosis, many patients see numerous doctors and specialists. It is not uncommon for people with POTS to live with symptoms for months — or even years — before finally getting answers. The gold standard for diagnosing POTS is the **tilt table test**, which carefully measures changes in your heart rate and blood pressure as your body is moved from a lying to an upright position. In addition to the tilt table test, your doctor may order: - Blood and urine tests to identify the underlying cause of POTS or to rule out conditions that look similar to POTS - QSART (a specialized test that measures how well the autonomic nerves controlling your sweat glands are working) - An autonomic breathing test (to assess how your heart rate and blood pressure respond during exertion) - TST (tuberculin skin test) - Skin nerve biopsy - Echocardiogram (an ultrasound of the heart) - Blood volume and hemodynamic studies ### How Is POTS Treated? - Medications such as salt tablets, fludrocortisone, pyridostigmine, midodrine, and/or a beta blocker may be prescribed to help manage POTS symptoms. - Thigh-high medical compression stockings may be recommended. These stockings help push blood upward from the legs, reducing POTS symptoms. - You should obtain a blood pressure monitor to track your blood pressure and pulse at home. These devices are available at most pharmacies, online, or at medical supply stores. Be sure to have your home monitor's readings verified against your doctor's readings to confirm accuracy. - Even though the heart is structurally healthy in most people with POTS, you may be evaluated for a cardiac rehabilitation (cardiac rehab) program. This structured exercise approach uses the cardiac rehab model to help recondition the body, improve overall health, and better control POTS symptoms. In fact, some of the strongest evidence for treating POTS comes from cardiac rehab programs. **Source:** <https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots> **References:** - National Institutes of Health. NINDS POTS. Accessed 1/20/2021. - Dysautonomia International. General Information Brochure on Orthostatic Intolerance and its Treatment. Accessed 1/20/2021. - NHS. Postural Tachycardia Syndrome PoTS. Accessed 1/20/2021. ---
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Care planPost-Viral Fatigue SyndromeMillions of people have found themselves still feeling sick long after the acute phase of a COVID-19 infection has passed. The lingering symptoms — brain fog, shortness of breath, chronic cough, muscle and joint pain, and relentless fatigue — have come to define what many are now calling "Long COVID" or "The Long Haul." *Science* magazine brought this struggle into the spotlight in their August 7, 2020 issue, with a sub-headline that captured the moment perfectly: "Some COVID-19 survivors are still sick months later. Doctors want to learn why and what they can do." Viruses like SARS-CoV-2 are remarkably skilled at hijacking the inner workings of our cells, bending the cellular environment to favor their own survival and replication. Among the most vulnerable targets is the mitochondria — the intricate, interconnected network of structures that power our cells. When mitochondria are disrupted by a viral infection, the consequences can be far-reaching, and in some people, this disruption appears to contribute to a puzzling, persistent illness known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Strikingly, a study of patients who remained ill six months after a mild or moderate COVID-19 infection found that roughly half met the criteria for ME/CFS. This protocol draws on a presentation by Dr. Jeffrey Bland of the Personalized Lifestyle Medicine Institute on immune rejuvenation and its role in conditions rooted in chronic immune dysfunction — including Long COVID — as well as research shared by Dr. Rick Mayfield at the 2022 Great Lakes Conference. Together, Drs. Bland and Mayfield outlined a thoughtful, functional medicine approach to addressing Long COVID symptoms that centers on the following key areas. > ⚠️ **IMPORTANT NOTE:** Based on clinical experience, the **two most foundational areas to address in any general nutritional support plan for Long COVID recovery** are restoring gut health and supporting mitochondrial health. ## Understanding Long COVID ### Restoring Gut Health > *"Conclusion: This study demonstrated the presence of long COVID-19 which correlates with gut microbiota dysbiosis in recovered patients at one-year after discharge, **indicating gut microbiota may play an important role in long COVID-19.**"* According to research performed by Siew Ng, MBBS, PhD, associate director at Chinese University of Hong Kong, Center for Gut Microbiota Research: "To our knowledge, this is the first study to show that **altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus.**" > *"Gut microbiota influences the health of the host. It provides crucial benefits in the form of immune system development, prevention of infections, nutrient acquisition, and brain and nervous system functionality. Considering the millions of people infected during the ongoing pandemic, **our findings are a strong impetus for consideration of microbiota modulation to facilitate timely recovery and reduce the burden of post–acute COVID-19 syndrome.**"* > > — Siew Ng, MBBS, PhD **References:** - *J Korean Med Sci.* 2023 Apr 17; 38(15): e120. Published online 2023 Apr 5. doi:10.3346/jkms.2023.38.e120. PMCID: PMC10111044. PMID: 37069814. Gut Microbiota Dysbiosis Correlates With Long COVID-19 at One-Year After Discharge. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111044/> - <https://www.med.cuhk.edu.hk/press-releases/cu-medicine-study-shows-distinct-gut-microbial-profile-associated-with-long-covid> ### Supporting Mitochondrial Health > *"**One of the underlying mechanisms of long COVID may be mitochondrial dysfunction.** Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can alter the mitochondria responsible for energy production in cells. This alteration leads to mitochondrial dysfunction which, in turn, increases oxidative stress. Ultimately, this results in a loss of mitochondrial integrity and cell death. Moreover, **viral proteins can bind to mitochondrial complexes, disrupting mitochondrial function and causing the immune cells to over-react**. This over-reaction leads to inflammation and potentially long COVID symptoms. It is important to note that the roles of mitochondrial damage and inflammatory responses caused by SARS-CoV-2 in the development of long COVID are still being elucidated. **Targeting mitochondrial function may provide promising new clinical approaches for long-COVID patients.**"* **Reference:** *Int J Mol Sci.* 2023 May; 24(9): 8034. Published online 2023 Apr 28. doi:10.3390/ijms24098034. PMCID: PMC10179190. PMID: 37175745. Possible Pathogenesis and Prevention of Long COVID: SARS-CoV-2-Induced Mitochondrial Disorder. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179190/> > 📝 **NOTE:** Long COVID is an emerging syndrome that affects 50% to 70% of COVID-19 survivors. Low vitamin D levels have been linked to a greater likelihood of needing mechanical ventilation and poorer survival in hospitalized COVID-19 patients. Additionally, COVID-19 patients with low vitamin D levels are more likely to go on to develop Long COVID. **Reference:** *The Journal of Clinical Endocrinology & Metabolism*, dgad207. <https://doi.org/10.1210/clinem/dgad207> <https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgad207/7116659?login=false> ---
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Care planPrader-Willi Syndrome (PWS)Prader-Willi syndrome (PWS) is the most common form of human genetic obesity, caused by mutations in the paternal genes on chromosome 15q11.2–q13. **PWS is a rare, complex condition that affects many parts of the body. It is a genetic disorder caused by the loss of function of specific genes on chromosome 15. It can cause physical problems — like extreme hunger and weak muscles — as well as mild to moderate intellectual impairment and behavioral challenges. There is no cure. Medical care focuses on a healthy diet and regular exercise.** Prader-Willi syndrome is frequently associated with a constant, extreme, relentless hunger that persists no matter how much the patient eats, often leading to severe obesity. **Caregivers need to strictly limit the patients' access to food**, usually by installing locks on refrigerators and on all closets and cabinets where food is stored. It is the most common genetic cause of severe obesity in children and type 2 diabetes. Managing body weight in children with PWS has proven to be extraordinarily difficult. These children tend to have low muscle tone, which leads to less physical activity than usual, along with a chronic and uncontrollable sense of hunger and a profound inability to feel full — all of which drives their constant food-seeking behavior. Research has shown that a diet rich in non-digestible carbohydrates can shift the imbalanced gut microbial community toward a healthier profile — with relatively fewer bacteria that produce potentially harmful byproducts from digesting fats and proteins, and more bacteria that produce beneficial compounds from fermenting carbohydrates. According to a [2015 study](https://doi.org/10.1016/j.ebiom.2015.07.007) published in *EBioMedicine*, reshaping the gut microbiome through diet helped ease metabolic problems in both PWS and simple obesity groups — suggesting that an unhealthy gut microbial community may play a shared role in driving disease progression, whether obesity is genetically driven or simply diet-related. **In other words, using diet to reshape the gut microbiome may become a powerful and promising strategy for managing metabolic disease.** **Reference:** *EBioMedicine.* 2015 Aug; 2(8): 968–984. Published online 2015 Jul 10. doi: 10.1016/j.ebiom.2015.07.007. PMCID: PMC4563136. Dietary Modulation of Gut Microbiota Contributes to Alleviation of Both Genetic and Simple Obesity in Children. When it comes to supporting the brain and nervous system in PWS, there is still much we don't know. **The primary focus in managing this condition appears to be (supervised) dietary control — both quality and calories — along with gut health support (the microbiome) and foundational nutrition.** Neurological support may — and this remains an open question — begin with the basics: B6, B12, folate, and DHA. **Given how complex this condition is, and that it so often involves children, no dietary supplements should be introduced without the express approval of the entire clinical care team, including the geneticist.** > *"...The neuropathologic abnormalities associated with Prader-Willi syndrome (PWS) are largely unknown... Intracranial abnormalities in individuals with PWS included ventriculomegaly (100% of individuals), decreased volume of brain tissue in the parietal-occipital lobe (50%), sylvian fissure polymicrogyria (60%), and incomplete insular closure (65%)...The specific mechanisms underlying these neuropathological abnormalities and their correlation with the clinical phenotype remain to be elucidated…"* > > **Reference:** *Am J Med Genet A.* 2007 Mar 1;143A(5):476–83. Intracranial abnormalities detected by three-dimensional magnetic resonance imaging in Prader-Willi syndrome. Miller et al. ---
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Care planPrebiotics> *"The link between the microbiome and human health is so pervasive that there are few conditions that are out of the realm of possibility. It really is a frontier.* > > *Not that the microbiome causes everything, but by understanding and manipulating the microbiome, we could at least palliate, or slow down, particular pathologic processes.* > > *For all the major causes of death in the United States — cardiovascular disease, cancer, dementia and neurodegenerative diseases, diabetes, and lung, liver, and kidney diseases — there is ongoing investigation of the microbiome. A greater promise would be to prevent or cure these illnesses."* > > **— Martin J. Blaser, MD**, Henry Rutgers Chair of the Human Microbiome; Director, Center for Advanced Biotechnology and Medicine, Rutgers University > > **Source:** <https://www.medscape.com/viewarticle/where-microbiome-revolution-headed-next-2023a1000vz1?ecd=WNL_mdpls_231222_mscpedit_wir_etid6179755&uac=149193PV&spon=17&impID=6179755> --- ## Understanding Prebiotics To put it simply, probiotics are the beneficial, "good" bacteria that live in your gut — collectively known as the gut flora, or gut microbiota — and they perform many vital functions throughout your body. **Prebiotics are essentially food for these bacteria.** These prebiotic substances come from types of carbohydrates (mostly fiber) that your body cannot digest on its own. Instead, your beneficial gut bacteria consume this fiber as their primary fuel source. **Prebiotics** (first identified and named by Marcel Roberfroid in 1995) are substances that encourage the growth or activity of microorganisms — such as bacteria and fungi — that contribute to their host's well-being. The most familiar example is in the gastrointestinal tract, where prebiotics can shift the makeup of the gut microbiome. In terms of diet, prebiotics are typically non-digestible, fiber-based compounds that travel through the upper digestive tract undigested and then stimulate the growth or activity of beneficial bacteria in the large intestine by serving as a fuel source for them. Researchers have found that prebiotics are valuable for increasing the populations of helpful bacteria already present in the gut — bacteria that reduce disease risk and support general well-being. [Florowska 2016] Unlike probiotic bacteria, prebiotic fiber is remarkably resilient: it is not broken down by heat, stomach acid, or time, and the fermentation process it undergoes does not vary significantly from person to person. The scientific literature indicates that increasing your prebiotic fiber intake supports immunity, digestive health, bone density, regularity, weight management, and brain health. > *"...prebiotic fibers are required to maximize the health benefits of the microbiome / microbiota (probiotic colonization)..."* What most people overlook — or simply do not realize — is that what we eat is absolutely critical to supplying the prebiotic building blocks needed to maintain a healthy microbiome (through a clean, whole-food, plant-based diet). This is explained in greater depth in the article below, titled ***"Enhancing the Microbiome Through Diet, Sleep, and Exercise"*** by David A. Johnson, MD. **Prebiotics are non-digestible fibers that nourish beneficial gut bacteria, helping to cultivate a healthy microbiome.** Their primary roles in health include: 1. **Gut Health**: Prebiotics stimulate the growth of beneficial bacteria like *Bifidobacteria* and *Lactobacilli*, improving digestion and keeping harmful bacteria in check. 2. **Immune Support**: By nurturing a balanced microbiome, prebiotics strengthen immune function and help reduce the risk of infections and inflammation. 3. **Improved Digestion**: They help regulate bowel movements, easing constipation and improving the body's ability to absorb nutrients. 4. **Mental Health**: Emerging research points to a meaningful connection between gut health and brain function, suggesting that prebiotics may help improve mood and cognitive performance. 5. **Metabolic Health**: Prebiotics may support healthier weight management, lower the risk of diabetes, and help reduce cholesterol levels. In short, prebiotics support gut health, immunity, digestion, mental well-being, and metabolic balance — all at once. ### How Does What You Eat Affect Your Gut Bacteria? The foods you eat play a decisive role in maintaining the balance between beneficial and harmful gut bacteria. For example, a diet high in sugar and fat can negatively disrupt your gut bacteria and may contribute to insulin resistance and a range of other health conditions. When you consistently feed the wrong bacteria, they are able to multiply faster and take hold more easily — especially when there aren't enough beneficial bacteria to keep them in check. An overgrowth of harmful bacteria and unhealthy gut flora has also been linked to higher body mass index (BMI). Additionally, foods treated with pesticides may have negative effects on gut bacteria, though more research is needed to fully understand this relationship. Studies have also shown that antibiotics can cause lasting changes to certain types of bacteria — particularly when taken during childhood and adolescence. Because antibiotic use is so widespread, researchers are now actively studying how this may lead to health consequences later in life. ---
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Care planPreeclampsiaPreeclampsia is a serious pregnancy complication marked by high blood pressure and signs of damage to one or more organ systems — most commonly the liver and kidneys. It typically appears after 20 weeks of pregnancy in women whose blood pressure had previously been normal. Without treatment, preeclampsia can lead to life-threatening complications for both you and your baby. The most effective way to treat preeclampsia is to deliver your baby — but even after delivery, recovery can take time. When preeclampsia is diagnosed too early in pregnancy for safe delivery, you and your doctor face a difficult balancing act: your baby needs more time to grow and mature, yet waiting too long puts both of you at risk for serious complications. In rare cases, preeclampsia develops after delivery — a condition called postpartum preeclampsia. ## Understanding Preeclampsia ### Recognizing the Symptoms Preeclampsia doesn't always announce itself with obvious warning signs. Blood pressure may rise gradually or spike suddenly — and since elevated blood pressure is often the first clue, keeping up with your prenatal appointments is essential. A blood pressure reading above 140/90 millimeters of mercury (mm Hg) on two separate occasions at least four hours apart is considered abnormal during pregnancy. Other signs and symptoms of preeclampsia may include: - Excess protein in your urine (proteinuria) or other signs of kidney problems - Severe headaches - Vision changes, including temporary vision loss, blurring, or light sensitivity - Pain in the upper abdomen, typically under the ribs on the right side - Nausea or vomiting - Decreased urine output - A low platelet count in your blood (thrombocytopenia) - Impaired liver function - Shortness of breath caused by fluid in your lungs Sudden weight gain and swelling (edema) — especially in your face and hands — can occur with preeclampsia, but these are also common in normal pregnancies, so on their own they are not reliable indicators of the condition. ### When to Seek Medical Attention Keeping all your prenatal appointments allows your care team to monitor your blood pressure consistently. However, if you experience severe headaches, blurred or disturbed vision, significant abdominal pain, or sudden shortness of breath, contact your doctor immediately or go to an emergency room right away. Because headaches, nausea, and general aches are common during pregnancy, it can be hard to know when something is simply a normal part of being pregnant versus a warning sign of something more serious — especially during a first pregnancy. When in doubt, reach out to your doctor. ### What Causes Preeclampsia? The exact cause of preeclampsia is complex and involves multiple factors. Experts believe it originates in the placenta — the organ responsible for nourishing your baby throughout pregnancy. Early in a healthy pregnancy, new blood vessels develop to efficiently deliver blood to the placenta. In women with preeclampsia, these blood vessels appear to develop abnormally. They are narrower than usual and respond differently to hormonal signals, limiting how much blood can flow through them. Possible contributors to this abnormal development include: - Reduced blood flow to the uterus - Damage to the blood vessels - Problems with the immune system - Certain genetic factors **Other High Blood Pressure Conditions During Pregnancy** Preeclampsia is one of four high blood pressure disorders that can arise during pregnancy. The other three are: - **Gestational hypertension.** Women with gestational hypertension have high blood pressure but no excess protein in their urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia. - **Chronic hypertension.** Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. But because high blood pressure usually doesn't have symptoms, it may be hard to determine when it began. - **Chronic hypertension with superimposed preeclampsia.** This condition occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy. ### Who Is at Risk? Preeclampsia occurs only as a complication of pregnancy. Known risk factors include: - **History of preeclampsia.** A personal or family history of preeclampsia significantly raises your risk of preeclampsia. - **Chronic hypertension.** If you already have chronic hypertension, you have a higher risk of developing preeclampsia. - **First pregnancy.** The risk of developing preeclampsia is highest during your first pregnancy. - **New paternity.** Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner. - **Age.** The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 35. - **Race.** Black women have a higher risk of developing preeclampsia than women of other races. - **Obesity.** The risk of preeclampsia is higher if you're obese. Pre-pregnancy body mass index (BMI) is positively associated with the risk of preeclampsia. A 2015 population-based cohort study in British Columbia including 226,958 singleton pregnancies showed that a 10% difference in pre-pregnancy BMI was associated with a 10% reduction in preeclampsia risk. - **Multiple pregnancy.** Preeclampsia is more common in women who are carrying twins, triplets, or other multiples. - **Spacing between pregnancies.** Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia. - **Pre-existing health conditions.** Having certain conditions before you become pregnant — such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus — increases your risk of preeclampsia. - **In vitro fertilization.** Your risk of preeclampsia is increased if your baby was conceived with in vitro fertilization. ### Possible Complications The more severe preeclampsia is — and the earlier it develops in your pregnancy — the greater the risks for both you and your baby. Preeclampsia may require induced labor and delivery. A cesarean delivery (C-section) may be necessary when clinical or obstetric circumstances call for a quicker delivery. Otherwise, your doctor may recommend a planned vaginal delivery. Your obstetric provider will discuss with you what type of delivery is best for your specific situation. **Complications of preeclampsia may include:** - **Fetal growth restriction.** Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight, or preterm birth. - **Preterm birth.** If you have preeclampsia with severe features, you may need to be delivered early, to save the life of you and your baby. Prematurity can lead to breathing and other problems for your baby. Your health care provider will help you understand when is the ideal time for your delivery. - **Placental abruption.** Preeclampsia increases your risk of placental abruption, a condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both you and your baby. - **HELLP syndrome.** HELLP — which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes, and low platelet count — is a more severe form of preeclampsia, and can rapidly become life-threatening for both you and your baby. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems at once. It can develop suddenly — sometimes even before high blood pressure is detected — or with no warning signs at all. - **Eclampsia.** When preeclampsia isn't controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia. Eclampsia often strikes without warning signs, and because it poses serious risks for both mother and baby, delivery becomes necessary regardless of how far along the pregnancy is. - **Other organ damage.** Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia. - **Long-term cardiovascular risk.** Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery. To minimize this risk, after delivery try to maintain your ideal weight, eat a variety of fruits and vegetables, exercise regularly, and don't smoke. ### Can Preeclampsia Be Prevented? Researchers continue to explore ways to prevent preeclampsia, but so far, no single strategy has proven definitively effective. Some studies have found a link between deficiencies in zinc and vitamin D and a higher risk of preeclampsia. Increasing intake of vitamins C and E has also shown potential benefit in some research. **Calcium supplements.** In certain populations, women who are low in calcium before pregnancy — and who don't get adequate calcium through their diet during pregnancy — may benefit from calcium supplements to help reduce preeclampsia risk. Always speak with your doctor before starting any medications, vitamins, or supplements during pregnancy. Before becoming pregnant — especially if you've had preeclampsia before — focus on optimizing your overall health. Work toward a healthy weight if needed, and make sure existing conditions like diabetes are well-controlled. Once pregnant, give yourself and your baby the best possible start by seeking early and consistent prenatal care. Catching preeclampsia early means you and your doctor can work together to prevent complications and make informed decisions every step of the way. ### How Is Preeclampsia Diagnosed? To be diagnosed with preeclampsia, you must have high blood pressure along with at least one of the following complications after the 20th week of pregnancy: - Protein in your urine (proteinuria) - A low platelet count - Impaired liver function - Signs of kidney problems beyond protein in the urine - Fluid in the lungs (pulmonary edema) - New-onset headaches or visual disturbances In the past, a diagnosis required both high blood pressure and protein in the urine. We now know that preeclampsia can occur without any protein in the urine at all. A blood pressure reading above 140/90 mm Hg is considered abnormal during pregnancy — but a single elevated reading is not enough to confirm preeclampsia. If one abnormal reading is recorded, your doctor will monitor you closely. A second abnormal reading four hours after the first may support the diagnosis of preeclampsia. Your doctor may schedule additional blood pressure checks, as well as blood and urine tests. **If preeclampsia is suspected, your doctor may order the following tests:** - **Blood tests.** Your doctor will order liver function tests, kidney function tests, and also measure your platelets — the cells that help blood clot. - **Urine analysis.** Your doctor will ask you to collect your urine for 24 hours, for measurement of the amount of protein in your urine. A single urine sample that measures the ratio of protein to creatinine — a chemical that's always present in the urine — also may be used to make the diagnosis. - **Fetal ultrasound.** Your doctor may also recommend close monitoring of your baby's growth, typically through ultrasound. The images of your baby created during the ultrasound exam allow your doctor to estimate fetal weight and the amount of fluid in the uterus (amniotic fluid). - **Nonstress test or biophysical profile.** A nonstress test is a simple procedure that checks how your baby's heart rate reacts when your baby moves. A biophysical profile uses an ultrasound to measure your baby's breathing, muscle tone, movement, and the volume of amniotic fluid in your uterus. ### Treatment Options The most effective treatment for preeclampsia is delivery. Until your blood pressure comes down, you remain at elevated risk for seizures, placental abruption, stroke, and severe bleeding. Of course, if it's too early in your pregnancy, delivery may not be the safest option for your baby. A preeclampsia diagnosis means more frequent prenatal visits than a typical pregnancy — along with additional blood tests, ultrasounds, and nonstress tests to keep a close eye on both you and your baby. **Medications** Possible treatments for preeclampsia may include: - **Blood pressure-lowering medications.** These medications, called antihypertensives, are used to lower your blood pressure if it's dangerously high. Blood pressure in the 140/90 mm Hg range generally isn't treated. Many antihypertensive medications exist, but not all are safe during pregnancy. Talk with your doctor about whether medication is appropriate for your situation and which options are safest for you and your baby. - **Corticosteroids.** If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours — an important step in preparing a premature baby for life outside the womb. - **Seizure-prevention medications.** If your preeclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure. **Bed Rest** Bed rest was once routinely recommended for women with preeclampsia. However, research has not shown meaningful benefit from this approach, and it can actually raise the risk of blood clots while also affecting your daily work and social life. For most women, bed rest is no longer recommended. **Hospital Care** Severe preeclampsia may require hospitalization. In the hospital, your doctor may regularly perform nonstress tests or biophysical profiles to assess your baby's well-being and check the volume of amniotic fluid. Low amniotic fluid can signal that your baby is not receiving adequate blood supply. **Delivery** If preeclampsia is diagnosed near the end of your pregnancy, your doctor may recommend inducing labor promptly. The readiness of your cervix — whether it is beginning to open (dilate), thin (efface), and soften (ripen) — may also factor into the timing and approach for labor induction. In severe cases, gestational age and cervical readiness may not be factors that can be considered. If waiting is not an option, your doctor may induce labor or schedule a C-section immediately. During delivery, magnesium sulfate may be given intravenously to help prevent seizures. > ⚠️ **IMPORTANT NOTE:** If you need pain relief after delivery, ask your doctor what is safe to take. NSAIDs such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can raise blood pressure and should be used with caution. After delivery, it may take some time for blood pressure and other symptoms of preeclampsia to fully resolve. **Emotional Support and Coping** Learning that you have a potentially serious pregnancy complication can be frightening. If diagnosed late in pregnancy, you may feel blindsided to learn that labor will be induced right away. If diagnosed earlier, you may spend weeks anxious about your baby's health and your own. Knowledge can be empowering. In addition to talking openly with your doctor, take time to research your condition from reliable sources. Be clear on when to call your care team, how to monitor yourself and your baby at home — and then find meaningful ways to occupy your time so that worry doesn't take over. **Source:** <https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751> **References:** - *Nutrients.* 2015 Sep; 7(9): 7806–7820. Published online 2015 Sep 15. doi: 10.3390/nu7095366. The Relationship between Serum Zinc Level and Preeclampsia: A Meta-Analysis. - *Obstet Gynecol Int.* 2017; 2017: 8249264. Published online 2017 Aug 17. doi: 10.1155/2017/8249264. PMCID: PMC5585545. PMID: 28912817. The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia. - *BMC Pregnancy Childbirth.* 2017; 17: 231. Published online 2017 Jul 15. doi: 10.1186/s12884-017-1408-3. PMCID: PMC5513133. PMID: 28709403. The role of vitamin D in pre-eclampsia: a systematic review. ---
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Care planPremenstrual Syndrome (PMS)**Premenstrual syndrome, or PMS,** is a collection of symptoms that typically begin one to two weeks before your period. Most women experience at least some PMS symptoms, which usually resolve once their period begins. For some women, however, these symptoms are severe enough to disrupt daily life — a more intense form of PMS called premenstrual dysphoric disorder, or PMDD. ## Understanding PMS and Hormonal Headaches **Common PMS symptoms include:** - Breast swelling and tenderness - Acne - Bloating and weight gain - Pain — headaches or joint aches - Food cravings - Irritability, mood swings, crying spells, and depression Researchers are still working to fully understand what causes PMS. The leading explanation is that PMS symptoms are tied to cyclical shifts in: - Female sex hormones - Pituitary hormones - Prostaglandins (hormone-like compounds involved in pain and inflammation) - Certain brain chemicals called neurotransmitters **Other factors that may play a role include:** - Environmental "endocrine disruptors" — chemicals in the environment that can interfere with your hormones - Magnesium deficiency **Reference:** *Dept. of Health and Human Services Office on Women's Health* --- ### Premenstrual Dysphoric Disorder (PMDD): When PMS Becomes More Serious Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). Women with PMDD experience the same physical symptoms as PMS — bloating, headaches, and breast tenderness — in the weeks leading up to their period. But PMDD goes further, also causing intense anxiety, depression, and significant mood changes. In some cases, women with PMDD may experience suicidal thoughts, making it important to seek professional care. --- ### Hormonal Headaches and Menstrual Migraines: Why Women Are Disproportionately Affected Migraines affect women far more often than men. Like many other health conditions — including autoimmune disease, stroke, depression, anxiety, and osteoarthritis — migraines show a clear gender difference.[4] A significant part of this disparity is thought to stem from the natural fluctuations in [sex hormone levels](https://www.metagenicsinstitute.com/ce-education/clinical-tools/estrogen-function/) that women experience throughout their lives. Notably, many women who suffer from chronic migraines find that their headaches improve or disappear entirely after [menopause](https://www.metagenicsinstitute.com/blogs/perimenopause-symptoms/) — further pointing to the powerful role that sex hormones and hormonal patterns play in triggering migraines. ### How Your Menstrual Cycle Can Trigger Migraines Menstrual migraine (sometimes termed *catamenial migraine*) is comprised of two subtypes — the pure menstrual migraine and the menstrually related migraine. The **pure menstrual migraine** is one that occurs on day 1 ± 2 of menstruation and at no other time of the cycle; it happens during at least 2 of 3 consecutive menstrual cycles, and no aura is present.[5–7] Similarly, no auras are associated with the **menstrually related migraine**, which occurs on day 1 ± 2 of menstruation but, in contrast, this type of migraine can also come about at other times in the menstrual cycle; this must be present during at least 2 of 3 consecutive menstrual cycles.[5,6] It is worth mentioning that, while this describes the typical clinical presentation, there are exceptions — for example, a case report of a perimenopausal woman who experienced sensory aura that exclusively heralded pure menstrual migraines.[8] The most common trigger for menstrual migraines is a **sharp drop in estrogen, typically occurring 2 to 3 days before menstruation begins.**[9] This decline is hypothesized to "unmask non-nuclear mitogen-activated hyperexcitability of cell membranes," leading to the oversensitization of neurons, which trigger the resultant migraine.[9] Moreover, low levels of estrogen may increase inflammatory activity and increase peptide-modulated central sensitization, which can lead to higher levels of pain and disability during migraines.[9] If estrogen is administered premenstrually, migraines can be delayed without affecting onset of menses.[6] It has also been shown that giving long-acting estrogen implants — delivering uneven amounts of estrogen throughout the cycle — may trigger migraines.[6] Several types of headaches are directly connected to fluctuating levels of estrogen and progesterone. Women often experience menstrual migraines anywhere from 2 days before their period to 3 days after it starts. That said, anything that disrupts these hormone levels — not just your cycle — can act as a trigger. Importantly, it is the *degree* to which hormone levels shift, not simply the fact that they change, that determines how severe a headache becomes. ### Recognizing the Symptoms A menstrual migraine feels very similar to a typical migraine. You may experience: - An aura before the headache begins (though not everyone experiences this) - Throbbing pain on one side of your head - Nausea - Vomiting - Sensitivity to light and sound A PMS-related headache that occurs before your period may feel a bit different and can include: - Head pain - Fatigue - Acne - Joint pain - Urinating less frequently than usual - Constipation - Difficulty with coordination - Increased appetite - Cravings for chocolate, salty foods, or alcohol ### What Drives Hormonal Headaches? Common Causes and Triggers **Birth control pills:** Oral contraceptives affect migraines differently in different women — for some, they make migraines worse; for others, they provide relief. For three weeks of the month, the pill keeps your hormone levels relatively stable. But during the week you take placebo pills or skip pills altogether — the week of your period — estrogen levels drop sharply, and head pain can follow. If you are prone to hormonal migraines, a pill formulated with lower estrogen levels or one that contains only progestin may be a better option for you. **Hormone replacement therapy (HRT):** The hormones women take during menopause to ease symptoms can also trigger headaches. An estrogen patch tends to be gentler on headaches than other forms of estrogen, because it delivers a low, consistent dose of the hormone rather than causing peaks and valleys. **Menopause:** Once your periods stop for good, migraines often become less frequent or disappear entirely. If you are using estrogen replacement therapy and your headaches worsen, your doctor may adjust your dose, recommend stopping it, or switch you to a different form. An estrogen patch is often the best choice at this stage, as it maintains steady estrogen levels and reduces the likelihood of menstrual migraines. Some women do notice, however, that while migraines improve, tension headaches may increase during this transition. **Menstruation:** If you feel like your migraines always show up around your period, you are not imagining it. About 60% of women who suffer from migraines experience what are known as menstrual migraines. Just before your period begins, levels of estrogen and progesterone — two key female hormones — drop significantly. This sudden hormonal shift can trigger the throbbing headaches so many women dread each month. **Perimenopause:** In the years leading up to menopause, estrogen levels can fluctuate dramatically. During this transitional phase, many women experience both tension headaches — often related to stress — as well as migraines. **Pregnancy:** During the first trimester, estrogen levels rise quickly before leveling off. Because of this hormonal stabilization, many women find their migraines improve or disappear after the third month of pregnancy. If headaches persist, avoid taking medications without consulting your provider first — many migraine drugs are not safe during pregnancy. **Source:** <https://www.webmd.com/migraines-headaches/hormones-headaches#1> **References:** 1. Weatherall MW. The diagnosis and treatment of chronic migraine. *Ther Adv Chronic Dis.* 2015;6(3):115–123. 2. The Migraine Foundation. Migraines. <https://migraineresearchfoundation.org/about-migraine/migraine-facts/> Accessed January 29, 2019. 3. The Migraine Trust. Menopause and midlife. <https://www.migrainetrust.org/about-migraine/trigger-factors/menopause-and-midlife/> Accessed January 29, 2019. 4. NIH. What health issues or conditions affect women differently than men? <https://www.nichd.nih.gov/health/topics/womenshealth/conditioninfo/howconditionsaffect> Accessed January 29, 2019. 5. International Headache Society. IHS Classification. <https://www.ichd-3.org/appendix/a1-migraine/a1-1-migraine-without-aura/a1-1-1-pure-menstrual-migraine-without-aura/> Accessed February 13, 2019. 6. Mathew PG et al. A cyclic pain: the pathophysiology and treatment of menstrual migraine. *Obstet Gynecol Surv.* 2013;68(2):130–140. 7. Mayo Clinic. Video: migraine aura. <https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/multimedia/migraine-aura/vid-20084707> Accessed February 15, 2019. 8. Chen JJ et al. Pure menstrual migraine with sensory aura: a case report. *J Headache Pain.* 2012;13(5):431–433. 9. MacGregor EA. Menstrual migraine: the therapeutic approach. *Ther Adv Neurol Disord.* 2009;2(5):327–336. 10. Mayo Clinic. Headaches and Hormones. <https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/in-depth/headaches/art-20046729> Accessed January 30, 2019. ---
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Care planPrimary Sclerosing Cholangitis (PSC)Primary sclerosing cholangitis is a progressive disease that damages your bile ducts and your liver. It causes chronic inflammation and scarring. Over time, scar tissue restricts the flow of bile through the ducts and prevents the liver from working properly. ## Understanding Primary Sclerosing Cholangitis ### What Is Primary Sclerosing Cholangitis? Primary sclerosing cholangitis (PSC) is a disease of the bile ducts. It causes chronic inflammation in your bile ducts (cholangitis), which eventually leads to scarring (sclerosis). Scar tissue causes your bile ducts to narrow, restricting the flow of bile (biliary stricture). When bile can't flow forward, it backs up into your liver — where it originated — and causes progressive damage over time. ### Is Primary Sclerosing Cholangitis Serious? Yes. You might not notice any symptoms at first, but PSC is a progressive disease that worsens over time. When bile stalls in your bile ducts (cholestasis), bile toxins can leak into your bloodstream, making you sick. It also causes ongoing damage to your liver. Within 10 to 15 years, this can lead to liver failure — and you cannot survive without a functioning liver. While there are treatments that can help manage symptoms, there is currently no cure for PSC other than a liver transplant. ### What Is the Difference Between Primary and Secondary Sclerosing Cholangitis? "Primary" means that the disease itself is the original cause of inflammation and scarring in your bile ducts — there is no other underlying cause. In secondary sclerosing cholangitis, the same inflammation (cholangitis) and scarring (sclerosis) occur, but as side effects of something else entirely. Some causes of secondary sclerosing cholangitis include: - Bile duct injury (for example, during surgery). - Infections of the bile ducts. - Chemotherapy. - Gallstones in your bile ducts. - Recurring pancreatitis. ### What Is the Difference Between Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis? Primary biliary cholangitis (PBC) is the updated name for what was formerly called primary biliary cirrhosis. PBC and PSC are both progressive liver diseases rooted in bile duct damage, and they share many symptoms and effects. In both conditions, your bile ducts gradually deteriorate — scarring causes them to narrow, bile flow stalls, and bile backs up into the liver, causing further injury. Left unchecked, this leads to cirrhosis. **Here are the primary differences:** - PBC only affects the bile ducts within your liver (intrahepatic), while PSC can affect the bile ducts inside or outside of your liver (extrahepatic). - PBC is more predominant in people assigned female at birth, by a ratio of 10:1. PSC is more predominant in people assigned male at birth, by a ratio of 2:1. - PSC is highly associated with preexisting IBD (80%), while PBC is not. - PSC is associated with an increased risk of developing bile duct cancer, while PBC is not. - PBC treatment involves using ursodeoxycholic acid (UDCA) to slow its progression. PSC currently has no medical treatment. ### How Common Is This Condition? PSC is rare, estimated to affect about 1 in 10,000 people worldwide. ### Who Does It Affect? PSC occurs twice as often in people assigned male at birth as in those assigned female at birth. It is most commonly diagnosed around age 40. About 80% of people with PSC also have inflammatory bowel disease, most often ulcerative colitis. Having a family history of PSC also increases your likelihood of developing it. ---
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Care planProbiotic Formula for Children> *"The link between the microbiome and human health is so pervasive that there are few conditions that are out of the realm of possibility. It really is a frontier.* > > *Not that the microbiome causes everything, but by understanding and manipulating the microbiome, we could at least palliate, or slow down, particular pathologic processes.* > > *For all the major causes of death in the United States — cardiovascular disease, cancer, dementia and neurodegenerative diseases, diabetes, and lung, liver, and kidney diseases — there is ongoing investigation of the microbiome. A greater promise would be to prevent or cure these illnesses."* > > **— Martin J. Blaser, MD,** Henry Rutgers Chair of the Human Microbiome and Director of the Center for Advanced Biotechnology and Medicine, Rutgers University While probiotics have a well-established track record of benefits in adults, a growing body of research shows they can be equally valuable for children. Just as in adults, probiotics may help support a child's digestive and immune health — and may even help with specific concerns like constipation, colic, acid reflux, and more. **From the very moment of birth, the gut microbiome grows and evolves alongside your child — shaping their metabolism, brain development, and long-term health. How this microbial community develops in early life matters enormously for health later on.** The growth and maturation of a child's gut microbiome is a highly dynamic, ever-changing process — one that is shaped by many factors surrounding birth and early childhood. These include external influences like how a baby is delivered, whether they are breastfed or formula-fed, antibiotic exposure, lifestyle habits, and even geographic location, as well as factors intrinsic to the child themselves. A wealth of research has shown that breast milk helps protect infants from infection, thanks to powerful immune factors like immunoglobulin A (IgA). Beyond immune protection, breastfeeding also helps shape and mature the infant's immune system and guides the development of their gut microbiome. In fact, it is well established that the gut microbiome looks quite different in breastfed versus formula-fed babies. Breastfed infants tend to have a less diverse microbiome overall, but one that is richly populated with *Bifidobacterium* species — bacteria that thrive on the natural sugars found in human breast milk, known as human milk oligosaccharides (HMOs). During roughly the first 7 to 9 years of life, *Bifidobacterium* species dominate the gut microbiome. This development doesn't follow the same timeline in every child — some develop more slowly and may spend time in an in-between state. This window of childhood is actually a valuable opportunity: a child's microbiome appears to be more flexible and responsive to environmental influences than an adult's, making it an ideal time for targeted probiotic support. Diet, lifestyle, and the influences of a modern Western lifestyle in particular can all meaningfully shape the gut bacterial community in children, just as they do in adults. > 📝 **NOTE:** Interestingly, it is the *stopping* of breastfeeding — not the introduction of solid foods — that appears to be one of the most significant turning points for the infant microbiome. When solid foods are introduced, the gut sees an increase in the total number and variety of bacteria, higher levels of beneficial short-chain fatty acids, and a shift toward *Bacteroides* and *Firmicutes* species, which are better equipped to break down complex carbohydrates. A child's gut also houses many other strains of beneficial bacteria. Around age 9 to 10, the dominant bacterial species typically shifts from *Bifidobacterium* to *Lactobacillus* — though this transition varies from child to child. Given all of this, the prevailing view among experts is that any high-quality, certified, strain-identified, multi-strain probiotic formula is appropriate for use at any age, starting from birth. **High-quality, strain-identified probiotic formulas are safe and effective from birth onward — including during pregnancy and nursing — and cannot be "overdosed," since these bacteria are naturally at home in the human intestinal tract.** **References:** - <https://www.medscape.com/viewarticle/where-microbiome-revolution-headed-next-2023a1000vz1?ecd=WNL_mdpls_231222_mscpedit_wir_etid6179755&uac=149193PV&spon=17&impID=6179755> - *JAMA Pediatr.* 2013 Dec;167(12):1150–7. doi: 10.1001/jamapediatrics.2013.2572. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis. - *Trends in Microbiology.* Published: August 29, 2019. doi: <https://doi.org/10.1016/j.tim.2019.08.001>. The Gut Microbiota in the First Decade of Life. ---
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Care planProbioticsYour body is home to trillions of microorganisms — and not all of them are out to get you. Probiotics are live, beneficial bacteria and yeasts that naturally inhabit your body and actively work to keep you healthy. While "bacteria" often brings to mind images of illness, the truth is more nuanced: your body hosts two kinds of bacteria at all times — helpful and harmful. Probiotics belong firmly in the helpful camp. They serve as your body's microscopic allies, doing everything from fending off harmful bacteria to supporting your overall well-being. Probiotics are living microorganisms also found in fermented foods and cultured dairy products, and they have long been used in infant nutrition. Celebrated as "health-friendly bacteria," probiotics offer a remarkable range of benefits: supporting digestive health, strengthening the immune system, aiding those with lactose intolerance, maintaining a balanced gut environment, helping to lower cholesterol and blood pressure, easing symptoms of menopause, and even reducing the misery of traveler's diarrhea — to name just a few. ## Understanding Probiotics ### What Exactly Are Probiotics? Probiotics are defined as live microorganisms that, when consumed in adequate amounts, confer a health benefit to the host. This definition was established in 2001 by the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO), and has guided both science and regulation ever since. **Probiotics are one piece of a much bigger puzzle — your microbiome.** Picture your microbiome as a thriving, complex ecosystem, much like a forest, where countless organisms work in concert to keep your body functioning at its best. This ecosystem is made up of tiny life forms called microbes, and you carry trillions of them in and on your body. Your personal microbial community includes: - Bacteria - Fungi (including yeasts) - Viruses - Protozoa Your microbiome is as unique to you as your fingerprint. No two people — not even identical twins — share the exact same microbial makeup. **Not every microbe earns the title of "probiotic." To qualify, a microorganism must be able to:** - Be isolated from a human - Survive the journey through your digestive system after being swallowed - Demonstrate a proven health benefit to you - Be safe to consume While your gut — particularly the large intestine — is the most well-known home for beneficial microbes, healthy microbial communities thrive in several other areas of your body that interface with the outside world, including your: - Gut - Mouth - Vagina - Urinary tract - Skin - Lungs > *"The link between the microbiome and human health is so pervasive that there are few conditions that are out of the realm of possibility. It really is a frontier. Not that the microbiome causes everything, but by understanding and manipulating the microbiome, we could at least palliate, or slow down, particular pathologic processes. For all the major causes of death in the United States — cardiovascular disease, cancer, dementia and neurodegenerative diseases, diabetes, and lung, liver, and kidney diseases — there is ongoing investigation of the microbiome. A greater promise would be to prevent or cure these illnesses."* > > **— Martin J. Blaser, MD,** Henry Rutgers Chair of the Human Microbiome and Director of the Center for Advanced Biotechnology and Medicine, Rutgers University ---
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Care planProstate CancerThe prostate is a walnut-sized gland located just below a man's bladder — its main job is to produce fluid that nourishes and transports sperm. Prostate cancer is one of the most common cancers in older men, though it is rarely seen in men under 40. The key risk factors include being over 65, having a family history of the disease, and being of African-American descent. **Warning signs of prostate cancer can include:** - Urinary problems — such as pain, difficulty starting or stopping the flow of urine, or leaking/dribbling - Lower back pain - Pain during ejaculation The comprehensive **"Nutrition and Lifestyle Support Strategies for Prostate Cancer"** outlined below is built on recommendations from the seminar *"Nutrition and Cancer - New Strategies to Win the War on Cancer - Essential Information for the 563,700+ New Cancer Patients Who Will be Diagnosed This Year"* — Robert A. Rakowski, DC, CCN, DACBN, DIBAK. It is an in-depth, proactive nutrition support protocol that addresses the biochemical underpinnings of prostate cancer. **Robert A. Rakowski, DC, CCN, DACBN, DIBAK** is a chiropractor, clinical nutritionist, kinesiologist, certified biological terrain instructor, AFMCP graduate, and clinic director of the Natural Medicine Center in Houston, Texas. Dr. Rakowski has lectured to health professionals across the country and around the world on a wide range of health topics for over 20 years, and has appeared on numerous television and radio programs as a recognized expert in natural medicine. ---
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Care planProstate-Specific Antigen (PSA)A prostate-specific antigen (PSA) test is a simple blood test that measures the amount of PSA — a protein naturally produced by your prostate gland — circulating in your bloodstream. The prostate is a small but important gland in the male reproductive system, nestled just beneath the bladder, where it produces the fluid component of semen. It's perfectly normal to have a small amount of PSA in your blood. When that level rises above normal, however, it can signal a number of different conditions, including: - Prostate cancer - An enlarged prostate (BPH, or benign prostatic hyperplasia) - Other common prostate conditions - Certain medications It's important to understand that a PSA test alone cannot tell you *why* your levels are elevated. If your result comes back high, your doctor will likely recommend additional testing to get a clearer picture. **Source:** <https://medlineplus.gov/lab-tests/prostate-specific-antigen-psa-test/> ---
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Care planProstatitis (Prostatic Hypertrophy, Benign)Benign prostatic hyperplasia (BPH) — also known as an enlarged prostate — is one of the most common conditions men face as they age. When the prostate gland grows larger than it should, it can press on the urethra (the tube that carries urine out of the body), making it harder to urinate normally. Left unaddressed, it can also affect the bladder, urinary tract, and even the kidneys. - As of 2024, the 3rd most commonly diagnosed urological disease in US males - Up to 16% prevalence among US males - Accounts for up to 25% of US outpatient urology visits - Global incidence of 8.2%, approximately 8 million annual physician visits annually - An estimated 60% of men with symptoms actually seek treatment, suggesting a higher rate of incidence than expected - Cause of Chronic Pelvic Pain Syndrome in men ## Understanding BPH and Prostatitis ### What Is Happening in the Prostate? BPH affects roughly 4 out of every 5 American men over age 50. In this condition, multiple small, benign (non-cancerous) nodules grow within the prostate, causing it to swell and squeeze the urethra — which can partially or fully block the normal flow of urine out of the bladder. ### How Does an Enlarged Prostate Affect Urination? Over time, the bladder has to work harder to push urine past the narrowed opening. This leads to a familiar pattern: needing to urinate more often, feeling sudden urgency, difficulty getting the stream started, a weak or stop-and-go flow, and the frustrating sensation that the bladder never fully empties. ### Recognizing the Symptoms The urinary symptoms associated with BPH are grouped into two categories — voiding symptoms (related to the act of urinating) and storage symptoms (related to how the bladder holds urine). It's important to know that BPH is a common cause of these symptoms, but not the only one — bladder conditions and other health issues can produce the same picture. Some men with an enlarged prostate have very few symptoms, while others with a relatively small prostate may struggle significantly. Prostate size alone doesn't determine how much trouble a man will have. **Voiding (Obstructive) Symptoms — Trouble Getting Urine Out** These symptoms arise when something is physically blocking or slowing the flow of urine. Obstruction is the most serious complication of BPH and warrants prompt medical attention. Voiding symptoms include: - A hesitation before urine flow starts despite the urgency to urinate - Straining when urinating - Weak or intermittent urinary stream - A sense that the bladder has not emptied completely - Dribbling at the end of urination or leakage afterward **Storage (Irritative) Symptoms — Trouble Holding Urine** These symptoms reflect how the bladder responds to the ongoing stress of BPH. Storage symptoms, also referred to as filling symptoms, include: - An increased frequency of urination (every few hours) - An urgent need to urinate and difficulty postponing urination - Painful or burning sensation when urinating ---
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Care planPyroluria**Pyroluria** is known by several names and spellings, all of which refer to the same condition and are used interchangeably: - Pyrole disease (pyrrole disease) - Pyrole disorder (pyrrole disorder and pyrolle disorder) - Kryptopyrrole - Kryptopyroluria (kryptopyrroluria) - Mauve factor - Hemepyrole (hemepyrrole, hemopyrrole, hemopyrole) **Pyroluria is an inherited chemical imbalance rooted in an abnormality in how the body makes hemoglobin.** Hemoglobin is the protein responsible for carrying iron inside red blood cells. People with this condition overproduce a byproduct of hemoglobin synthesis called "kryptopyrrole" (KP) or "hemepyrrole." Kryptopyrrole appears to serve no useful purpose in the body and is simply flushed out in the urine. **The real problem is what kryptopyrrole takes with it: it latches onto vitamin B6 and zinc, stripping them from the body before they can do their jobs.** These two nutrients are critical helpers in hundreds of the body's enzyme-driven processes. When bound to kryptopyrrole, they are swept out of the bloodstream and lost in the urine. A third important nutrient, arachidonic acid (an omega-6 fatty acid), also becomes depleted as a result. **The impact of pyroluria can range from mild to severe, depending on how pronounced the imbalance is.** Most people with this condition show signs of zinc and/or B6 deficiency — things like difficulty handling stress, nervousness, anxiety, mood swings, intense inner tension, episodes of explosive anger, poor short-term memory, and depression. Most people with pyroluria experience at least two of these challenges. Because vitamin B6 plays a key role in the final step of serotonin production (serotonin being the brain chemical that helps regulate mood and anxiety), people with pyroluria often struggle to make enough of it. Many find some relief from SSRI antidepressants such as Prozac, Paxil, Zoloft, and Celexa — but like all psychiatric medications, these come with side effects, and they don't address the underlying nutritional problem. **Beyond mood and mental health, pyroluria often shows up in the body in surprising ways — frequent infections, difficulty tanning, unusual fat distribution, and heightened sensitivity to light and sound.** As you might expect, an antidepressant alone won't fix these physical effects. Targeted nutritional support is a far more logical — and often more effective — approach. **Pyroluria is diagnosed by testing urine for abnormal pyrrole levels, which show up as a purple color on test paper — this is what researchers call "the mauve factor."** Most healthy individuals have less than 10 mcg of KP per deciliter of urine. Levels between 10–20 mcg/dl are considered "borderline" and may warrant treatment. Levels above 20 mcg/dl, particularly when paired with the symptoms described above, confirm a diagnosis of pyroluria. Testing for KP can be tricky because the compound breaks down quickly and easily. It may sometimes be necessary to repeat the urine test to get an accurate picture of KP levels. For the initial test, it's important to stop all vitamins and minerals for two days beforehand — otherwise, supplementation can mask the problem and produce a falsely normal result. The urine sample also needs to be handled carefully: collected and frozen right away, and wrapped in aluminum foil to protect it from light. Follow-up testing can help track whether treatment is working. **People with mild-to-moderate pyroluria often notice improvement relatively quickly once treatment begins, provided no other chemical imbalances are present.** Those with more severe pyroluria may need several weeks before they see meaningful progress, with gradual improvement continuing over 3 to 12 months. Importantly, symptoms typically return within 2 to 4 weeks if treatment is stopped — which means **ongoing, lifelong treatment is necessary.** **The cornerstone of pyroluria management is replenishing vitamin B6 and zinc.** How these nutrients are replaced matters enormously — zinc must be in a form the body can actually absorb, and B6 comes in several formulations with very different effects. Both supplements should be guided by a physician, as too much can be harmful, the wrong form may be useless, and certain other supplements or minerals can interfere with their absorption. **Several other nutrients play a supporting role in pyroluria management, including niacinamide, pantothenic acid, manganese, vitamins C and E, omega-6 fatty acids, and cysteine.** Foods and supplements that contain copper or red and yellow artificial dyes should be avoided. Because **people with pyroluria handle stress poorly,** they are especially vulnerable to the effects of stress that builds up over multiple days. For instance, parents of a child with pyroluria may find that brief, calm, and direct discipline works far better than prolonged emotional exchanges. It's also important to know that relapses are common — particularly during illness, injury, or periods of emotional upheaval. ---
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Care planRamsay Hunt Syndrome (Herpes Zoster Oticus)Ramsay Hunt syndrome — also known as herpes zoster oticus — happens when the varicella-zoster virus (the virus behind chickenpox and shingles) reawakens from dormancy and inflames the facial nerves near your inner ear. Treatment typically involves antiviral medications and corticosteroids to calm the infection and reduce nerve inflammation. ## Understanding Ramsay Hunt Syndrome ### What Is Ramsay Hunt Syndrome? Ramsay Hunt syndrome is a complication of the varicella-zoster virus — the same virus responsible for chickenpox and shingles (herpes zoster). You may also hear it called herpes zoster oticus or Ramsay Hunt syndrome type 2. The condition was named after James Ramsay Hunt, an American army officer and neurologist who first described it in 1907. If you had chickenpox as a child, the virus doesn't simply disappear — it goes into hiding, lying dormant in your nerve tissue for years or even decades. When it eventually reactivates, we call that shingles. When that reactivation specifically targets your facial nerve, the result is Ramsay Hunt syndrome. The hallmark features of Ramsay Hunt syndrome are facial nerve paralysis (called facial palsy) and intense ear pain. Many people also develop a painful rash on the ear, face, or inside the mouth. ### Who Can Get Ramsay Hunt Syndrome? Anyone who has ever had chickenpox or shingles is potentially at risk. That said, most cases occur in people age 60 and older. While the condition is unusual in children, it has been diagnosed in kids as young as three. People with weakened immune systems are at higher risk, tend to have more severe symptoms, and are less likely to make a full recovery. ### How Common Is Ramsay Hunt Syndrome? Ramsay Hunt syndrome affects approximately 5 out of every 100,000 people in the U.S. each year. However, many researchers believe the condition is frequently missed or misidentified, which makes nailing down its true prevalence tricky. What we do know is that Ramsay Hunt syndrome is the second most common cause of facial nerve paralysis, accounting for roughly 7% of all cases — just behind Bell's palsy, which holds the top spot. ### What Causes Ramsay Hunt Syndrome? Ramsay Hunt syndrome occurs when the varicella-zoster virus reactivates specifically within the facial nerve — the cranial nerve that controls movement in your face, as well as sensation in your tongue and inner ear. This is the same virus that causes chickenpox and shingles. After childhood chickenpox, the virus lies dormant in your nerve tissue. Years later, if it reactivates, it travels along nerve fibers toward the skin, producing the painful sores characteristic of shingles. In some cases, this reactivation zeroes in on the facial nerve, leading to Ramsay Hunt syndrome. Exactly why the facial nerve is sometimes the target remains an open question that researchers are still working to answer. ### Recognizing the Symptoms Ramsay Hunt syndrome can cause weakness or stiffness on one side of your face, depending on which branch of the facial nerve is affected. You might find it difficult to close your eye, wrinkle your forehead, or make simple expressions like smiling or frowning. In more serious cases, you may experience drooping or paralysis on one side of your face, which can lead to slurred speech and difficulty eating. Because the syndrome typically affects only one side of the face, symptoms are usually one-sided as well. Beyond facial changes, Ramsay Hunt syndrome may also cause: - Painful rash on your eardrum, ear canal, and earlobe - Fluid-filled blisters in your ear canal and on the outside of your ear - Rash on your tongue, throat, and roof of your mouth on the affected side - Severe ear pain - Ringing in your ear (tinnitus) - Increased sensitivity to sounds (hyperacusis) - Hearing loss on one side - Dry eyes and mouth - Hoarseness - Loss of sense of taste - Social anxiety because of facial abnormalities Ramsay Hunt syndrome can also trigger vertigo — the unsettling sensation that the world around you is spinning or shifting, even when you're perfectly still. ### Is Ramsay Hunt Syndrome Contagious? Ramsay Hunt syndrome itself is not contagious. However, having it means the varicella-zoster virus is active in your body, and that virus can spread to others through direct contact with blister fluid. People who have never had chickenpox or the chickenpox vaccine are most vulnerable to catching the virus this way. For those with compromised immune systems, exposure can be particularly serious. Until your blisters have fully scabbed over, it's wise to avoid close contact with: - People who've never had chickenpox or gotten the chickenpox vaccine - People with weakened immune systems - Newborns - Pregnant people ### How Is Ramsay Hunt Syndrome Diagnosed? Your healthcare provider will start with a thorough physical exam, asking about your medical history and symptoms, and checking for the characteristic rash and facial weakness. Diagnosis can be challenging because the various symptoms don't always appear at the same time. When there's uncertainty, your provider may order a laboratory test — collecting a sample of saliva, blood, or blister fluid — to confirm the presence of the varicella-zoster virus under a microscope. In some cases, your provider may also recommend an MRI scan — not because it's strictly necessary, but because it can rule out other conditions that might be mimicking Ramsay Hunt syndrome. ### How Is Ramsay Hunt Syndrome Treated? Treatment for Ramsay Hunt syndrome typically involves a combination of medications tailored to your symptoms. Your healthcare provider may prescribe: - An **antiviral medication** to treat the infection or decrease symptoms, such as acyclovir or valacyclovir - A **corticosteroid** to reduce inflammation of the nerve, such as prednisone - A **pain reliever** to reduce pain - A variety of possible medications to relieve symptoms of vertigo - An **anti-seizure medicine**, such as carbamazepine, to treat persistent pain (postherpetic neuralgia) On the home care side, a cold compress can help ease pain, and wearing an eye patch may be helpful if you're having trouble closing your eye — leaving it open puts your cornea at risk of damage from dryness and irritation. Artificial tears or eye lubricants can also help keep your eye comfortable and protected. In cases of complete facial paralysis, your healthcare provider may recommend surgery to relieve pressure on the affected facial nerves. ### How Long Does Recovery Take? Recovery time varies considerably and depends largely on how much nerve damage has occurred. If the nerve damage is mild and you are otherwise in good health, symptoms may begin to improve within a few weeks to a few months — though full recovery can take up to a year. More extensive nerve damage reduces the likelihood of a complete recovery. Antiviral medications can meaningfully improve outcomes, but timing matters: your chances of a full recovery are significantly better if treatment begins within three days of your symptoms appearing. With prompt treatment, about 70% of people with Ramsay Hunt syndrome regain complete or near-complete facial function. That said, even with early intervention, some people are left with permanent facial paralysis or lasting hearing loss. ### Can Ramsay Hunt Syndrome Come Back? While quite rare, Ramsay Hunt syndrome can recur — just as shingles can. This is because the varicella-zoster virus never fully leaves your body; it simply returns to its dormant state within your nerves, where it can potentially reactivate again in the future. ### What Complications Can Ramsay Hunt Syndrome Cause? As nerves heal, they don't always reconnect to the right structures. This can lead to unusual, involuntary reactions — for example, smiling might trigger your eye to close. Other possible complications include: - Facial appearance changes (disfigurement) due to loss of movement - Change in your sense of taste - Eye damage due to corneal ulcers, abrasions, and infections, which can cause vision loss - Facial muscle spasms - Social anxiety If the virus reactivates in other parts of the nervous system — such as the brain or spinal cord — more serious complications can develop, including: - Confusion - Drowsiness - Headaches - Weakness in your arms and legs - Nerve pain > ⚠️ **IMPORTANT NOTE:** If you notice any symptoms of Ramsay Hunt syndrome — painful rash, severe ear pain, or facial paralysis — contact your healthcare provider right away. You are more likely to make a full recovery with prompt diagnosis and treatment. **Source:** <https://my.clevelandclinic.org/health/diseases/6093-ramsay-hunt-syndrome> ### A Note on Vaccinations for Herpes Zoster | Shingles Although immunocompromised patients are at greater risk for herpes zoster, the herpes zoster vaccine is not recommended for these patients. As it is a live-attenuated vaccine, there is a risk for developing varicella from the vaccination. In the general population, the use of a live-attenuated zoster vaccine (Zostavax, Merck) has been shown to decrease the risk for herpes zoster development by about 50%. **The number needed to vaccinate in the general population of those aged at least 60 years to prevent one herpes zoster episode during 3 years was 60 to 70 people.** **Source:** <https://www.healio.com/news/infectious-disease/20130917/10_3928_1081_597x_20130101_01_1309005> ---
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Care planRetinitis Pigmentosa**Retinitis Pigmentosa (RP)** is the name given to a group of inherited eye diseases (IRDs) that damage the retina. Many different genetic mutations can lead to retinitis pigmentosa. The retina is a thin, light-sensitive layer at the back of your eye that transforms light into electrical signals, allowing your brain to make sense of the world around you. RP is the most common inherited eye disease. Other inherited retinal diseases include: - Cone-rod dystrophy - Congenital stationary night blindness - Leber congenital amaurosis - Usher syndrome Think of your eye like an old-fashioned film camera. The front of your eye has a lens — just like a camera lens — that focuses images onto the inside back surface of your eye, the retina, which acts like the film. If that film is damaged, it doesn't matter how sharp or precise the lens is; the picture will never come out right. In the same way, a damaged retina will impair your vision even if everything else about your eye is working perfectly — including for people who wear corrective glasses or contact lenses. Your retina is made up of specialized nerve cells that respond to light — most notably photoreceptor cells (rods and cones) and retinal pigment epithelium (RPE) cells. These cells must work in harmony for you to see clearly. In RP and other IRDs, genetic mutations disrupt this teamwork, causing the cells to malfunction or die. Because RP is really a family of related disorders, the way it affects vision varies from person to person. Most people with RP experience significant vision loss, and some lose their sight entirely. Vision changes often begin in childhood, though they can progress so gradually that you may not notice them at first. Others experience a faster decline. In certain forms of RP, vision loss levels off at some point and does not worsen further. **Retinitis pigmentosa typically affects both eyes.** If you receive a diagnosis of RP or another IRD, genetic testing is a critically important next step. A specially trained genetic counselor can guide you through the testing process and help you interpret the results. Knowing your specific genetic mutation can shed light on how your disease may progress, help identify which family members may be at risk, and — importantly — may qualify you for gene therapy or enrollment in a gene therapy clinical trial. In most forms of retinitis pigmentosa, the light-sensing cells in the retina known as "rods" gradually die off. This leads to worsening night vision and a shrinking ability to see things off to the side — what doctors call peripheral vision. In some forms of RP, the "cone" cells also die, which affects central vision and the ability to distinguish colors. Across all forms of RP, vision loss typically unfolds slowly over many years, and is usually first noticed during childhood or early adulthood. **Conventional medical treatment for retinitis pigmentosa is largely limited to vision aids and, in select cases, gene therapy.** --- ## Understanding Retinitis Pigmentosa ### How Many People Have Retinitis Pigmentosa? In Europe and the United States, an estimated 1 in 3,500 to 1 in 4,000 people live with retinitis pigmentosa. Globally, RP affects approximately 1 in 3,000 to 1 in 4,000 people — roughly two million individuals worldwide. In the U.S. alone, that number is estimated at about 100,000 people. ### What Are the Warning Signs and Symptoms of Retinitis Pigmentosa? Early signs and symptoms of retinitis pigmentosa include: - Difficulty seeing at night - Trouble seeing in dim or low light - Blind spots in your peripheral (side) vision As RP progresses, later signs and symptoms may include: - Seeing flickering or flashing lights - Tunnel vision — seeing only what's directly in front of you - Sensitivity to or discomfort in bright light (photophobia) - Loss of color vision - Severely reduced vision ### What Causes Retinitis Pigmentosa? Like other IRDs, retinitis pigmentosa is caused by mutations in specific genes — the biological instructions that govern how the cells of your retina develop and function. ### How Is Retinitis Pigmentosa Diagnosed? Keeping up with regular eye exams is essential. If your eye care provider suspects you may have retinitis pigmentosa, they will use some or all of the following tests to reach a diagnosis. Genetic testing and counseling may also be recommended. **Dilated eye exam with visual field test** Your exam may be performed by an optometrist or an ophthalmologist. During this visit, your provider will: - Ask you to read letters off a chart on the wall - Ask you to follow moving objects with your eyes - Measure the pressure inside your eyes - Evaluate your side (peripheral) vision with a visual field test - Check how your pupils respond to light - Use eye drops to widen (dilate) your pupils so they can see inside your eye - Photograph your retina **Electroretinography (ERG)** An electroretinogram is a test that measures how your retina responds to light. It evaluates the function of different retinal cell types by flashing light in front of your eyes and recording your retina's electrical activity. ERG is a type of ophthalmic electrophysiology test — a category of tests that assess how your eyes and brain work together to process visual information, by measuring electrical signals in your retinas, optic nerves, and visual pathways. **Optical coherence tomography (OCT) scan** OCT is a painless, non-invasive imaging test that measures the thickness of your retina and evaluates its structural integrity. You simply look at a target while a specialized camera captures a detailed image of the back of your eye. **Fundus autofluorescence imaging** This non-invasive imaging technique captures information about the health of your retinas and is used to help diagnose, guide treatment, and monitor changes over time. ### How Is Retinitis Pigmentosa Managed? The field of RP and inherited retinal diseases has advanced considerably in recent years, with gene therapy representing one of the most exciting breakthroughs. Current approaches to managing RP include: - Using low vision aids and assistive technology. A wide range of magnifiers and smart devices are available that can identify objects or people that the user points toward. - Wearing sunglasses and taking steps to limit exposure to bright light, which may worsen RP. - Treating related conditions — such as cystoid macular edema (CME), a buildup of fluid in the center of your retina that can occur alongside RP. - Surgically removing cataracts, which develop when the lens of the eye becomes cloudy and further reduces vision. ### Are There Newer or Emerging Treatments for Retinitis Pigmentosa? The FDA has approved voretigene neparvovec-rzyl (Luxturna®), a gene therapy for a specific form of retinitis pigmentosa. People who carry mutations in both copies of the RPE65 gene may benefit from this treatment. This particular form of RP affects an estimated 1,000 to 2,000 people in the United States. Clinical trials are actively underway investigating gene therapies for other forms of RP and related IRDs. For individuals with severe RP, an artificial retina — also known as a retinal prosthesis — may be an option. ### Can Retinitis Pigmentosa Be Prevented? Because most forms of retinitis pigmentosa are inherited, there is currently no way to prevent RP. That said, you can take meaningful steps to protect your eye health as much as possible by: - Scheduling and keeping regular appointments with your ophthalmologist - Wearing sunglasses and minimizing exposure to bright light - Supporting your overall health through good nutrition and safe, regular exercise ### What Should I Expect Living With Retinitis Pigmentosa? RP does not follow a predictable timeline, in part because so many different genes can be involved — and different genetic forms of the disease progress in different ways and at different rates. This is why genetic testing and counseling are so important for anyone diagnosed with retinitis pigmentosa. Don't hesitate to ask your provider about clinical trials, support groups, or vision aids that may help improve your quality of life. ### When Should I Contact My Eye Care Provider? As a general rule, schedule eye exams on a regular basis. Always reach out to your provider promptly if you notice new or worsening symptoms, including: - A noticeable change in vision — whether in sharpness or color perception - New feelings of discomfort or eye pain ### A Note from Cleveland Clinic There are many different types of retinitis pigmentosa, and not all of them lead to total blindness. The best way to preserve as much vision as possible is to stay consistent with eye exams and follow the guidance of your care team. Ask your provider about clinical trial opportunities and support groups that may be available to you. While many experiences with RP are shared, your journey is also shaped by your own unique genetic makeup — and that matters. **Source:** <https://my.clevelandclinic.org/health/diseases/17429-retinitis-pigmentosa> ---
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Care planRingwormRingworm (tinea), also known as dermatophytosis, is a common skin infection that causes itchy, red patches. Despite its misleading name, ringworm has nothing to do with worms — it's actually caused by a fungus and spreads very easily from person to person. ## Understanding Ringworm ### What Does Ringworm Look Like? Symptoms can vary depending on where the infection takes hold and how widespread it is. The telltale sign of ringworm is a raised, ring-shaped rash that is red and mildly inflamed, with scaly edges and a patch of normal-looking skin at the center. It tends to be quite itchy and can sometimes blister or ooze. This distinctive rash can be triggered by several different fungi and can appear virtually anywhere on the body — on the skin (tinea corporis), scalp (tinea capitis), or nails (tinea unguium). You may already know ringworm by its more familiar names: when it strikes the feet, it's called athlete's foot (tinea pedis); when it shows up in the groin, it's called jock itch (tinea cruris). ### What Causes Ringworm? Despite its name, ringworm is caused by a fungus, not a worm. It develops when microscopic fungi latch onto your body, much like tiny parasites. These fungi — called **dermatophytes** — thrive in the cells of the outermost layer of your skin. Ringworm is highly contagious and can pass from person to person through direct skin contact. It can also spread from animals to humans — including cats, dogs, ferrets, rabbits, goats, pigs, and horses. You can even pick it up indirectly by touching objects that have been in contact with an infected person, such as towels, bedding, shower or pool surfaces, and combs or brushes. In rare cases, contact with fungus-contaminated soil can also be a source of infection. ### Who Is Most at Risk? The fungi responsible for ringworm thrive in warm, moist environments. Infections tend to be more common in summer and can affect people of any age. The following factors can increase your chances of developing ringworm: - Having close contact with an infected person or their belongings - Having had a previous fungal infection - Having a weakened immune system due to AIDS, cancer, or diabetes - Living in a warm, humid climate - Wearing tight, damp clothing — like a bathing suit — for extended periods of time - Playing contact sports, such as wrestling or football - Sweating excessively ### How Is Ringworm Diagnosed? Doctors can usually identify ringworm just by examining the appearance of the affected skin. In some cases, a small scraping of skin may be collected and viewed under a microscope to confirm the diagnosis. ### Standard Treatment Options Ringworm often responds well to simple self-care and typically clears up on its own within about four weeks. Helpful measures include: - Keeping the affected area clean and dry - Washing sheets and bedding every day while infected to help prevent the infection from spreading - Applying over-the-counter antifungal lotions, powders, creams, or ointments that contain clotrimazole (Lotrimin AF), miconazole (Micatin), terbinafine (Lamisil), or tolnaftate (Tinactin) If ringworm is severe, has spread over large areas of the body, or isn't responding to self-care, a doctor may prescribe stronger prescription antifungal creams or oral medications such as Sporanox and Diflucan. These drugs can carry unwanted side effects — including rash, stomach upset, and changes in liver function — and may also interfere with the blood thinner warfarin (Coumadin). ### Natural Approaches to Ringworm The best strategy is prevention. Keeping your feet dry and wearing breathable footwear can go a long way toward preventing both infection and recurrence. Changing your socks frequently — especially in warm weather or after physical activity — and thoroughly drying your feet and the spaces between your toes after swimming or bathing are also smart habits. In addition to the self-care steps described above, eating one or two cloves of raw garlic each day is recommended, as garlic is a potent natural antifungal agent. Tea tree oil can work just as well as pharmaceutical antifungal products — without the side effects. Apply a thin layer to the affected area three or four times a day, and continue applying it for two weeks after the infection has cleared to make sure the fungus is fully eliminated. ---
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Care planSarcopeniaSarcopenia is the gradual, age-related loss of muscle mass and strength that begins in your 30s and quietly accelerates with each passing decade. It's one of the most underappreciated threats to long-term health — not just because it weakens muscles, but because it chips away at your ability to move freely, stay independent, and live well. This protocol covers what drives muscle loss, the real risks of being underweight, and proven strategies for gaining muscle and healthy weight through both lifestyle and targeted nutritional support. ## Understanding Sarcopenia From the moment you're born until around your 30th birthday, your muscles are growing — getting bigger, stronger, and more capable. But somewhere in your 30s, that tide begins to turn. If you live a physically inactive lifestyle, you could lose as much as 3% to 5% of your muscle mass every decade after age 30. And even if you stay active, some degree of muscle loss is still inevitable. There's no single test or magic number that officially "diagnoses" sarcopenia — any loss of muscle is meaningful, because it chips away at your strength and your ability to move freely through the world. Sarcopenia tends to accelerate around age 75, though for some people it picks up speed as early as 65 or as late as 80. It is a major contributor to frailty, and it significantly raises the risk of falls and fractures as we get older. ### What Does Sarcopenia Feel Like — and What Causes It? The most noticeable symptoms are weakness and fatigue, which can make it harder to stay physically active — and less activity, in turn, causes even more muscle to melt away. It's a frustrating cycle. While sarcopenia is most common in people who are sedentary, the fact that it also affects physically active individuals tells us that other forces are at work. Researchers believe these include: - A decline in the nerve cells responsible for sending signals from the brain to the muscles to initiate movement - Falling levels of key hormones, including growth hormone, testosterone, and insulin-like growth factor - A reduced ability to convert protein into energy - Not consuming enough calories or protein each day to maintain muscle mass ### How Is Sarcopenia Treated? The cornerstone of sarcopenia treatment is exercise — specifically resistance training or strength training. These activities build muscle strength and endurance using weights or resistance bands. Resistance training benefits your neuromuscular system and your hormones. It can also improve an older adult's ability to convert protein into energy in as little as two weeks — a remarkably fast turnaround. Getting the right combination of exercise volume, intensity, and frequency is crucial for maximizing results while minimizing injury risk. Working with an experienced physical therapist or personal trainer to design a plan tailored to you is strongly recommended. --- ## Understanding Underweight and Unhealthy Weight Loss About two thirds of people in the US are either overweight or obese. However, there are also many people with the opposite problem of being too skinny. **This is a concern, as being underweight can be just as bad for your health as being obese.** Additionally, many people who are not clinically underweight still want to gain some muscle. Whether you're clinically underweight or simply struggling to gain muscle weight, the main principles are the same. ### What Does It Actually Mean to Be Underweight? Being underweight is defined as having a body mass index (BMI) below 18.5 — a level considered too low to support optimal health. For reference, a BMI over 25 is classified as overweight, and over 30 as obese. That said, BMI has well-known limitations — it only accounts for height and weight, completely ignoring muscle mass. Some people are naturally lean and perfectly healthy. Falling below 18.5 on the BMI scale doesn't automatically mean something is wrong. Being underweight is about 2–3 times more common among girls and women than men. In the US, 1% of men and 2.4% of women aged 20 and older fall into this category. ### What Are the Real Health Risks of Being Underweight? Obesity rightfully gets a lot of attention as a global health crisis — but being underweight carries serious risks of its own. According to one study, being underweight was associated with a 140% greater risk of early death in men, and 100% in women. Compare that to obesity, which was associated with a 50% greater risk of early death — suggesting that being underweight may actually be even more dangerous for your long-term health. Another study found an increased risk of early death specifically in underweight men but not women, hinting that the consequences may differ by sex. Beyond mortality, being underweight can weaken your immune system, increase your vulnerability to infections, lead to osteoporosis and bone fractures, and cause fertility problems. People who are underweight are also far more likely to develop sarcopenia and may face a higher risk of dementia. ### What Can Cause Someone to Become Underweight? Several medical conditions can drive unhealthy weight loss, including: - **Eating disorders:** This includes anorexia nervosa, a serious mental disorder. - **Thyroid problems:** Having an overactive thyroid (hyperthyroidism) can boost metabolism and cause unhealthy weight loss. - **Celiac disease:** The most severe form of gluten intolerance. Most people with celiac disease don't know that they have it. - **Diabetes:** Having uncontrolled diabetes (mainly type 1) can lead to severe weight loss. - **Cancer:** Cancerous tumors often burn large amounts of calories and can cause someone to lose a lot of weight. - **Infections:** Certain infections can cause someone to become severely underweight. This includes parasites, tuberculosis, and HIV/AIDS. If you're underweight, it's worth seeing a doctor to rule out any serious underlying conditions — especially if you've recently been losing significant weight without trying. ---
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Care planScheuermann's Disease## Understanding Scheuermann's Disease Scheuermann's Disease is a developmental condition affecting the spine. You may also hear it called Calvé disease or juvenile osteochondrosis of the spine. Scheuermann's disease disrupts the normal growth of the vertebrae — most commonly in the thoracic (upper) spine, though it can also affect the lumbar (lower) spine. In Scheuermann's disease, the back side of the vertebral body grows normally while the front grows more slowly or abnormally. This creates a wedge-shaped vertebra — and a chain reaction that increases the natural curve of your upper back, a condition known as increased dorsal kyphosis, or a more pronounced "hunchback" posture. Alongside this wedging, changes also occur at the junction between the spinal discs and the vertebrae — called endplate irregularities. When disc material pushes into the vertebra through these irregular zones, it creates what are known as Schmorl's nodes, which are typically visible on an X-ray. Schmorl's nodes are permanent, but they don't appear to cause any long-term problems. In fact, many people only discover they have them incidentally — when getting an X-ray for something entirely unrelated — and have never experienced a day of back pain. ### What Causes Scheuermann's Disease? Scheuermann's disease tends to run in families, and it affects males and females roughly equally. Its exact cause remains unknown, but it is likely the result of multiple contributing factors working together. Those factors may include juvenile osteoporosis (low bone density in youth), problems with nutrient absorption, infection, hormonal disorders, and physical/mechanical factors such as a shortened breastbone (sternum). ### What Does Scheuermann's Disease Feel Like? Scheuermann's disease most commonly causes pain in and around the upper back (thoracic spine). It can also produce a more noticeable rounding of the mid-to-upper back, and may limit how far you can bend backward (a motion called extension). Pain often flares with physical activity — particularly sports that involve a lot of twisting, or forceful bending and arching of the spine, such as gymnastics, cricket, or track and field events. ### How Is Scheuermann's Disease Diagnosed? A standard plain X-ray is usually all that's needed to confirm a diagnosis of Scheuermann's Disease — it will show the characteristic wedging of the thoracic vertebrae and, sometimes, the Schmorl's nodes. An MRI can provide a more detailed picture if needed. ### How Is Scheuermann's Disease Treated? **PHASE I — Relieving Pain & Protecting Your Spine** Getting your pain under control is the main reason you're seeking care — and while pain may be the last symptom to develop, it's typically the first to improve with the right treatment. Inflammation associated with Scheuermann's disease is best addressed through nutritional support strategies, ice therapy, and techniques or exercises that take pressure off the irritated structures in your spine. Your practitioner will draw on a variety of tools to help reduce your pain and calm inflammation — including nutrition guidance, ice therapy, electrotherapy, acupuncture, unloading taping techniques, and soft tissue massage. Your doctor may also suggest a short course of non-steroidal anti-inflammatory medications like ibuprofen, or pain relievers such as paracetamol. During this phase, it's important to avoid activities that place heavy demands on your thoracic spine — including intense bending exercises like crunches or sit-ups. **PHASE II — Rebuilding Range of Motion & Strength** As your pain and inflammation subside, your physiotherapist will shift focus toward restoring as much movement as possible — with a particular emphasis on improving your ability to bend backward (extension). Equally important is rebuilding the muscles that support and control your spinal movement and posture. Your physiotherapist will evaluate how your muscles are working together and design an exercise program tailored specifically to your needs. **PHASE III — Getting Back to Full Activity** There is every reason to expect a full return to activity — including sport — after Scheuermann's disease. You may just need some guidance on safely reintroducing movements that involve twisting or strong spinal bending. A progressive exercise program will also help you rebuild sport- or activity-specific strength that may have been lost during your recovery period. **PHASE IV — Staying Ahead of Future Problems** Taking a proactive approach to your spinal health can significantly reduce your risk of future setbacks. Keeping your back flexible and your core muscles strong helps maintain better posture and gives your vertebrae the support they need to function well long-term. **Scheuermann's Disease Stretches:** <https://www.stretchify.com/scheuermanns-disease-stretches/> ### What Can I Expect Long-Term? (Prognosis) The pain from active Scheuermann's disease will eventually resolve, and for most people, their thoracic vertebrae will cause no further trouble. Some individuals may be left with a reduced range of motion, and those whose disease caused a significant degree of kyphosis (spinal curvature) may experience ongoing postural challenges. ---
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Care planSchizophreniaSchizophrenia is a serious mental illness that changes the way a person experiences reality. It can cause a mix of hallucinations, delusions, and severely disorganized thinking and behavior — all of which can make daily life extremely difficult, and in some cases, profoundly disabling. Schizophrenia is a lifelong condition, but it is treatable. Starting treatment early — before serious complications arise — can help bring symptoms under control and improve quality of life over the long term. ## Understanding Schizophrenia ### Recognizing the Symptoms Schizophrenia affects thinking, behavior, and emotions in many ways. While symptoms differ from person to person, they typically involve delusions, hallucinations, or disorganized speech — and they reflect a meaningful decline in a person's ability to function. Common symptoms include: - **Delusions.** These are deeply held false beliefs with no basis in reality. For example, you might believe you are being harmed or persecuted; that certain gestures or comments are secretly directed at you; that you have extraordinary powers or celebrity status; that someone is secretly in love with you; or that a major disaster is imminent. Delusions occur in the vast majority of people living with schizophrenia. - **Hallucinations.** These typically involve seeing or hearing things that aren't actually there. Yet for the person experiencing them, these perceptions feel completely real and vivid — as real as anything in everyday life. Hallucinations can involve any of the senses, but hearing voices is by far the most common. - **Disorganized thinking (speech).** Disorganized thinking reveals itself through disorganized speech. The ability to communicate effectively can break down — answers to questions may be only loosely connected, or completely off-topic. In rare cases, speech may involve stringing together random, meaningless words in a way that can't be understood, a phenomenon sometimes called "word salad." - **Severely disorganized or unusual physical behavior.** This can look very different from person to person — from childlike silliness to sudden, unpredictable agitation. Behavior tends to be aimless and purposeless, making it hard to complete tasks. It may include resisting instructions, holding strange or rigid postures, becoming completely unresponsive, or engaging in excessive, repetitive movements. - **Negative symptoms.** This term refers to a reduced or absent ability to function in ways most people take for granted. For example, a person may stop attending to personal hygiene, or seem emotionally flat — avoiding eye contact, showing little facial expression, or speaking in a monotone. They may lose interest in activities they once enjoyed, withdraw from social connections, or find it difficult to feel pleasure. Symptoms can shift in type and intensity over time — with periods of flare-ups and periods of relative calm. Some symptoms may persist continuously. In men, schizophrenia symptoms typically emerge in the early to mid-20s. In women, they tend to appear in the late 20s. It is uncommon for children to be diagnosed with schizophrenia, and it is rare for a first diagnosis to occur after age 45. ### Schizophrenia in Teenagers Schizophrenia symptoms in teenagers closely resemble those in adults, but the condition can be harder to recognize in younger people. Part of the reason is that some of the earliest warning signs overlap with typical teenage behavior, such as: - Pulling away from friends and family - A noticeable decline in school performance - Difficulty sleeping - Irritability or low mood - Loss of motivation It's also worth noting that recreational drug use — including marijuana, methamphetamines, or LSD — can sometimes produce symptoms that look similar to schizophrenia. Compared with adults, teenagers with schizophrenia may be: - Less likely to experience delusions - More likely to experience visual hallucinations ### When to Seek Help People with schizophrenia often don't recognize that what they're experiencing stems from a mental illness that needs medical care. As a result, it frequently falls to family members or close friends to take the first steps toward getting them help. ### How to Help Someone Who May Have Schizophrenia If you suspect someone you care about may be experiencing symptoms of schizophrenia, start by gently sharing your concerns with them. While you cannot force someone to seek professional help, you can offer steady encouragement and support — and assist them in finding a qualified doctor or mental health professional. If your loved one appears to be a danger to themselves or others, or is unable to meet their own basic needs for food, clothing, or shelter, it may be necessary to call 911 or other emergency services so they can be evaluated by a mental health professional. In some situations, emergency hospitalization may be required. Laws governing involuntary psychiatric care vary from state to state. Your local community mental health agency or police department can provide information specific to your area. ### Suicidal Thoughts and Crisis Situations > ⚠️ **IMPORTANT NOTE:** Suicidal thoughts and behaviors are unfortunately common among people with schizophrenia. If someone you love appears to be at risk of attempting suicide — or has already made an attempt — do not leave them alone. Call 911 or your local emergency number right away. If you can do so safely, take the person directly to the nearest hospital emergency room. ### What Causes Schizophrenia? The exact cause of schizophrenia remains unknown, but researchers believe it results from a combination of genetic, neurological, and environmental factors working together. Disruptions in certain naturally occurring brain chemicals — particularly the neurotransmitters dopamine and glutamate — are thought to play a role. Brain imaging studies have also revealed structural and functional differences in the central nervous systems of people with schizophrenia. While the full meaning of these differences is still being explored, they point clearly to schizophrenia as a disease of the brain. ### Who Is at Risk? While no single cause has been identified, several factors appear to raise the likelihood of developing schizophrenia, including: - A family history of schizophrenia - Certain pregnancy or birth complications, such as nutritional deficiencies (especially choline deficiency) or prenatal exposure to toxins or infections that may affect brain development - Use of mind-altering substances (psychoactive or psychotropic drugs) during the teenage years or early adulthood ### Potential Complications Without treatment, schizophrenia can significantly affect nearly every area of a person's life. Conditions and challenges that may arise alongside or as a result of schizophrenia include: - Suicide, suicide attempts, and suicidal thoughts - Anxiety disorders and obsessive-compulsive disorder (OCD) - Depression - Misuse of alcohol, drugs, or nicotine - Inability to work or continue with school - Financial hardship and homelessness - Social isolation - Physical health problems - Becoming a victim of crime or exploitation - Aggressive behavior, though this is uncommon ### Can Schizophrenia Be Prevented? There is no guaranteed way to prevent schizophrenia. However, staying committed to a treatment plan can go a long way toward preventing relapses and keeping symptoms from worsening. Researchers also hope that a better understanding of risk factors will eventually allow for earlier diagnosis and intervention — making a real difference in people's lives. **Source:** <https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443> ---
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Care planScoliosisScoliosis is an abnormal sideways curvature of the spine that is most commonly diagnosed during adolescence. While scoliosis can develop in children with conditions like cerebral palsy and muscular dystrophy, the underlying cause of most cases in childhood remains unknown. Most cases of scoliosis are mild, but in some children, the curve gradually worsens during periods of growth. Severe scoliosis can become significantly debilitating. A particularly serious spinal curve can actually squeeze the space inside the chest, making it harder for the lungs to work properly. Children with mild scoliosis are monitored carefully over time — typically with X-rays — to track whether the curve is progressing. In many cases, no treatment is needed at all. Some children may need to wear a back brace to keep the curve from worsening, while others may ultimately require surgery to correct more serious curves. **Scoliosis falls into two main categories:** idiopathic at 90% (meaning no other underlying disease is responsible) and secondary at 10% (these are less common cases, often associated with neuromuscular conditions like tetraparesis, among others). ### What Are the Signs and Symptoms? Common signs and symptoms of scoliosis include: - Uneven shoulders. - One shoulder blade that sticks out more than the other. - An uneven waistline. - One hip sitting higher than the other. - One side of the rib cage pushing forward. - A visible hump on one side of the back when bending forward. In most cases of scoliosis, the spine doesn't just curve side to side — it also rotates or twists. This causes the ribs or muscles on one side of the body to protrude farther than those on the other side. ### What Causes Scoliosis? **Doctors don't yet know what causes the most common type of scoliosis** — though genetics appear to play a role, since the condition sometimes runs in families. Less common types of scoliosis may be caused by: - **Certain neuromuscular conditions,** such as cerebral palsy or muscular dystrophy. - **Birth defects** that affect how the bones of the spine develop. - **Prior chest wall surgery** performed during infancy. - **Injuries to or infections** of the spine. - **Irregularities of the spinal cord.** ### Who Is Most at Risk? The following factors can increase a child's risk of developing the most common type of scoliosis: - **Age.** Signs and symptoms typically first appear during adolescence. - **Sex.** Although boys and girls develop mild scoliosis at roughly the same rate, girls face a significantly higher risk of their curve worsening to the point of needing treatment. - **Family history.** Scoliosis can run in families, though most children diagnosed with scoliosis have no family history of the condition. ### Potential Complications While most people with scoliosis have a mild form of the condition, in some cases scoliosis can lead to more serious complications, including: - **Breathing difficulties.** In severe scoliosis, the rib cage can press against the lungs, making it noticeably harder to breathe. - **Chronic back pain.** People who had scoliosis as children may be more prone to persistent back pain as adults, particularly if their curves were large and left untreated. - **Changes in appearance.** As scoliosis progresses, it can produce increasingly visible changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and torso to one side. Many people with scoliosis become self-conscious about these changes in their body. ### How Is Scoliosis Diagnosed? Your child's care team will begin with a thorough medical history and may ask about recent growth patterns. During the physical exam, your provider will likely ask your child to stand and then bend forward at the waist with arms hanging freely — this helps reveal whether one side of the rib cage appears more prominent than the other. Your provider may also perform a neurological exam to assess: - Muscle weakness. - Numbness. - Reflexes. ### Imaging Tests Standard X-rays can confirm a scoliosis diagnosis and help determine how serious the spinal curve is. Since multiple X-rays are taken over the years to monitor progression, repeated radiation exposure can become a concern over time. To reduce this risk, your provider may recommend a specialized imaging system that uses lower radiation doses to create a detailed 3D model of the spine. However, this technology is not yet available at all medical centers. Ultrasound is another alternative, though it tends to be less precise when measuring the severity of the curve. Magnetic resonance imaging (MRI) may be recommended if your provider suspects that an underlying issue — such as a spinal cord irregularity — is driving the scoliosis. ### How Balancing Hormones and Improving Nutrition Can Help Slow Scoliosis Progression Better nutrition and targeted supplementation may genuinely help children with idiopathic scoliosis. Multiple studies have confirmed that nutritional deficiencies can influence how scoliosis develops, although exactly how nutrition affects the condition is still not fully understood. An unhealthy diet, low levels of key minerals in the body, and hormonal imbalances can all contribute to scoliosis getting worse over time. That said, poor nutrition alone does not cause idiopathic scoliosis — a child either carries the genetic predisposition or does not. However, research does link nutritional deficiencies to the acceleration of the condition once it's present. Scoliosis is a genetic neuromuscular condition that may or may not progress. Under normal circumstances, a child's brain would continuously send signals to the muscles instructing them to keep the spine straight as it grows. In a child with scoliosis, however, the brain fails to recognize that the body's posture is out of alignment — and so those corrective signals are never sent. This breakdown in communication, combined with environmental triggers like poor nutrition or certain physical activities, can accelerate scoliosis progression. ### Addressing Hormonal Deficiencies to Enhance Treatment Outcomes Research from European studies links scoliosis progression to deficiencies in certain hormones — and to the brain's impaired ability to respond to them. These hormones include serotonin, melatonin, calmodulin, leptin, and growth hormones. The brain communicates with the rest of the body through chemical messengers called neurotransmitters, which help regulate the flow of signals from the brain to the body. That flow of communication can be sped up, slowed down, or blocked entirely when a child's neurotransmitters are running low. Because neurotransmitters are typically composed of amino acids and specific B vitamins, targeted supplementation can address many of these imbalances — including serotonin deficiency. Serotonin is essential for the body's ability to maintain proper upright posture dynamically. The body also converts serotonin into melatonin, another hormone whose deficiency has been linked to scoliosis. Amino acid supplementation can help correct both of these hormonal imbalances, supporting the neuromuscular retraining process that is so important in stopping scoliosis from progressing further. ---
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Care planSeasonal Affective Disorder (SAD)Seasonal Affective Disorder (SAD) — also called Seasonal Affective Depressive Disorder (SADD) — is a form of depression that follows the calendar: it arrives in the fall or winter and lifts in the spring and summer, almost like clockwork. ## Understanding Seasonal Affective Disorder ### What Causes SAD? SAD can begin as early as adolescence or young adulthood, and like most forms of depression, it affects women more often than men. The exact cause isn't fully understood, but researchers believe several factors play a role, including: - How much natural or "full-spectrum" light you're exposed to - Your body temperature regulation - The balance of hormones and brain chemicals (neurotransmitters) - Your vitamin D levels In rare cases, a similar pattern of depression occurs in summer rather than winter. ### Recognizing the Symptoms Symptoms tend to build slowly as the days get shorter in late autumn and winter. - Afternoon energy crashes with difficulty concentrating - Increased appetite and weight gain (unlike most other forms of depression, which tend to suppress appetite) - Sleeping more than usual and feeling drowsy during the day (again, the opposite of what's typical in other types of depression) - Low energy and a loss of interest in work or activities you normally enjoy - Feeling physically sluggish and slow - Pulling away from friends and family - Persistent unhappiness and irritability ### Start Here: The Fundamentals For any mood disorder, *"First and foremost, one should be addressing diet, exercise, base nutrition, essential fatty acids, and additional Vitamin D"* — Jay Lombard, DO We already know that diet and the nutritional quality of what we eat are deeply connected to conditions like heart disease, obesity, and diabetes. But the science is equally clear on something many people overlook: *"However current research also documents that what we consume, and the nutrient / phytonutrient density of what we consume, (or lack of), has significant implications for the brain, thus the need to address 'base nutrition / phyto-nutrition, and essential fatty acids.'"* Most of the health challenges Americans face stem from lifestyle and dietary habits — and depression is no exception. At the root of many cases of depression is dependence on nicotine, caffeine, and other stimulants. According to Joseph Beasley, M.D., the primary investigator of the landmark Kellog Report, "The Impact of Nutrition, Environment, and Lifestyle on Illness in America," the United States is a nation of addicts. Many people believe that smoking, drinking alcohol, or using drugs helps them relax or unwind. In reality, these substances make things worse. Any calming or euphoric effect is short-lived — and the aftermath adds more strain to an already taxed system. People dealing with depression or other mental health challenges need to make a full commitment to stopping smoking, reducing or eliminating alcohol, and cutting out coffee and other sources of caffeine. ### Smoking and Depression: A Hidden Connection Cigarette smoking plays a significant role in depression. At the center of nicotine's effects is its ability to trigger the release of stress hormones from the adrenal glands, including cortisol. Elevated cortisol is a well-recognized hallmark of depression. One of cortisol's most damaging effects on mood involves activating an enzyme called tryptophan oxygenase — which, when switched on, reduces the amount of tryptophan reaching the brain. Because the brain depends on tryptophan to produce serotonin (and melatonin), high cortisol effectively depletes these mood-regulating chemicals. Cortisol also makes the brain's serotonin receptors less responsive, so even the serotonin that remains has a harder time doing its job. Smoking also depletes vitamin C, since the body uses it to detoxify cigarette smoke. Low vitamin C levels in the brain have been linked to depression and emotional instability. ### Alcohol and Depression: What You Should Know If you're struggling with depression, cutting back on alcohol is essential. Alcohol is, at its core, a brain depressant. It ramps up stress hormone output, disrupts the normal functioning of brain cells, and throws off healthy sleep patterns. It also causes blood sugar to drop — a condition called hypoglycemia — which then triggers sugar cravings as the body tries to quickly restore its energy. That sugar spike, however, only worsens the blood sugar instability. This cycle of low blood sugar further aggravates the emotional and psychological struggles that often accompany alcohol use. ### Exercise: One of the Most Powerful Mood Boosters Available Regular exercise may well be the most effective antidepressant available — no prescription required. A wide body of research, from community-based surveys to clinical trials, has confirmed that exercise has profound effects on mood. Studies consistently show that getting active — whether through sports, fitness routines, or everyday physical activity — is strongly linked to lower levels of anxiety, depression, and that general "run-down" feeling. People who exercise regularly also report higher self-esteem and a greater overall sense of happiness and wellbeing. A large part of exercise's mood-lifting power comes from its ability to boost endorphins — the brain's natural "feel-good" chemicals. When endorphin levels are low, depression tends to follow. When they're elevated, so is your mood. Over 100 clinical studies have examined exercise as a treatment for depression, and the conclusion is consistent: exercise can be just as effective as antidepressant medications or psychotherapy. More recent, rigorously designed studies have confirmed this further. The most beneficial forms of exercise include strength training (weight lifting) and aerobic activities like brisk walking, jogging, cycling, cross-country skiing, swimming, aerobic dance, and racquet sports. The key is to exercise at an intensity that keeps your heart rate within your target training zone. ### How Nutrition Affects Depression Nutrition plays a critical and often underappreciated role in depression. To begin with, the brain needs a steady supply of blood sugar to function — so low blood sugar (hypoglycemia) must be taken seriously. Symptoms can range from mild to severe and include depression, anxiety, irritability, and other emotional disturbances; fatigue; headaches; blurred vision; excessive sweating; mental fog; incoherent speech; unusual behavior; and even seizures. Despite strong evidence linking hypoglycemia and depression, most physicians never consider it — even though research shows it is surprisingly common in people with depression. This oversight is particularly puzzling because, in some cases, simply removing refined carbohydrates from the diet is all it takes to relieve depression caused by blood sugar instability. Beyond glucose, the brain also relies on a constant supply of other nutrients. In fact, almost any nutritional deficiency can lead to impaired mental function. The human brain needs virtually every known nutrient to operate at its best — and correcting an underlying deficiency can restore mental clarity and relieve depression. Importantly, according to Dr. Werbach, one of the leading authorities on nutrition and mental health: *"Even in the absence of laboratory validation of nutritional deficiencies, numerous studies utilizing rigorous scientific designs have demonstrated impressive benefits from nutritional supplementation."* A high-quality, high-potency multivitamin provides a solid nutritional foundation to build on. When choosing a multivitamin and mineral supplement, look for one that covers the full spectrum of vitamins and minerals at meaningful levels. Among people with depression, the most commonly identified deficiencies are folic acid, vitamin B12, and vitamin B6. According to research published in *Lancet* and *Archives of General Psychiatry*, the genetic inability to efficiently convert folic acid into its two active forms (L-5-MTHF and 5-Formyl THF) is associated with anxiety and depression. ---
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Care planSemaglutide for Weight LossThe search for a safe and effective weight loss treatment can feel endless. Yet the newest anti-obesity medication, semaglutide, continues to make headlines — and for good reason. More than a year after its 2021 approval by the U.S. Food and Drug Administration, it remains one of the most talked-about medical breakthroughs in recent memory. The injectable drug, first used to treat diabetes, is the first medication since Saxenda (2014) approved for long-term weight management in the 70% of American adults living with obesity or excess weight. Study after study continues to confirm semaglutide's effectiveness for weight loss — and to reinforce a powerful message: obesity is a chronic metabolic disease, not a personal failure. Willpower and lifestyle changes alone are rarely enough. But semaglutide is not a miracle cure, and it isn't right for everyone. > *"It is important to remember that obesity is heterogenous, chronic and complex. There is no cure for obesity. It requires lifelong treatment that's not one size fits all."* > > **— Vijaya Surampudi, MD,** physician nutrition specialist and assistant director of the UCLA Weight Management Program (RFO) --- ## Understanding Semaglutide ### What Is Semaglutide — and What Is a GLP-1? Semaglutide belongs to a class of medications called **glucagon-like peptide-1 receptor agonists (GLP-1 RAs)**. It works by mimicking GLP-1, a hormone your gut naturally releases after you eat. One of GLP-1's key jobs is to prompt your body to release more insulin, which helps lower blood sugar (glucose). Because of this, doctors have used semaglutide for more than 15 years to help manage Type 2 diabetes. But at higher doses, GLP-1 also acts on the brain — specifically the regions that control appetite and feelings of fullness. When combined with a healthy diet and regular physical activity, semaglutide can lead to meaningful weight loss and a reduced risk of cancer, diabetes, and heart disease in people living with obesity or excess weight. ### Semaglutide's Weight Loss Potential Originally developed to treat Type 2 diabetes, semaglutide has generated significant excitement in the world of weight management. Clinical trial results have been striking — suggesting this medication may be a powerful tool in the fight against obesity. Like any medication, though, semaglutide comes with both benefits and important trade-offs worth understanding. For weight loss specifically, semaglutide is currently approved only under the brand name **Wegovy**. The standard dose is 2.4 milligrams, given once a week as a self-administered injection just under the skin. ### How Semaglutide Works Semaglutide is a GLP-1 receptor agonist, meaning it's designed to act like the natural hormone GLP-1. This hormone is released after you eat, and it plays a central role in regulating blood sugar. It does this by stimulating insulin release, slowing down digestion, and — importantly for weight loss — curbing appetite. Sold under the brand names **Ozempic** (injectable) and **Rybelsus** (oral tablet), semaglutide received FDA approval for Type 2 diabetes management in 2017. It's given once weekly by injection. While diabetes management is its original purpose, significant weight loss emerged as a notable and welcome effect — one that ultimately led to its approval as a dedicated weight loss therapy. ---
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Care planShin SplintsShin splints is the name for pain and tenderness along or just behind your shinbone — the large bone running down the front of your lower leg (called the **tibia**). They typically develop after intense exercise, sports, or any repetitive physical activity. Depending on the type, shin splints can cause pain along the front or outer side of your shin, or along the inner side of your lower leg just above the ankle. ## Understanding Shin Splints ### What Causes Shin Splints? Shin splints most often develop as a result of hard exercise, sports, or repetitive movement. Over time, that repeated impact and stress causes inflammation in the muscles, tendons, and the thin layer of tissue that wraps around the shinbone — and that inflammation is what produces the pain. ### What Are the Symptoms? The most common symptoms of shin splints include: - Pain along the front and outer side of the shin. It often first appears the moment your heel strikes the ground while running. Over time, the pain can become constant, and the shin may feel tender to the touch. - Pain along the inner side of the lower leg just above the ankle. This pain typically worsens when you rise up on your toes or roll your ankle inward — and it tends to get worse the longer the shin splint goes untreated. Keep in mind that the symptoms of shin splints can sometimes resemble those of other conditions. Always check with your healthcare provider to get a proper diagnosis. ### How Are Shin Splints Diagnosed? In most cases, your healthcare provider can diagnose shin splints by reviewing your medical history and performing a physical exam. X-rays are often needed as well. ### How Are Shin Splints Treated? The most important first step in treating shin splints is to stop the activity that's causing the pain and give your body time to heal. Additional treatment options may include: - Stretching exercises - Strengthening exercises - Cold packs / Ice — place ice packs on your shins for 15 to 20 minutes at a time - Over-the-counter pain relief medications, such as ibuprofen - Running shoes with a stiff heel and special arch support - Compression — try wearing a calf compression sleeve to help reduce inflammation around your shins - Elevation ### Can Shin Splints Be Prevented? You may be able to prevent shin splints by wearing properly fitted athletic shoes. It also helps to gradually — not suddenly — increase the intensity, duration, and frequency of any new exercise routine. Alternating between high-impact and low-impact activities, such as swimming or cycling, can give your shins a much-needed break and further reduce your risk. **Sources:** - <https://www.hopkinsmedicine.org/health/conditions-and-diseases/shin-splints> - <https://www.healthline.com/health/how-to-get-rid-of-shin-splints> - <https://draxe.com/fitness/shin-splints/> ---
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Care planShort Bowel SyndromeShort bowel syndrome is a condition in which your body cannot absorb enough nutrients from the foods you eat because you don't have enough small intestine. The small intestine is where the vast majority of the nutrients you consume are absorbed into your body during digestion. **Short bowel syndrome can develop when:** Part of the small intestine has been surgically removed. Conditions that may require removal of large portions of the small intestine include Crohn's disease, cancer, traumatic injuries, and blood clots in the arteries that supply blood to the intestines. Part of the small intestine is missing or damaged at birth. Some babies are born with a short small intestine or with a damaged small intestine that must be surgically removed. Treatment for short bowel syndrome typically involves specialized diets and nutritional supplements, and may require intravenous (IV) nutrition — delivered directly into a vein — to prevent malnutrition. ### Signs and Symptoms Common signs and symptoms of short bowel syndrome may include: - Diarrhea - Greasy, foul-smelling stools - Fatigue - Weight loss - Malnutrition - Swelling (edema) in the lower extremities ### What Causes Short Bowel Syndrome? Short bowel syndrome results from having portions of the small intestine surgically removed, or from being born with part of the small intestine missing or damaged. Conditions that may require surgical removal of portions of the small intestine include Crohn's disease, cancer, injuries, and blood clots. ### How Is Short Bowel Syndrome Diagnosed? To diagnose short bowel syndrome, your doctor may order blood or stool tests to measure nutrient levels. Additional tests may include imaging studies — such as an X-ray with a contrast material (barium X-ray), a CT scan, an MRI, or CT/MR enterography — that can reveal blockages or structural changes in the intestines. ### How Is Short Bowel Syndrome Treated? Your treatment plan for short bowel syndrome will depend on which parts of your small intestine are affected, whether your colon is intact, and your personal preferences. Treatment options for short bowel syndrome may include: - **Nutritional therapy.** People with short bowel syndrome will need to follow a specialized diet and take nutritional supplements. Some people may also need to receive nutrition through a vein (parenteral nutrition) or a feeding tube (enteral nutrition) to prevent malnutrition. - **Medications.** In addition to nutritional support, your doctor may recommend medications to help manage short bowel syndrome — such as drugs to control stomach acid, reduce diarrhea, or improve intestinal absorption after surgery. - **Surgery.** Surgery may be recommended for both children and adults with short bowel syndrome. Surgical options include procedures to slow the movement of nutrients through the intestine, a procedure to lengthen the intestine (autologous gastrointestinal reconstruction), and small bowel transplantation (SBT). **Source:** <https://www.mayoclinic.org/diseases-conditions/short-bowel-syndrome/symptoms-causes/syc-20355091> ---
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Care planSinusitisSinus infections (sinusitis) affect over 39 million Americans every year. They typically develop when the mucous membranes lining your nose and sinuses become irritated — by a cold, an allergy, or pollution, for example — and swell up in response. Once swollen, the tiny hair-like projections called cilia that coat these membranes (and are responsible for sweeping mucus along) slow down. At the same time, the irritation signals your mucous glands to ramp up production, secreting more mucus than usual to dilute any bacteria present. The result: mucus pools in your sinuses, where it can quickly become a breeding ground for infection. It's important to understand that antibiotics can actually make this problem worse. When used long-term, they can trigger serious complications that are difficult to reverse, including chronic yeast infections and a weakened immune system. What's more, as discussed below, **the vast majority of chronic sinusitis cases may be driven by mold or fungi rather than bacteria** — and antibiotics have absolutely no effect on fungi. ### Common Symptoms of a Sinus Infection - Congestion and pressure around your eyes, cheeks, and forehead - Thick, green, or yellow mucus - Toothache - Cold symptoms lasting more than 10 days - Postnasal drip (excess mucus draining down the back of your throat) - Fatigue --- ## Understanding Sinusitis ### Sinusitis Is Frequently Misdiagnosed One of the trickiest things about sinus problems is how easily they're misidentified. Sinus trouble and postnasal drip can actually be a telltale sign that mold or fungi are at the root of your symptoms. Groundbreaking research from the Mayo Clinic in the 1990s strongly suggests that **NEARLY ALL chronic sinusitis is caused by fungi — yet it gets blamed on bacteria and mistreated with antibiotics.** These findings were published in 1999 in two peer-reviewed journals, the *Journal of Allergy and Clinical Immunology* and *Mayo Clinic Proceedings*. Yet most physicians remain unaware of this research, or at least of its profound implications. A 1999 Mayo Clinic press release stated: > *"Mayo Clinic researchers say they have found the cause of most chronic sinus infections — an immune system response to fungus."* The Mayo Clinic study found that 96 percent of people with chronic sinusitis are "fungal sensitized," meaning their immune systems are reacting to inhaled fungal organisms. This explains why antibiotics so consistently fail for chronic sinusitis — they target bacteria, NOT fungi. In fact, antibiotics and steroids can actually worsen fungal-related infections by wiping out your body's natural biological defenses, effectively creating the ideal internal conditions for even more fungal growth. The bottom line: if you have chronic sinusitis, you MUST approach it as a potential fungal infection FIRST — not a bacterial one — even if that means having to bring your healthcare provider up to speed. A great starting point is sharing the Mayo Clinic study referenced above. The book *Mold: The War Within* is also a valuable resource. **References:** 1. K. Zhao, et al. *PLoS ONE.* October 13, 2011; 6(10): e24618. 2. Sinus Conditions. Centers for Disease Control and Prevention. December 12, 2011. 3. J.U. Ponikau, et al. *Mayo Clinic Proceedings.* September 1999; 74(9): 877–84. 4. Science Daily. September 10, 1999. 5. Kurt and Lee Ann Billings. *Mold: The War Within.* Amazon.com. August 31, 2010. ---
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Care planSkin Cancer PreventionTraditional sun protection methods like sunscreen and sunblock work well and are generally safe — but they have real-world limitations, especially when applied incorrectly or used inconsistently. Worry about sun-related skin damage — including skin cancer, premature aging, and the breakdown of collagen — has grown steadily, driving interest in complementary approaches to skin protection. While sun exposure is clearly linked to the mutations that cause basal cell carcinoma, squamous cell carcinoma, and melanoma, it also brings genuine benefits: vitamin D production, mood elevation, and even a natural sense of well-being tied to β-endorphin release. This creates a real tension for anyone who wants the good of sunlight without the harm. Standard protective steps — avoiding peak-hour sun, covering up, and wearing sunscreen — remain the foundation. But growing interest in whole-body, holistic care has fueled research into additional strategies, including dietary changes and oral supplements, which show real promise as added layers of photoprotection. ## Understanding Sun Protection ### Sunscreen and Sunblock Conventional sun protection products — chemical sunscreens and mineral-based sunblocks — are designed to be safe, stable, gentle on skin, and effective against the full spectrum of UV radiation. When used as directed, most modern formulations meet these goals and help reduce cumulative sun damage over time. That said, their real-world effectiveness is not without debate: some studies have reported higher rates of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma among regular sunscreen users — possibly because sunscreen gives people a false sense of security, leading to longer sun exposure; or due to concerns about certain ingredients; or even related to vitamin D deficiency. Speaking of ingredients — oxybenzone, a common chemical sunscreen agent, has been linked to photosensitivity reactions in some people and to coral reef damage in the environment, prompting restrictions in several regions. Despite these ongoing debates, sunscreen remains broadly recommended as an important tool for protecting your skin. ### Complementary and Alternative Approaches A growing body of research has identified several natural and integrative strategies that may offer additional photoprotection and skin cancer prevention — though most still need larger human trials before they can be formally recommended. - **Polypodium leucotomos** (fern extract) has some of the strongest evidence among natural agents, showing meaningful reductions in UV-induced DNA damage, inflammation, and sunburn — with very few side effects. - **Grape seed extract** (rich in proanthocyanidins) delivers antioxidant and anti-inflammatory benefits, with animal studies and small human trials supporting its role in UV protection and anti-aging effects. - **Coffee and tea (*Camellia sinensis*)** have been linked to a lower risk of skin cancer in some population-level studies — though results are mixed, and the benefit appears to depend on dose and how these beverages are prepared. - **Niacinamide (Vitamin B3)** has the most compelling human evidence of any supplement on this list: a landmark 2015 randomized controlled trial showed a 23% reduction in non-melanoma skin cancers among high-risk patients. - **Carotenoids (beta-carotene, lycopene)**, **genistein**, and **silymarin** have demonstrated photoprotective and cancer-fighting properties in animal studies, though confirmation in humans remains limited. - **Vitamins C and E**, primarily used as topical antioxidants, show potential for reducing UV-induced skin damage and supporting collagen production — though their ability to prevent skin cancer directly has not been firmly established. - **Vitamin D** has shown photoprotective effects and DNA repair benefits in both laboratory and human studies. - **Omega-3 fatty acids (EPA/DHA)** — With anti-inflammatory and immune-supporting properties, these healthy fats appear to reduce the immune suppression caused by UV exposure and may lower the risk of sun-induced skin cancer development. - **Curcumin** — The active compound in turmeric, curcumin dials down key inflammation and oxidative stress pathways, with animal studies showing meaningful reductions in UV-induced tumor formation. - **Green Tea Extract (EGCG)** — A potent plant compound with strong antioxidant and anti-inflammatory activity; both human and animal studies show protection against UV-induced DNA damage and a decreased risk of skin cancer. - **Resveratrol and Pterostilbene** — These plant-based compounds activate cellular repair pathways and encourage the natural elimination of damaged cells; animal and laboratory studies support their role in reducing tumor formation. - **Sulforaphane (from broccoli sprouts)** — Activates a critical cellular defense pathway (Nrf2) and boosts the body's own detoxification enzymes; protective effects against UV-induced damage and cancer development have been shown in animal studies and early human research. - **Silymarin**, a flavonoid complex derived from milk thistle seeds, possesses powerful antioxidant and anti-inflammatory properties that may help guard against skin cancer. Animal studies show that both topical and oral silymarin dramatically reduce UV-induced skin damage, tumor formation, and tumor size — with reductions in tumor incidence reported up to 74–96%. It works through multiple mechanisms: neutralizing harmful free radicals, reducing oxidative stress, calming inflammatory pathways, and activating tumor-suppressing proteins like p53. While human trials remain limited, the evidence paints a promising picture of silymarin as a chemoprotective ally against non-melanoma skin cancers and a meaningful complement to conventional sun protection. Taken together, these natural compounds may serve as **valuable add-ons** to conventional sun protection — working alongside standard measures to reduce oxidative stress, support the body's own DNA repair systems, and keep inflammation in check. No official clinical guidelines yet endorse their use, but the evidence increasingly supports their role as part of a well-rounded approach to photoprotection and long-term skin health. Every time your skin is exposed to UV radiation, it faces a wave of oxidative stress that can damage DNA and, over time, increase the risk of skin cancer. The body's own antioxidant defenses naturally weaken with age — but supplemental antioxidants and targeted nutrients may help pick up the slack, reducing oxidative stress and slowing the pace of skin damage. Research in both animal and human models shows that many topical and oral agents offer real, measurable photoprotective effects — though most studies are short-term, and definitive proof of skin cancer reduction in humans is still forthcoming. In the meantime, these agents may offer meaningful chemoprotective benefits as part of a broader strategy — while the most proven methods remain sun avoidance, protective clothing, and proper sunscreen use. Long-term human trials are still needed before formal recommendations can be made. **Adapted from the Review Article** — *Journal of Integrative Dermatology* — October 04, 2022 — Integrative Approaches to Skin Cancer Chemoprevention and Sun Protection: Beyond Sunscreen — Joseph Dodson, BS, Peter Lio, MD <https://www.jintegrativederm.org/article/38499-integrative-approaches-to-skin-cancer-chemoprevention-and-sun-protection-beyond-sunscreen> > 📝 **NOTE:** The majority of skin cancers do not originate from moles but rather from normal-looking skin. A major review in *JAMA Dermatology* found that: > > *"Most melanomas (70.9%) arise as new lesions rather than from preexisting nevi."* > > **Reference:** *JAMA Dermatol.* 2017;153(3):258–264. doi:10.1001/jamadermatol.2016.5979 ---
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Care planSleep ApneaSleep apnea is a condition that quietly robs you of restful sleep — not through tossing and turning, but through involuntary pauses in breathing, abnormally shallow breaths, and sudden, startling awakenings throughout the night. In fact, someone with sleep apnea can stop breathing up to 30 times every single hour — often for just a few seconds at a time, and often without ever realizing it's happening. Perhaps most surprising: many people with sleep apnea genuinely believe they're sleeping just fine. Make no mistake — this is far more than a snoring problem. Sleep apnea is a serious medical condition, and in some cases, a potentially life-threatening one. When breathing repeatedly stops and starts, less oxygen reaches the brain and the rest of the body. To compensate, the brain triggers a sudden awakening so you can gasp for air and reopen your airway. This cycle repeats night after night, producing a cascade of symptoms: loud snoring, choking sounds during sleep, poor sleep quality, and persistent fatigue and anxiety throughout the day. Lost sleep has real consequences — and they go well beyond feeling groggy. Over time, untreated sleep apnea raises the risk of serious conditions including heart disease, stroke, diabetes, obesity, depression, memory problems, weakened immune function, and sexual dysfunction. Sleep disruption has also been linked to car accidents, poor performance at work and school, and greater vulnerability to everyday illnesses like colds and flu. Many people with sleep apnea rely on a breathing mask (CPAP) to manage their symptoms — and while helpful, this approach doesn't address the root causes, including chronic inflammation of the throat and airway muscles. The good news is that sleep apnea can often be meaningfully improved — and even prevented — through targeted lifestyle changes: reaching a healthy weight, reducing inflammation throughout the body, improving your diet, and establishing a consistent exercise routine. --- ## Understanding Sleep Apnea ### Sleep Apnea by the Numbers - 50 million to 70 million Americans have sleep or wakefulness disorders, and sleep apnea affects at least 12 million to 18 million Americans every year. - It's most common among adults over 45 who are overweight, especially men — but it can also affect women, people of normal weight, and even children. - Men are twice as likely to have sleep apnea as women. But women have a higher chance if they become obese, are going through menopause, or drink excessive alcohol and smoke. - It's estimated that 4 out of every 100 middle-aged men and 2 out of every 100 middle-aged women have obstructive sleep apnea that causes noticeable symptoms. Studies show that sleep apnea occurs in about 2 percent of children and can occur even in very young children, especially if they're overweight. - According to the National Institute of Health, sleep apnea is the leading cause of excessive daytime drowsiness in adults. - Pauses in breathing associated with sleep apnea might last for 10 seconds to one minute and occur dozens of times per night. - A Yale University study found that sleep apnea is associated with double the risk for having a stroke. It can also increase blood pressure, risk for blood clots, and other cardiovascular diseases. - A February 2022 study from Japan points to a link between obstructive sleep apnea syndrome and increased joint pain and fatigue in postmenopausal women. <https://journals.lww.com/menopausejournal/Abstract/9000/Sleep_apnea_in_postmenopausal_women_is_associated.96803.aspx> - People who are obese have been found to have four times the risk of developing sleep apnea compared to people of normal weight. ---
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Care planSleep Terrors (Night Terrors)**Sleep Terrors (Night Terrors)** are episodes of sudden, intense fear — often accompanied by screaming and frantic movement — that happen while a person is still fully asleep. Frequently paired with sleepwalking, sleep terrors belong to a category of sleep disturbances called parasomnias — unwanted events that intrude on an otherwise peaceful night. Most episodes are brief, lasting anywhere from a few seconds to a few minutes, though some can run longer. Sleep terrors affect nearly 40 percent of children, and a much smaller share of adults. As alarming as they can be to witness, they are usually not a sign of something serious. Most children naturally grow out of them by the time they reach their teens. Treatment becomes important only when episodes are putting someone at risk of injury or consistently robbing the household of sleep. ## Understanding Sleep Terrors ### What Does a Sleep Terror Look and Feel Like? Sleep terrors are not the same as nightmares — and that distinction matters. A person waking from a nightmare knows they were dreaming and can often describe what frightened them. Someone in the middle of a sleep terror, by contrast, never actually wakes up. Children typically have no memory of the episode come morning. Adults may recall only a vague, fragmented impression of fear. Sleep terrors tend to strike during the first third to first half of the night, and are uncommon during daytime naps. They can sometimes transition into a sleepwalking episode. During a sleep terror, a person may: - Suddenly cry out or scream in terror - Bolt upright in bed with an expression of sheer fright - Stare wide-eyed, seemingly awake but unreachable - Break into a sweat, breathe rapidly, and show a racing pulse, flushed cheeks, and enlarged pupils - Kick and thrash about - Resist waking up, and seem disoriented if roused - Be impossible to console - Remember little to nothing about the episode the next day - In some cases, jump out of bed and move through the house, or become agitated if physically held back ### When Should You Talk to a Doctor? An occasional sleep terror, on its own, is rarely cause for alarm. If your child experiences them, feel free to bring it up casually at their next routine checkup. That said, it is worth scheduling a dedicated visit if sleep terrors: - Are happening more and more often - Are regularly disrupting sleep — for the affected person or anyone else in the household - Create a risk of injury - Leave the person excessively tired or struggling to function during the day - Persist past the teenage years, or appear for the first time in adulthood ### What Causes Sleep Terrors? Sleep terrors are classified as a parasomnia — an unwanted experience that surfaces during sleep. More specifically, they are a disorder of arousal, meaning they occur during N3 sleep: the deepest stage of non-rapid eye movement (NREM) sleep. Sleepwalking — which can occur alongside sleep terrors — is another disorder that arises from this same deep sleep stage. A number of everyday factors can set the stage for sleep terrors, including: - Sleep deprivation and deep fatigue - Stress - Disruptions to a normal sleep routine, travel, or fragmented sleep - Fever Sleep terrors can also be triggered by underlying conditions that interfere with restful sleep, such as: - Sleep-disordered breathing — a broad category that includes abnormal breathing patterns during sleep, the most familiar being obstructive sleep apnea - Restless legs syndrome - Certain medications - Mood disorders, including depression and anxiety - In adults, alcohol use ### Who Is Most at Risk? Sleep terrors tend to run in families — if a parent or sibling has a history of sleep terrors or sleepwalking, the likelihood increases. Among children, sleep terrors appear more commonly in girls. ### Possible Complications While sleep terrors are usually not dangerous in and of themselves, they can lead to real-world consequences, including: - Excessive daytime sleepiness, which can affect performance at school or work and make everyday tasks harder - Chronically disrupted sleep - Feelings of embarrassment about the episodes, or strain on personal relationships - Physical injury to the person experiencing the episode, or rarely to someone nearby ### How Are Sleep Terrors Diagnosed? Diagnosing sleep terrors starts with a thorough review of your medical history and a careful discussion of your symptoms. Your evaluation may include: - **A physical exam.** Your doctor will examine you to look for any underlying conditions that might be contributing to the episodes. - **A detailed conversation about your symptoms.** In most cases, sleep terrors can be diagnosed based on your account of what happens. Your doctor may ask about your family's sleep history and may have you or your bed partner complete a questionnaire about nighttime behaviors. - **An overnight sleep study (polysomnography).** When needed, your doctor may recommend spending a night in a sleep lab. Small sensors placed on your body will track brain activity, blood oxygen levels, heart rate, breathing, and eye and leg movements throughout the night. Video recording may also be used to capture what your body is doing during different sleep stages. ### Treatment Options When sleep terrors are infrequent, treatment is usually not needed. However, when episodes pose a safety risk, disrupt the rest of others in the household, or cause significant embarrassment or sleep loss for the person affected, treatment becomes worthwhile. The focus is generally on keeping everyone safe and identifying — then addressing — whatever may be triggering the episodes. Treatment options may include: - **Treating any underlying condition.** When sleep terrors are linked to an underlying medical issue, mental health condition, or another sleep disorder — such as obstructive sleep apnea — addressing that root cause is the priority. - **Managing stress.** If stress or anxiety appears to be a driving factor, your doctor may refer you to a therapist or counselor. Approaches such as cognitive behavioral therapy, hypnosis, biofeedback, or relaxation therapy may all be helpful. - **Anticipatory awakening.** This technique involves gently waking the person approximately 15 minutes before they typically experience a sleep terror, keeping them awake for a brief period, and then allowing them to drift back to sleep. - **Medication.** Medication is rarely needed — especially in children. When it is, benzodiazepines or certain antidepressants may be effective options. ### What You Can Do at Home Whether sleep terrors are affecting you or your child, the following strategies are worth trying: - **Prioritize sleep.** Fatigue is a known contributor to sleep terrors. If you or your child is running on too little sleep, try moving bedtime earlier and sticking to a consistent schedule. A brief nap during the day may also help. When possible, minimize noise or other disruptions that could fragment nighttime sleep. - **Build a calming pre-bedtime routine.** Wind down with gentle, soothing activities before bed — reading, puzzles, or a warm bath all fit the bill. Relaxation exercises or meditation can also help ease the transition into sleep. Keep the bedroom quiet and comfortable. - **Make the sleep environment as safe as possible.** Close and lock windows and exterior doors at night. Consider locking interior doors or adding alarms or bells. Use gates to block stairways or doorways, clear away cords or other tripping hazards, avoid bunk beds, move breakable or sharp objects out of reach, and secure any weapons in the home. - **Address stress directly.** Take stock of what is causing stress and think through ways to manage it. If a child seems anxious or unsettled, make time to talk about what is on their mind. A mental health professional can offer additional support. - **Stay calm and offer reassurance during an episode.** If your child is having a sleep terror, the most helpful thing you can do is wait it out. It can be difficult to watch, but it will not hurt them. Gentle cuddling, soft words, and a calm presence can help guide them back to sleep. Avoid shaking or raising your voice — this tends to make things worse. Most episodes resolve on their own within minutes. - **Track the pattern.** If your child experiences sleep terrors regularly, consider keeping a sleep diary. Note how many minutes after falling asleep each episode tends to occur. If the timing is fairly predictable, anticipatory awakening may be a useful tool. **Source:** <https://www.mayoclinic.org/diseases-conditions/sleep-terrors/diagnosis-treatment/drc-20353529> **References:** 1. Sateia M. Sleep terrors. In: *International Classification of Sleep Disorders*. 3rd ed. Darien, Ill.: American Academy of Sleep Medicine; 2014. <http://www.aasmnet.org/EBooks/ICSD3>. Accessed May 11, 2017. 2. Parasomnias. *Merck Manual Professional Version*. <http://www.merckmanuals.com/professional/neurologic-disorders/sleep-and-wakefulness-disorders/parasomnias>. Accessed May 10, 2017. 3. Non-rapid eye movement sleep arousal disorders. In: *Diagnostic and Statistical Manual of Mental Disorders DSM-5*. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. <http://dsm.psychiatryonline.org>. Accessed May 9, 2017. 4. AskMayoExpert. Parasomnias. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016. 5. Kotagal S. Sleepwalking and other parasomnias in children. <https://www.uptodate.com/home>. Accessed May 10, 2017. 6. Foldvary-Schaefer N. Disorders of arousal from non-rapid eye movement sleep in adults. <https://www.uptodate.com/home>. Accessed May 10, 2017. 7. Fleetham JA, et al. Parasomnias. *Canadian Medical Association Journal*. 2014;186:E273. 8. Olson EJ (expert opinion). Mayo Clinic, Rochester, Minn. May 18, 2017. ---
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Care planSmall Intestinal Bacterial Overgrowth (SIBO) / Small Bowel Bacterial Overgrowth (SBBO)The nutritional support guidance below draws from the Great Lakes Conference 2017 ("Let's Get Specific with Dysbiosis and SIBO Diagnosis and Treatment," Bradley Bush, ND) and the 48-Hour Nutrition Certificate Program – 2016 (Charles Sefcik, DC, DACNB, CCN), along with informational articles by Kara Fitzgerald, ND and Thomas Sult, MD, IFMCP. A thriving gut microbiome — the complex community of microorganisms living in your digestive tract — is the foundation of a healthy immune system and overall well-being. When bacteria overgrow in the small intestine, a range of health problems can follow. This condition, known as **small intestinal bacterial overgrowth (SIBO)**, produces both gut-related and whole-body symptoms and is linked to a surprising number of other health conditions. The good news: restoring balance to your gut through personalized lifestyle changes and targeted nutritional support can make a dramatic difference. **Small intestinal bacterial overgrowth (SIBO) / Small bowel bacterial overgrowth (SBBO) is a condition in which abnormally large numbers of bacteria grow in the small intestine.** SIBO occurs when bacteria that normally belong in the large intestine end up growing — in large numbers — in the small intestine, where they do not belong. Under normal conditions, a wave-like muscular action called the **migrating motor complex (MMC)** sweeps the contents of your small intestine into the colon between meals. When the MMC isn't working properly, this "housekeeping" sweep fails — and bacteria that have wandered into the small intestine are free to take up residence, disrupting digestion and absorption and setting the stage for uncomfortable symptoms and chronic illness. The *World Journal of Gastroenterology* reports a clear connection between irritable bowel syndrome (IBS) and SIBO, and recommends ruling out SIBO before diagnosing a patient with IBS. The large intestine (colon) harbors a dramatically different population of bacteria — both in type and in sheer number — compared to the small intestine. The small intestine contains approximately 10,000 bacteria per milliliter of fluid, while the large intestine is home to approximately 1 trillion bacteria per milliliter of fluid. The main job of bacteria in the colon is to ferment carbohydrates that the body couldn't digest on its own, producing short-chain fatty acids that nourish and help regenerate the cells lining the colon. The small intestine's primary job is to digest and absorb nutrients from the food you eat. The bacteria that normally live there play a supporting role: they help with digestion and nutrient absorption, manufacture important vitamins, bolster gut immunity, and protect against harmful invaders. Enzymes from the pancreas and the small intestine's inner lining break down carbohydrates and release their nutrients into the bloodstream. Bile, produced by the liver and stored in the gallbladder, breaks down dietary fats and also helps drive the wave-like muscular contractions of the small intestine — the migrating motor complex — that keep food moving along for further digestion and absorption. When colonic bacteria end up in the small intestine, they shift that environment from one of digestion and absorption to one of fermentation — which is not what the small intestine is designed to do. When carbohydrates ferment instead of being properly digested, measurable amounts of hydrogen and methane gases are produced. This fermentation process generates a cascade of symptoms that can be very difficult to treat without first identifying and addressing the root cause. --- ## Understanding SIBO ### SIBO and Hydrogen Gas Bacteria produce hydrogen gas by fermenting carbohydrates that haven't been fully absorbed. Normally, only small amounts of hydrogen are generated from the modest quantity of unabsorbed carbohydrates that reach the colon. However, if carbohydrates are poorly absorbed and/or bacteria are overgrowing in the small intestine, far larger amounts of hydrogen can be produced. This hydrogen is absorbed through the walls of the small and large intestines, carried in the bloodstream to the lungs, and exhaled — which is what makes breath testing possible. Elevated hydrogen levels are most often associated with IBS-D (diarrhea-predominant IBS) and faster digestive transit times. ### SIBO and Methane Gas About 15 to 30% of people carry gut microbes called *Methanobrevibacter smithii*, which convert 4 hydrogen atoms into 1 molecule of methane. Because these microbes "use up" the hydrogen that would otherwise be exhaled, people with methane-producing gut bacteria may not show elevated hydrogen on a breath test — even when SIBO or carbohydrate malabsorption is present. Elevated methane levels tend to be associated with IBS-C (constipation-predominant IBS) and slower digestive transit times. Both hydrogen and methane are produced by bacteria — they are not byproducts of normal human metabolism. Elevated levels of either gas, or both, indicate bacterial overgrowth in the small intestine. ### What Causes SIBO? - Overuse of antibiotics - Dysbiosis (an imbalance in gut bacteria) - Overgrowth of Candida (a type of yeast) - Use of acid-blocking medications - Presence of *H. pylori* (a stomach bacterium) - Constipation or sluggish movement in the small intestine - Gallbladder disease or liver dysfunction leading to reduced bile production - Poor digestive enzyme function - A diet high in carbohydrates, sugar, or fructose - Ileocecal valve dysfunction (a valve between the small and large intestines) - Parasitic infections **Worth knowing:** the breakdown of nutrients by bacteria in the small intestine can also damage the delicate cells that line the intestinal wall. ### Medical Conditions That Can Set the Stage for SIBO - Complications from diseases or surgeries that create pouches or blockages in the small bowel, such as Crohn's disease - Diseases that slow movement through the small bowel, such as diabetes, liver disease (cirrhosis), nonalcoholic steatohepatitis (NASH), and scleroderma - Immune system deficiencies, such as AIDS or immunoglobulin deficiency - Short bowel syndrome, which can result from surgically removing a large portion of the small intestine - Small bowel diverticulosis, in which small pouches form in the inner lining of the intestine, creating spaces where bacteria can accumulate and overgrow. Although these pouches can develop anywhere along the intestinal tract, they are much more common in the large bowel than in the small bowel. - Certain surgical procedures, such as a Billroth II type of stomach removal (gastrectomy), which can create a loop of small intestine where bacteria can proliferate. ### Conditions Linked to SIBO Research has identified connections between SIBO and a wide range of conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), digestive motility disorders, chronic pancreatitis, cirrhosis, and various immune deficiency conditions.[1-3] The link with IBS is particularly strong: a 2020 systematic review and meta-analysis of 25 case-controlled studies — involving 3,192 IBS patients and 3,320 controls — found that SIBO was significantly more prevalent among people with IBS.[4] Additional research has found that SIBO is more common in people with active *H. pylori* infection[5] and celiac disease[6] and may also occur at higher rates in people with obesity,[7] rosacea,[8] and nonalcoholic fatty liver disease (NAFLD) compared to those without these conditions. In a small study of obese children with SIBO, researchers found an increased risk of developing NAFLD.[9] That study concluded that the relationship between gut bacterial imbalance and diet can influence the gut-liver connection.[9] A 2022 meta-analysis of 18 studies (n=1,263 total participants) found that among adults with chronic non-alcoholic fatty liver disease, SIBO was present in as many as 35% of cases.[10] ### What About Fungal Overgrowth? In a healthy digestive tract, both bacteria and fungi are most concentrated in the colon, with far smaller populations present in the small intestine. Just as SIBO can cause problems, **small intestinal fungal overgrowth (SIFO)** can produce a range of whole-body symptoms — including migraines, fatigue, depression, and bloating.[11] And like SIBO, sluggish gut movement (dysmotility) and reduced stomach acid from the use of proton pump inhibitors (PPIs, a common class of acid-blocking drugs) are recognized risk factors for SIFO as well.[1,12-14] While antibiotics are a common treatment for SIBO, antifungal therapy may be used to address SIFO. Dietary changes can be beneficial for both conditions.[1,15] A pilot study looked at combining a targeted dietary approach with antifungal medications in patients with chronic intestinal *Candida* overgrowth.[15] Ten days after both the diet group and the control group received antifungal treatment, both showed satisfactory antifungal and symptom relief with no statistically significant difference between them. However, at a follow-up visit three months later, the dietary intervention group had a significantly higher proportion of symptom-free patients (85%) compared to the control group (42.5%).[15] ### Recognizing SIBO: Signs and Symptoms The most common symptoms are: - Abdominal fullness - Abdominal pain and cramps - Bloating - Diarrhea (usually watery) Other symptoms may include: - Fatty stool - Weight loss Conditions commonly associated with SIBO: - Nausea - Flatulence - Constipation and malnutrition - Irritable bowel syndrome (IBS) - Leaky gut syndrome - Chronic fatigue syndrome - Acid reflux / GERD - Rosacea - Fibromyalgia ### Diagnosing SIBO: Finding the Root Cause and Planning Treatment SIBO can be challenging to diagnose, and because SIFO shares many of the same symptoms, fungal overgrowth may also be contributing to gut imbalance — making it an important factor to evaluate when searching for root causes and choosing the best treatment approach. Current evidence suggests there is no single gold-standard test for SIBO diagnosis.[16] According to the American College of Gastroenterology clinical guidelines, a culture of fluid collected from the small intestine (small bowel aspirate and culture) is often considered appropriate for diagnosis, as is breath testing for patients with IBS. The guidelines also acknowledge ongoing efforts to refine both the diagnostic criteria for SIBO and the best methods for testing.[1] When SIBO or SIFO is suspected, identifying and addressing the underlying conditions driving the microbial imbalance in the small intestine is essential. Research on the use of probiotics and prokinetics (agents that support gut motility) as part of SIBO treatment continues to grow.[17-20] Functional medicine approaches to improving gut health often include nutritional strategies to reduce carbohydrate fermentation in the gut — helping to curb both bacterial and fungal overgrowth — or elimination diets that remove trigger foods to reduce inflammation and ease symptoms. The Institute for Functional Medicine's **5R framework** offers a structured, step-by-step approach to a wide range of digestive health challenges, including SIBO and SIFO: Remove, Replace, Re-inoculate, Repair, and Rebalance — each step aimed at restoring natural balance to the GI system.[3] To read more about augmenting SIBO interventions with nutritional therapies, please read IFM's article *[Managing SIBO Through Dietary Interventions](https://www.ifm.org/news-insights/managing-sibo-dietary-interventions/)* by guest authors Kara Fitzgerald, ND, IFMCP, and Lara Zakaria, RPh, MSc, CNS, CDN, IFMCP. ### How SIBO Is Tested and Diagnosed - At-Home Breath Testing for SIBO — Neurovanna Laboratory, 105 New England Place, Suite 220, Stillwater, MN 55082 — Phone (651) 342-1043 — <www.neurovanna.com> for collection instructions and demonstration video. - SIBO 3-Hour Breath Test — #900 BioHealth Laboratory — 23900 Hawthorne Blvd #150, Torrance, CA 90505 — 800-570-2000 (USA/Canada) | 307-212-6600 | <www.biohealthlab.com> - Blood chemistry tests (such as albumin level) - Complete blood count (CBC) - Fecal fat test - Small intestine x-ray - Vitamin levels in the blood > 📝 **NOTE:** Ileocecal valve dysfunction and SIBO — the ileocecal valve is a smooth muscle and if it palpates as "hard," this seems to be a good indicator of SIBO. ### Treating SIBO The primary goal of treatment is to address the underlying cause of the bacterial overgrowth. Depending on the situation, antibiotics or medications that help speed up intestinal movement (prokinetics) may be recommended. Maintaining adequate hydration and nutrition is also a critical part of recovery. If dehydration has occurred, intravenous (IV) fluids may be needed. In cases where malnutrition is significant, nutrition delivered directly through a vein (total parenteral nutrition, or TPN) may be necessary. ### Potential Complications When SIBO is severe, malnutrition can result. Other possible complications include: - Dehydration - Excess bleeding due to vitamin deficiency - Liver disease - Osteomalacia (softening of the bones) or osteoporosis ### Other Names for This Condition Overgrowth — intestinal bacteria; Bacterial overgrowth — intestine **References:** - Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. *Cecil Medicine*. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011: chap 142. - 48-Hour Nutrition Certificate Program – 2016 / Charles Sefcik, DC, DACNB, CCN - "Let's Get Specific with Dysbiosis and SIBO Diagnosis and Treatment." Bradley Bush, ND. Great Lakes Conference 2017. **References [1–20]:** 1. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG clinical guideline: small intestinal bacterial overgrowth. *Am J Gastroenterol*. 2020;115(2):165-178. doi: 10.14309/ajg.0000000000000501 2. Lee AA, Baker JR, Wamsteker EJ, Saad R, DiMagno MJ. Small intestinal bacterial overgrowth is common in chronic pancreatitis and associates with diabetes, chronic pancreatitis severity, low zinc levels, and opiate use. *Am J Gastroenterol*. 2019;114(7):1163-1171. doi: 10.14309/ajg.0000000000000200 3. Patel SM, Young MC. The identification and management of small intestinal bacterial overgrowth: a functional medicine approach. *Phys Med Rehabil Clin N Am*. 2022;33(3):587-603. doi: 10.1016/j.pmr.2022.04.003 4. Shah A, Talley NJ, Jones M, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. *Am J Gastroenterol*. 2020;115(2):190-201. doi: 10.14309/ajg.0000000000000504 5. Zhu D, Wang XL, Dai Y, Li SY, Wang WH. [Influence of *Helicobacter pylori* infection and its eradication treatment on small intestinal bacterial overgrowth]. *Zhonghua Yi Xue Za Zhi*. 2022;102(42):3382-3387. doi: 10.3760/cma.j.cn112137-20220316-00551 6. Shah A, Thite P, Hansen T, et al. Links between celiac disease and small intestinal bacterial overgrowth: a systematic review and meta-analysis. *J Gastroenterol Hepatol*. 2022;37(10):1844-1852. doi: 10.1111/jgh.15920 7. Wijarnpreecha K, Werlang ME, Watthanasuntorn K, et al. Obesity and risk of small intestine bacterial overgrowth: a systematic review and meta-analysis. *Dig Dis Sci*. 2020;65(5):1414-1422. doi: 10.1007/s10620-019-05887-x 8. Wang FY, Chi CC. Rosacea, germs, and bowels: a review on gastrointestinal comorbidities and gut-skin axis of rosacea. *Adv Ther*. 2021;38(3):1415-1424. doi: 10.1007/s12325-021-01624-x 9. Belei O, Olariu L, Dobrescu A, Marcovici T, Marginean O. The relationship between non-alcoholic fatty liver disease and small intestinal bacterial overgrowth among overweight and obese children and adolescents. *J Pediatr Endocrinol Metab*. 2017;30(11):1161-1168. doi: 10.1515/jpem-2017-0252 10. Gudan A, Jamiol-Milc D, Hawrylkowicz V, Skonieczna-Zydecka K, Stachowska E. The prevalence of small intestinal bacterial overgrowth in patients with non-alcoholic liver diseases: NAFLD, NASH, fibrosis, cirrhosis — a systematic review, meta-analysis and meta-regression. *Nutrients*. 2022;14(24):5261. doi: 10.3390/nu14245261 11. Singh R, Mullin GE. A wasting syndrome and malnutrition caused by small intestine fungal overgrowth: case report and review of the literature. *Integr Med (Encinitas)*. 2017;16(3):48-51. 12. Su T, Lai S, Lee A, He X, Chen S. Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. *J Gastroenterol*. 2018;53(1):27-36. doi: 10.1007/s00535-017-1371-9 13. Jacobs C, Coss Adame E, Attaluri A, Valestin J, Rao SS. Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. *Aliment Pharmacol Ther*. 2013;37(11):1103-1111. doi: 10.1111/apt.12304 14. Banaszak M, Górna I, Wozniak D, Przyslawski J, Drzymala-Czyz S. Association between gut dysbiosis and the occurrence of SIBO, LIBO, SIFO and IMO. *Microorganisms*. 2023;11(3):573. doi: 10.3390/microorganisms11030573 15. Otaševic S, Momcilovic S, Petrovic M, Radulovic O, Stojanovic NM, Arsic-Arsenijevic V. The dietary modification and treatment of intestinal *Candida* overgrowth – a pilot study. *J Mycol Med*. 2018;28(4):623-627. doi: 10.1016/j.mycmed.2018.08.002 16. Adike A, DiBaise JK. Small intestinal bacterial overgrowth: nutritional implications, diagnosis, and management. *Gastroenterol Clin North Am*. 2018;47(1):193-208. doi: 10.1016/j.gtc.2017.09.008 17. Revaiah PC, Kochhar R, Rana SV, et al. Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics. *JGH Open*. 2018;2(2):47-53. doi: 10.1002/jgh3.12045 18. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for preventing and treating small intestinal bacterial overgrowth: a meta-analysis and systematic review of current evidence. *J Clin Gastroenterol*. 2017;51(4):300-311. doi: 10.1097/MCG.0000000000000814 19. Achufusi TGO, Sharma A, Zamora EA, Manocha D. Small intestinal bacterial overgrowth: comprehensive review of diagnosis, prevention, and treatment methods. *Cureus*. 2020;12(6):e8860. doi: 10.7759/cureus.8860 20. Nickles MA, Hasan A, Shakhbazova A, Wright S, Chambers CJ, Sivamani RK. Alternative treatment approaches to small intestinal bacterial overgrowth: a systematic review. *J Altern Complement Med*. 2021;27(2):108-119. doi: 10.1089/acm.2020.0275 ---
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Care planSmoking CessationTobacco smoke is one of the most well-documented chemical hazards in human history — and quitting smoking is one of the single most powerful things a person can do to protect their health. Of the more than **7,000 chemicals** found in tobacco smoke, at least **250 are known to be harmful** — including hydrogen cyanide, carbon monoxide, and ammonia. Of those, at least **69 are known to cause cancer.** No matter how long someone has smoked, quitting at any age can substantially reduce the risk of serious disease. ## Understanding Smoking and Its Dangers ### What's Actually in Tobacco Smoke? The cancer-causing chemicals in tobacco smoke include: - Arsenic - Benzene - Beryllium (a toxic metal) - 1,3-Butadiene (a hazardous gas) - Cadmium (a toxic metal) - Chromium (a metallic element) - Ethylene oxide - Nickel (a metallic element) - Polonium-210 (a radioactive chemical element) - Vinyl chloride **Additional toxic chemicals in tobacco smoke are also suspected of causing cancer,** including: - Formaldehyde - Benzo[α]pyrene - Toluene ### What Health Problems Does Smoking Actually Cause? Smoking damages nearly every organ in the body and takes a serious toll on overall health. Millions of Americans are living with health conditions directly caused by smoking. - **Smoking is a leading cause of cancer — and of dying from cancer.** It causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia. - **Smoking also causes heart disease, stroke, and aortic aneurysm** (a dangerous balloon-like bulge in an artery in the chest). - **It contributes to chronic obstructive pulmonary disease (COPD)** — which includes chronic bronchitis and emphysema — as well as asthma, hip fractures, and cataracts. - **Smokers are significantly more likely to develop pneumonia and other serious airway infections.** - **A woman who smokes during pregnancy is at higher risk of delivering her baby too early and at an abnormally low birth weight.** Smoking during or after pregnancy also raises the risk of Sudden Infant Death Syndrome **(SIDS)** — the unexplained death of an otherwise healthy infant. - **Men who smoke face a greater risk of erectile dysfunction.** - **Cigarette smoking and secondhand smoke exposure cause more than 440,000 premature deaths every year in the United States.** Of these, roughly 40 percent are due to cancer, 35 percent from heart disease and stroke, and 25 percent from lung disease. Smoking remains the leading cause of preventable, premature death in this country. The good news: no matter how long someone has smoked, quitting at any age can substantially reduce the risk of serious disease — including cancer. ### What Are the Risks of Tobacco Smoke to People Who Don't Smoke? Secondhand smoke — also called environmental tobacco smoke, involuntary smoking, or passive smoking — is a mixture of "sidestream" smoke (the smoke released from a burning tobacco product) and "mainstream" smoke (the smoke exhaled by the smoker). The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have all classified secondhand smoke as a known human carcinogen (cancer-causing agent). Inhaling secondhand smoke causes lung cancer in nonsmoking adults. Approximately **3,000 lung cancer deaths** occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke. The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker's chances of developing lung cancer by **20 to 30 percent**. Exposure to secondhand smoke may increase the risk of heart disease by an estimated **25 to 30 percent**. In the United States, exposure to secondhand smoke is thought to cause about **46,000 deaths from heart disease** each year. Pregnant women exposed to secondhand smoke are at risk of having a baby with low birth weight. Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand smoke slows the growth of children's lungs and can cause them to cough, wheeze, and feel breathless. ### Is Smoking Addictive? Yes — powerfully so. Nicotine is a naturally occurring drug found in the tobacco plant, and it is the primary reason people become addicted to cigarettes and other tobacco products. When you smoke, nicotine reaches your lungs almost instantly and travels to your brain within seconds. The addiction it creates is comparable to that produced by drugs like heroin and cocaine. The amount of nicotine varies widely across tobacco products, as do levels of cancer-causing substances and other toxicants. A single cigarette (which contains less than 1 gram of tobacco) can have between **13.7 and 23.2 milligrams** of nicotine per gram of dry tobacco. A cigar (which can contain as much as 20 grams of tobacco) may contain between **5.9 and 335.2 milligrams** of nicotine per gram of tobacco. That said, how you smoke matters more than what's on the label — nicotine is absorbed through the lungs and the lining of the mouth, and deeper, more frequent puffs deliver significantly more nicotine into your body. ### Is Any Tobacco Product Safer Than Cigarettes? No. All tobacco products are harmful, all cause cancer, and none should be used. There is no safe level of tobacco use. All forms of tobacco carry real risk, and all contain nicotine and cancer-causing substances. Anyone using any form of tobacco should be strongly encouraged to quit. Beyond conventional cigarettes and cigars, tobacco comes in many forms — each with its own documented risks: - **Cigars:** Information about cigars and cancer is available in the NCI fact sheet *Cigar Smoking and Cancer* at <http://www.cancer.gov/cancertopics/causes-prevention/risk/tobacco/cigars-fact-sheet>. - **Smokeless tobacco** (also known as chewing tobacco, snuff, and snus): Information about smokeless tobacco and cancer can be found in the NCI fact sheet *Smokeless Tobacco and Cancer* at <http://www.cancer.gov/cancertopics/causes-prevention/risk/tobacco/smokeless-fact-sheet>. - **Pipes:** Pipe smoking causes lung cancer and raises the risk of cancers of the mouth, throat, larynx, and esophagus. - **Hookahs or waterpipes** (other names include argileh, ghelyoon, hubble bubble, shisha, boory, goza, and narghile): A hookah is a device used to smoke tobacco in which the smoke passes through a partially filled water bowl before being inhaled. Many people believe hookah smoking is less harmful or less addictive than cigarettes — but this is a myth. All forms of tobacco smoking are harmful and addictive, and hookah smoke contains the same dangerous chemicals, including carbon monoxide and cancer-causing substances, as other forms of tobacco smoke. - **Bidis:** A bidi is a flavored cigarette made by rolling tobacco in a dried leaf from the tendu tree, which is native to India. Bidi use is associated with heart attacks and cancers of the mouth, throat, larynx, esophagus, and lung. - **Kreteks:** A kretek is a cigarette blended with tobacco and cloves. Smoking kreteks is associated with lung cancer and other serious lung diseases. ### What Happens to Your Body the Moment You Quit Smoking? The health benefits of quitting begin almost immediately: - Your heart rate and blood pressure — both abnormally elevated while smoking — begin returning to normal. - Within a few hours, carbon monoxide levels in your blood begin to drop. (Carbon monoxide reduces your blood's ability to carry oxygen.) - Within a few weeks, circulation improves, you produce less phlegm, and coughing and wheezing become less frequent. - Within several months, lung function can improve substantially. - Your sense of smell sharpens, and food begins to taste better. ### What Are the Long-Term Rewards of Quitting Smoking? Quitting smoking meaningfully reduces your risk of cancer, heart disease, COPD, and many other smoking-related illnesses. Regardless of age, people who quit are less likely to die from smoking-related disease than those who keep smoking: - **Quitting at age 30:** Studies show that smokers who quit around age 30 reduce their chances of dying prematurely from smoking-related disease by more than **90 percent**. - **Quitting at age 50:** People who quit around age 50 cut their risk of premature death by **50 percent** compared with those who continue to smoke. - **Quitting at age 60:** Even people who quit at age 60 or older live longer than those who keep smoking. ### Does Quitting Smoking Lower Your Cancer Risk? Yes. Quitting reduces both your risk of developing cancer and your risk of dying from it. It takes some years after quitting for cancer risk to begin declining, but the longer you stay smoke-free, the greater the benefit. Your overall risk depends on several factors: how many years you smoked, how many cigarettes you smoked per day, how old you were when you started, and your health status at the time you quit. For people who have already been diagnosed with cancer, quitting smoking reduces the risk of developing a second cancer. For people undergoing surgery, chemotherapy, or other treatments, quitting smoking helps the body heal more effectively and respond better to therapy. It also lowers the risk of pneumonia and respiratory complications — and may reduce the risk of the original cancer returning, or a new one developing. ---
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Care planSnoring*Adapted from an article by Dr. Josh Axe — "How to Stop Snoring – 11 Remedies that Work!"* Have you ever lain awake, frustrated, while your partner's snoring rattled the walls? Or perhaps you've startled yourself out of a deep sleep — only to realize the culprit was you? You're not alone. Here's something that might surprise you: everyone snores from time to time. It's a perfectly natural result of your throat relaxing during sleep. That said, when snoring becomes frequent or severe, it can wreak havoc on sleep quality — leaving both the snorer and their bed partner exhausted, irritable, and searching for answers. It's worth knowing, however, that snoring can sometimes signal something more serious: sleep apnea, a potentially dangerous condition in which breathing actually stops during sleep, jolting the sleeper awake to breathe again. Unlike garden-variety snoring, sleep apnea significantly disrupts sleep architecture. If you're waking up feeling utterly drained — exhausted despite a full night in bed — please don't brush it off. See your doctor. What feels like "just snoring" may need proper evaluation. Snoring is also one of the most common drivers of insomnia, a problem that affects nearly half of Americans — 48 percent report occasional sleeplessness, and 22 percent struggle with it consistently. The good news? Once you understand why you snore, there are real, practical solutions that can help you — and everyone else in your household — finally get a good night's rest. --- ## Understanding Snoring ### What Is Snoring and Why Does It Happen? At its core, snoring happens when airflow through your nose and throat is restricted during sleep. That restricted airflow causes the surrounding soft tissues to vibrate — and that vibration is the sound that keeps everyone awake. Some people are simply more prone to snoring because they have more soft tissue in their nose and throat — including the uvula, that small teardrop-shaped structure that hangs at the back of your mouth — that's more likely to vibrate. Your tongue position also plays a role: during sleep, it can fall backward toward the throat, narrowing the airway and setting the stage for that signature snoring sound. Beyond being an annoyance, chronic poor sleep carries real health consequences: weight gain, depression, cognitive impairment, hormonal imbalances, elevated blood pressure, increased risk of heart disease, stroke, and diabetes, and even accelerated aging. Sleep matters — deeply — and it's worth taking snoring seriously. ### What Causes Snoring? #### 🏃 1. Fitness Level and Body Composition Being overweight or physically inactive can worsen snoring significantly. Excess body fat — particularly fat deposited around the neck and throat — narrows the airway, making obstruction during sleep more likely. This is notably more common in men, who tend to gain weight around the neck more readily than women. When you lie on your back, that fatty tissue presses on the airway from the outside, compressing it further. The encouraging news: regular exercise, weight loss, and addressing obesity can sometimes eliminate snoring entirely — while delivering a host of other health benefits along the way. It's worth noting that children aren't immune. A study published in the *Journal of Paediatrics and Child Health* found that snoring and sleep apnea were significantly more prevalent in obese children. #### 🌡️ 2. Menopause As if the hormonal shifts of menopause weren't enough, this life stage can also bring an increased tendency to snore. As women age, muscle tone naturally decreases — including in the throat — and modest weight gain becomes more common. By around age 70, women are roughly as likely to snore as men of the same age. It's yet another reminder that staying active and maintaining a healthy weight throughout life pays dividends in ways we don't always anticipate. #### 🕰️ 3. Normal Aging As we move through middle age — roughly 45–64 — the throat naturally becomes narrower and muscle tone in the throat gradually declines. This is simply part of getting older. But it doesn't mean snoring is inevitable. Positive lifestyle habits, consistent sleep routines, and yes, even throat exercises can make a meaningful difference. #### 🧬 4. Why Men Snore More Than Women Men snore more frequently than women largely because of anatomy: men have naturally narrower air passages. Characteristics like a narrow throat, a cleft palate, or enlarged adenoids — all of which contribute to snoring — also tend to run in families, so genetics plays a role too. #### 🤧 5. Nasal and Sinus Congestion A stuffy or blocked nose forces you to work harder to inhale, creating a vacuum-like effect in the throat that promotes snoring. Keeping your home free of dust and allergens — and supporting your body's overall immune health — can help address both the congestion and the snoring it causes. (See: **[Sinus Infections (Sinusitis) – Chronic Sinusitis / Chronic Nasal-Drip](/plans/05c8cf81-03b2-58c2-b735-92c0df2f692e)**) #### 🍷 6. Alcohol, Smoking, and Certain Medications Alcohol, tobacco, and some medications — including tranquilizers and diazepam — all promote muscle relaxation, which exacerbates snoring. Smoking, beyond its many other harms, directly compromises lung and airway function. If you smoke, stopping is one of the most important things you can do for your breathing — and that includes electronic cigarettes as well. #### 🛏️ 7. Sleep Position Research confirms that the position in which you sleep has a significant impact on snoring and obstructive sleep apnea. A study published in *Scientific Reports* found that a specially designed head-positioning pillow reduced snoring sounds in most patients — regardless of whether they were overweight or normal weight. And a separate study from Amsterdam found that, on average, 56 percent of patients with obstructive sleep apnea had snoring that was significantly influenced by whether they slept on their back (supine) versus on their side. #### 🫁 8. Asthma The connection between asthma and sleep apnea — and the snoring that often accompanies it — is well established and perhaps not surprising. Both conditions share overlapping mechanisms, including intermittent low oxygen levels, nerve reflex changes, airway inflammation, and the effects of leptin. Other shared risk factors include certain medications, nasal disease, smoking, obesity, and acid reflux. Addressing asthma with natural, supportive strategies may therefore also help reduce snoring in those who live with both conditions. (See: **[Asthma](/plans/c389c315-d1ef-50bd-a16e-6677b3bcd143)**) ### What Kind of Snorer Are You? One of the most useful things you can do is figure out what type of snorer you are. Pinpointing the pattern behind your snoring is often the key to finding the right solution — and getting consistent, restful sleep. The best way to do this? Enlist your partner's help. Keep a simple sleep diary together to track when and how you snore. Patterns will emerge, and those patterns can point you toward the most effective remedy. Here are the four common snorer profiles: **The Closed-Mouth Snorer** — If your mouth stays shut while you snore, the issue likely originates with your tongue or nasal passages, rather than your throat tissue. **The Open-Mouth Snorer** — Snoring with your mouth wide open often points to throat tissue as the primary culprit. When the airway is partially blocked, your body's instinct is to force in more air — and that forced airflow through a narrowed space is what creates the snoring sounds. **The Back Sleeper Snorer** — Sleeping on your back tends to promote mouth breathing, which in turn makes snoring worse. Simply changing your sleep position may be a surprisingly effective fix. **The Every-Position Snorer** — If you snore loudly no matter how you position yourself, that's worth taking seriously — it may be a sign of sleep apnea or another underlying condition. Please see your doctor if your snoring is loud enough to keep your partner awake, you regularly wake yourself up, nothing you've tried has helped, or you snore in every sleeping position. A healthcare provider can offer a more targeted evaluation and personalized recommendations. (See: **[Sleep Apnea](/plans/eb1100c3-25bf-5bd7-a991-b2044425ddcd)**) ---
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Care planSoluble vs. Insoluble FiberFiber comes in two forms — soluble and insoluble — and both are essential for your health, your digestion, and your long-term disease prevention. All fiber originates from plant-based foods and travels through your digestive system largely intact — your body can't fully break it down the way it does other nutrients. The key distinction between the two types is simple: some fiber dissolves in water, and some doesn't. Both kinds matter. - **Soluble fiber** draws in water and forms a thick gel as it moves through your digestive tract, which naturally slows the digestive process. You'll find it in oat bran, barley, nuts, seeds, beans, lentils, peas, and certain fruits and vegetables. It's also the active ingredient in psyllium, one of the most widely used fiber supplements. Certain types of soluble fiber are linked to a reduced risk of heart disease. - **Insoluble fiber** — found in wheat bran, vegetables, and whole grains — doesn't dissolve in water at all. Instead, it adds bulk to your stool and helps move food through your stomach and intestines more efficiently. It's made up of plant structural components like cellulose and hemicellulose, and it's the reason high-fiber diets are so closely associated with digestive regularity. Most plant foods naturally contain both types of fiber, just in different proportions. Together, they form one of the most powerful and underappreciated pillars of a healthy diet — supporting everything from your gut to your heart to your hormones. ---
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Care planSpinal Stenosis**Spinal stenosis** is a narrowing of the spinal canal that puts pressure on the spinal cord, or a narrowing of the small openings (called neural foramina) through which spinal nerves exit the spine. ## Understanding Spinal Stenosis ### What Causes Spinal Stenosis? Spinal stenosis most commonly develops as a natural part of aging. - The cushioning discs between your vertebrae gradually dry out and begin to bulge inward. - The bones and ligaments of the spine thicken or enlarge — a process driven by arthritis or long-standing inflammation. Spinal stenosis can also develop from other causes, including: - Spinal arthritis, which most commonly affects middle-aged and older adults - Bone diseases, such as Paget disease - A structural defect or abnormal growth in the spine present from birth - A herniated or slipped disc, often from an injury in the past - A traumatic injury that compresses the nerve roots or spinal cord - Tumors within or near the spine ### What Does Spinal Stenosis Feel Like? Symptoms typically develop gradually and worsen over time. They most often affect one side of the body, though both legs can be involved. Common symptoms include: - Numbness, cramping, or pain in the back, buttocks, thighs, or calves — or in the neck, shoulders, or arms - Weakness in part of a leg or arm Symptoms tend to flare up or worsen when you stand or walk, and often ease when you sit down or lean slightly forward. Most people with spinal stenosis find it difficult to walk for extended periods of time. More serious symptoms that warrant prompt attention include: - Difficulty walking or problems with balance - Loss of bladder or bowel control ### How Is Spinal Stenosis Diagnosed? During a physical examination, your doctor will work to pinpoint the location of your pain and assess how it affects your ability to move. You will likely be asked to: - Sit, stand, and walk — your doctor may also ask you to walk on your toes and then your heels. - Bend forward, backward, and side to side. - Lie down and lift your legs straight up. If this worsens your pain — especially if you also feel numbness or tingling down one leg — it may suggest sciatica. Your doctor will also move your legs into different positions, bending and straightening your knees, to evaluate your strength and range of motion. To assess nerve function, your doctor will tap specific areas with a small rubber hammer to test your reflexes, and gently touch your legs with a pin, cotton swab, or feather to evaluate sensation. A neurological examination helps confirm leg weakness and reduced sensation. The following tests may also be ordered: - EMG (electromyography, a test of nerve and muscle activity) - Spinal MRI or CT scan - X-ray of the spine ### How Is Spinal Stenosis Treated? Your doctor and care team will work together to help manage your pain and keep you as active as possible. - Your doctor may refer you to a physical therapist, who will guide you through targeted stretches and strengthening exercises to support your back muscles. - Other practitioners — such as a chiropractor, massage therapist, or acupuncturist — may also provide meaningful relief, often within just a few visits. - Nutritional support may offer additional, natural pain relief. - Cold packs and heat therapy can both be helpful during pain flare-ups. Specific treatments for spinal stenosis-related back pain include: - Medications to help reduce pain and inflammation. - Cognitive behavioral therapy (CBT), a structured form of talk therapy that helps you better understand your pain and develop practical strategies for managing it. - An epidural spinal injection (ESI), in which medication is delivered directly into the space surrounding your spinal nerves or spinal cord to reduce pain and inflammation. Spinal stenosis symptoms often worsen over time, though the progression is usually slow. If conservative treatments fail to provide adequate relief — or if you experience significant loss of movement or sensation — surgery may be the next step. - Surgery is aimed at relieving pressure on the affected nerves or spinal cord. - You and your doctor will work together to decide if and when surgery is the right choice for you. Surgical options may include removing a bulging disc, removing a portion of the vertebral bone, or widening the openings through which your spinal nerves pass. In some cases, the surgeon may fuse two or more vertebrae together after the procedure to improve spinal stability. ### What Can You Expect Long-Term? Many people with spinal stenosis are able to remain active and lead full lives, though some adjustments to daily activities or work may be necessary. Surgery often provides partial or complete symptom relief — but predicting outcomes in advance can be difficult, and results vary from person to person. - People who lived with significant back pain for a long time before surgery are more likely to continue experiencing some degree of pain afterward. - If you required more than one type of back surgery, your risk of future complications may be higher. - The segments of the spine just above and below a spinal fusion are more prone to stress and may be more likely to develop problems over time. In rare cases, nerve changes caused by prolonged compression may be permanent, even after the pressure has been relieved. ### When to Reach Out to Your Doctor Contact your healthcare provider if you develop any symptoms of spinal stenosis. The following symptoms are more serious and require prompt medical attention: - Difficulty walking or problems with balance - Progressive numbness or weakness in your arms or legs - Loss of bladder or bowel control - Difficulty urinating or having a bowel movement ### Other Names for This Condition Pseudo-claudication; Central spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain — spinal stenosis **References:** - Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. *N Engl J Med*. 2008;358:794–810. - Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. *N Engl J Med*. 2008;358:818–825. - Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis. Four-year results of the Spine Patient Outcomes Research Trial. *Spine*. 2010;35:1329–1338. - Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. *Spine*. 2009;34:1094–1109. - Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. *Spine*. 2009;34:1078–1093. ---
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Care planSpontaneous Coronary Artery Dissection (SCAD)Spontaneous coronary artery dissection — sometimes referred to as SCAD — is a rare but serious emergency that happens when a tear develops in one of the arteries supplying blood to your heart. That tear can slow or completely block blood flow to the heart, potentially triggering a heart attack, a dangerous heart rhythm, or even sudden death. SCAD most commonly strikes women in their 40s and 50s, though it can happen at any age and can affect men as well. Importantly, many people who experience SCAD have none of the usual warning signs for heart disease — no high blood pressure, no high cholesterol, no diabetes. SCAD can be fatal if not caught and treated quickly. If you ever experience heart attack symptoms, seek emergency care immediately — even if you're convinced a heart attack couldn't happen to you. ### Symptoms to Watch For Signs and symptoms of SCAD may include: - Chest pain - A rapid heartbeat or fluttery feeling in your chest; pain in your arms, shoulders, or jaw - Shortness of breath - Sweating - Unusual, extreme tiredness - Nausea - Dizziness > ⚠️ **IMPORTANT NOTE:** If you're experiencing chest pain or suspect you might be having a heart attack, call 911 or your local emergency number right away. If emergency medical services aren't available, have someone drive you to the nearest hospital. Driving yourself should be an absolute last resort. ### What Causes SCAD? The exact cause of SCAD remains unknown. However, researchers and physicians have identified patterns and commonalities among those who develop it. ### Who Is at Risk? Risk factors for SCAD include: - **Being female.** While SCAD can affect anyone, it disproportionately occurs in women. - **Recent childbirth.** Some women who develop SCAD have recently given birth. SCAD appears to occur most often in the first few weeks following delivery. - **Underlying blood vessel conditions.** Fibromuscular dysplasia (FMD) — a condition characterized by abnormal cell growth in artery walls — is closely associated with SCAD. FMD can weaken artery walls, leading to blockages, dissections, or aneurysms, as well as high blood pressure, stroke, and tears in other blood vessels. Women are more likely to have FMD than men. - **Inflammatory blood vessel diseases,** such as lupus and polyarteritis nodosa, have also been linked to SCAD. - **Twisted or tortuous arteries** are more frequently found in people who have experienced SCAD. - **Inherited connective tissue diseases.** Genetic conditions that affect the body's connective tissues — such as vascular Ehlers-Danlos syndrome and Marfan syndrome — have been identified in some people who develop SCAD. - **Very high blood pressure.** Severe hypertension may be associated with SCAD. Illegal drug use — particularly cocaine and other illicit substances — may also raise your risk. Whether intense physical exertion or extreme emotional stress contribute to SCAD risk remains unclear. Researchers have noted a possible connection, but more study is needed before drawing firm conclusions. ### How SCAD Affects the Body SCAD creates a tear within an artery that delivers blood to the heart. When the artery's inner layers separate from the outer layers, blood can pool in the space between them. The pressure from this pooling blood can extend a small tear into a much larger one — and the trapped blood can form a clot (called a hematoma). This process can slow blood flow through the artery, weakening the heart muscle over time. If blood flow is cut off entirely, part of the heart muscle dies — a heart attack. It's worth noting that a SCAD-related heart attack is mechanically different from one caused by the hardening and narrowing of arteries (atherosclerosis). SCAD can recur even after successful treatment — sometimes shortly after the initial event, sometimes years later. People who have had SCAD may also face a higher risk of other heart complications, such as heart failure resulting from muscle damage caused by prior heart attacks. Researchers are actively working to understand why SCAD recurs and which patients are most vulnerable to a second event. ### How Is SCAD Diagnosed? The tests used to diagnose SCAD are similar to those used to evaluate other types of heart attacks. These may include: - **Coronary angiogram —** A special dye is injected into your arteries so they show up clearly on imaging. To deliver the dye, doctors thread a long, thin tube (catheter) through an artery — usually in your leg or arm — up to your heart's arteries. Once the dye is in place, X-rays are used to capture detailed images of your arteries. These images can reveal abnormalities that confirm SCAD, including any twisting or tortuousness of the coronary arteries. - **Intravascular ultrasound —** During a heart catheterization procedure, a specialized imaging catheter may be advanced into your arteries to produce pictures using sound waves (ultrasound). This is often performed alongside coronary angiography to help confirm SCAD and guide treatment decisions. - **Optical coherence tomography —** A catheter equipped with a specialized light source may be guided into your arteries to generate high-resolution, light-based images. This is typically performed after coronary angiography. The resulting images can detect artery abnormalities that help confirm the diagnosis and provide detail to shape your treatment plan. - **Cardiac computerized tomography (CT) angiography —** You lie on a table inside a large, doughnut-shaped scanner. An X-ray tube rotates around your body, collecting cross-sectional images of your heart and chest that can reveal artery abnormalities. Cardiac CT angiography may be used alongside other tests or as a follow-up study to monitor your condition after a SCAD event. ### Treatment Options The primary goal of SCAD treatment is to restore blood flow to your heart. In some cases, this happens on its own as the artery heals naturally. In others, doctors may need to open the artery using a balloon or stent, or reroute blood flow through bypass surgery. The right approach for you depends on your specific situation — including the size and location of the tear and the symptoms you're experiencing. Whenever it's safe to do so, doctors prefer to allow the artery to heal on its own rather than intervening with invasive procedures. For some people, medications alone may be enough to manage SCAD symptoms. If chest pain or other symptoms continue, additional treatments may become necessary. - **Stenting to keep the artery open —** If SCAD has blocked blood flow to your heart, or if medications aren't controlling your chest pain, your doctor may recommend placing a small mesh tube (stent) inside the affected artery to hold it open and restore circulation. To place the stent, doctors thread a catheter through an artery — usually in your leg or arm — to reach the coronary arteries. X-ray imaging guides the catheter into position. A wire carrying a deflated balloon is then advanced through the catheter to the site of the tear. The balloon is inflated, expanding the stent against the artery walls, and is left in place permanently to keep the artery open. - **Bypass surgery to reroute blood flow —** If other treatments haven't been effective, or if there are multiple tears in the artery, your doctor may recommend surgery to create an alternate route for blood to reach your heart. Coronary bypass surgery involves harvesting a blood vessel from another part of your body — often the leg — and stitching it into place so that it carries blood around the damaged section of artery. - **Medications —** After SCAD, your doctor may recommend one or more of the following: - **Aspirin.** Aspirin may help reduce the risk of future cardiovascular problems after SCAD. Blood-thinning drugs (anticoagulants) work by reducing the number of clot-forming platelets in your blood, which lowers the chance of a clot developing at the site of the tear. - **Blood pressure medications.** These drugs reduce the heart's demand for blood, which eases pressure on the damaged artery. You may need to take blood pressure medications long-term to help prevent another SCAD event. - **Medications for chest pain.** Certain medications (nitrates and calcium channel blockers) can help relieve ongoing chest pain following SCAD. - **Cholesterol-lowering medications.** If you have abnormal cholesterol levels or other risk factors, medications to manage cholesterol may be recommended. ### Ongoing Care After SCAD After SCAD treatment, regular follow-up appointments with your doctor are essential to track your recovery and catch any changes early. Your care team may also recommend additional steps to support healing and reduce the risk of future problems, including: - **Cardiac rehabilitation.** Cardiac rehab is a personalized program that combines supervised exercise, nutritional counseling, emotional support, and education to help you safely recover from a serious heart event. - **A review of your family medical history.** Certain inherited conditions — like the connective tissue disorder Marfan syndrome — have been identified in people who develop SCAD. Your doctor may refer you to a genetic counselor to review your family history and determine whether genetic testing makes sense for you. - **Screening other blood vessels for weakness.** Your doctor may recommend CT angiography to look for vulnerabilities or abnormalities in other blood vessels, such as those associated with FMD. ### Living with SCAD: Coping and Finding Support A SCAD diagnosis can feel overwhelming and deeply frightening. The condition often strikes people who had no reason to expect a serious heart problem, and the symptoms themselves can be alarming. Everyone finds their own path through a diagnosis like this. With time, you'll discover what works for you. In the meantime, here are some strategies that may help: - **Get informed about your diagnosis.** Learning enough about SCAD to have meaningful conversations with your doctor is empowering. Don't hesitate to ask about the specifics — the location and size of your tear, and what your treatment has involved. - **If you're a woman** who has had SCAD, your doctor may advise against future pregnancy. Have an open conversation with your doctor about their specific recommendations for your situation. - **Ask your care team where to find reliable resources about SCAD.** - **Take good care of yourself.** Support your recovery by prioritizing sleep, eating a nourishing diet rich in fruits and vegetables, and finding healthy outlets for stress — whether that's music, journaling, or another activity that grounds you. If you're feeling anxious or depressed, tell your doctor. A referral to a mental health professional (such as a psychologist) may be an important part of your healing. If your doctor determines it's safe, aim for moderate physical activity — like walking — for 30 to 40 minutes most days of the week. - **Connect with others who understand what you're going through.** SCAD is rare, but national organizations can help you find community. Groups like the American Heart Association and WomenHeart: The National Coalition for Women with Heart Disease offer phone and online support networks. - **Lean on the people you love.** Spending time with family and friends and sharing what you're experiencing can be a powerful source of comfort and strength. **Sources:** - <https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711?p=1> - <https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/diagnosis-treatment/drc-20353716?p=1> ---
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Care planSprain / StrainA sprain happens when a joint is wrenched or twisted, partially tearing the ligaments that hold it together. A strain, on the other hand, is an overstretching of a muscle. Both are caused by physical trauma — but between the two, a sprain is generally the more serious injury. Sprains are classified into three grades of severity: - **Grade 1:** A mild sprain with no actual tearing of the ligament. You may notice some pain, swelling, and tenderness around the joint. - **Grade 2:** A moderate sprain involving a partial tear of the ligament or tendon. Expect noticeable pain, swelling, bruising, reduced range of motion, and some looseness or instability in the joint. - **Grade 3:** The most severe type — a complete tear of the ligament. This presents as intense pain, significant swelling, bleeding into the tissue, major joint instability, and a complete loss of normal range of motion. ### What to Watch For - A recent injury or trauma to the area - Pain - Swelling - Tenderness to the touch - Bruising - Difficulty moving the joint through its full range of motion - Joint looseness or instability — how much depends on the grade of the sprain ---
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Care planStatin Side EffectsThe benefits of statin drugs have been widely overstated — and whatever benefit these drugs do offer has nothing to do with their ability to lower cholesterol. Statins work, to whatever extent they do, by reducing inflammation. - Statin drugs deplete CoQ10, one of the most critical nutrients for heart health. Low CoQ10 levels can cause muscle pain, weakness, and fatigue. - Your brain depends on cholesterol to work at its best. Cholesterol plays an active role in supporting thinking and memory. - Multiple studies show that statin drugs reduce sex hormone levels. Sexual dysfunction is a common — but rarely reported — side effect of statins. - A 2024 study in *The Lancet* confirms that statins raise the risk of developing diabetes, with high-intensity statins increasing that risk by 36%. This reinforces concerns that were first raised by the 2008 JUPITER trial. - Statins may also raise the risk of cancer, cataracts, and neurological problems. Long-term use has been linked to a higher risk of pancreatic cancer, particularly after five or more years of use. - Statins interfere with serotonin receptors in the brain. - There are troubling signals that statin drugs may be associated with higher risks of both cancer and diabetes. - Statins should not be prescribed for older adults or for the vast majority of women — and they should never be prescribed for children. - Research shows that — with rare exceptions — any benefit from statin drugs is seen only in middle-aged men who already have confirmed coronary artery disease. > *"You can lower cholesterol with a drug, yet provide no health benefits whatsoever. And dying with corrected cholesterol is not a successful outcome."* > > — John Abramson, MD, Professor of Medicine at Harvard Medical School, author of *Overdosed America* **The debate over using statins to prevent cardiovascular disease in people who have not yet had a heart attack** is back in the spotlight. A 2019 analysis suggests that prescribing statins to low-risk patients "may be an example of low value care (having little benefit and potential to cause harm) in these patients and, in some cases, represent a waste of healthcare resources," the researchers conclude. The research team, led by Paula Byrne, PhD, of the National University of Ireland Galway, argues that **it remains genuinely uncertain whether the benefits of statins outweigh the risks for primary prevention — and whether prescribing them so broadly can be justified from a public health standpoint.** **Reference:** Analysis: Statins for primary prevention of cardiovascular disease. *BMJ* 2019; 367 doi: <https://doi.org/10.1136/bmj.l5674> (Published 16 October 2019) Cite this as: BMJ 2019;367:l5674 Weighing in on that analysis, Metin Avkiran, MD, associate medical director at the British Heart Foundation (BHF), said: *"**The conclusions are not surprising and align with what we know already, based on the evidence from numerous independent clinical trials.**"* > *"… a critical assessment of research on the reduction of cholesterol levels by statin treatment to reduce cardiovascular disease. **Our opinion is that although statins are effective at reducing cholesterol levels, they have failed to substantially improve cardiovascular outcomes.*** > > *"We have described the deceptive approach statin advocates have deployed to create the appearance that cholesterol reduction results in an impressive reduction in cardiovascular disease outcomes through their use of a statistical tool called relative risk reduction (RRR), a method which amplifies the trivial beneficial effects of statins."* > > *"**We have also described how the directors of the clinical trials have succeeded in minimizing the significance of the numerous adverse effects of statin treatment.**"* **Reference:** David M Diamond & Uffe Ravnskov, How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease. *Expert Review of Clinical Pharmacology*, Volume 8, 2015 - Issue 2, Pages 201–210. Published online: 12 Feb 2015. <http://dx.doi.org/10.1586/17512433.2015.1012494> ---
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Care planStem Cell Nutritional Support**Stem cells are the body's raw materials** — the fundamental building blocks from which all other specialized cells are made. Given the right conditions, whether inside the body or in a laboratory, stem cells divide to produce what are called daughter cells. These daughter cells either remain as stem cells (self-renewal) or transform into specialized cells (differentiation) with a more defined role — such as blood cells, brain cells, heart muscle cells, or bone cells. No other cell in the body naturally has this remarkable ability to give rise to entirely new cell types. ## Understanding Stem Cells ### Why Is There So Much Excitement Around Stem Cells? Researchers and doctors hope that studying stem cells will help us: - **Better understand how diseases develop.** By observing stem cells as they mature into bone, heart muscle, nerve, and other tissue cells, scientists may gain crucial insights into how diseases and medical conditions take hold. - **Grow healthy cells to replace diseased ones (regenerative medicine).** Stem cells can be guided to become specific cell types, which can then be used to rebuild and repair diseased or damaged tissues. **People who might benefit from stem cell therapies include those living with spinal cord injuries, type 1 diabetes, Parkinson's disease, amyotrophic lateral sclerosis, Alzheimer's disease, heart disease, stroke, burns, cancer, and osteoarthritis.** Stem cells hold the potential to be grown into new tissue for use in transplantation and regenerative medicine. Researchers continue to push the boundaries of what is possible with stem cells and their applications in these fields. - **Test new drugs for safety and effectiveness.** Before experimental drugs are ever tested in people, researchers can use certain types of stem cells to evaluate their safety and quality. This approach is expected to have its earliest and most direct impact on cardiac toxicity testing during drug development. An exciting new area of investigation involves using human stem cells that have been programmed into tissue-specific cells to screen new drugs. For this kind of testing to be meaningful, the cells must be programmed to closely mimic the behavior of the cells that the drug is designed to target. Techniques for achieving this level of precision are still actively being refined. For example, nerve cells could be generated in the lab to test a new drug designed for a nerve disease — revealing both whether the drug works and whether it causes any harm to the cells themselves. ### Where Do Stem Cells Come From? Researchers have identified several different sources of stem cells: - **Embryonic stem cells.** These stem cells come from embryos that are three to five days old. At this stage, an embryo is called a blastocyst and contains about 150 cells. These are pluripotent (ploo-RIP-uh-tunt) stem cells — meaning they can either continue dividing as stem cells or develop into virtually any type of cell in the body. This remarkable versatility is what makes embryonic stem cells so valuable for regenerating or repairing diseased tissues and organs. - **Adult stem cells.** These stem cells are found in small numbers throughout most adult tissues, including bone marrow and fat. Compared to their embryonic counterparts, adult stem cells have a more limited ability to give rise to different cell types. Until recently, scientists believed that adult stem cells could only produce cells similar to their tissue of origin. For example, stem cells in the bone marrow were thought to give rise only to blood cells. However, emerging evidence suggests that adult stem cells may be more versatile than previously thought. For instance, bone marrow stem cells may have the ability to form bone or even heart muscle cells. These promising findings have led to early-stage clinical trials exploring the usefulness and safety of adult stem cells in people — including those with neurological or heart disease. - **Adult cells reprogrammed to behave like embryonic stem cells (induced pluripotent stem cells).** Scientists have successfully converted ordinary adult cells into stem cells through a process called genetic reprogramming. By modifying the genes within adult cells, researchers can essentially "reset" them to behave much like embryonic stem cells. This breakthrough technique may one day allow researchers to use reprogrammed cells in place of embryonic stem cells, potentially sidestepping the risk of immune rejection. However, scientists are still working to determine whether using these reprogrammed cells could cause unintended effects in humans. In one notable advance, researchers successfully transformed ordinary connective tissue cells into functional heart cells. In animal studies, subjects with heart failure that received these new heart cells showed meaningful improvements in heart function and survival. - **Perinatal stem cells.** Researchers have discovered stem cells in both amniotic fluid and umbilical cord blood — and these cells also have the ability to develop into specialized cell types. Amniotic fluid is the protective liquid that surrounds a developing baby in the womb. Stem cells have been found in samples of amniotic fluid drawn from pregnant women during a prenatal testing procedure known as amniocentesis. Further research is needed to fully understand the potential of amniotic fluid stem cells. ### Why Is There Controversy Around Embryonic Stem Cell Research? Embryonic stem cells are taken from early-stage embryos — clusters of cells that form when a woman's egg is fertilized by a man's sperm, typically in an in vitro fertilization (IVF) clinic. Because human embryonic stem cells are derived from human embryos, their use in research raises important ethical questions that continue to be debated. In 2009, the National Institutes of Health established guidelines for human stem cell research. These guidelines define what embryonic stem cells are, how they may be used in scientific studies, and include recommendations for how embryonic stem cells should be donated. Importantly, the guidelines specify that embryonic stem cells from IVF-created embryos may only be used when those embryos are no longer needed for reproductive purposes. ### Where Do These Embryos Come From? The embryos used in embryonic stem cell research come from eggs that were fertilized at IVF clinics but were never implanted into a woman's uterus. The stem cells derived from these embryos are donated with the full informed consent of the donors. Once in the laboratory, these stem cells can survive and multiply in specially formulated solutions, in test tubes or petri dishes. ### Why Can't Researchers Simply Use Adult Stem Cells? While research into adult stem cells is exciting and full of promise, adult stem cells may not be as versatile or resilient as embryonic stem cells. They may not be capable of being coaxed into producing every cell type needed, which limits their potential applications in treating disease. Adult stem cells are also more susceptible to abnormalities — whether from environmental exposures like toxins or from errors that accumulate during the normal process of cell replication. That said, researchers have found that adult stem cells are considerably more adaptable than originally believed. ### What Are Stem Cell Lines and Why Do Researchers Value Them? A stem cell line is a collection of cells that all originate from a single parent stem cell and are cultivated in a laboratory setting. Cells within a stem cell line continue to divide and grow, but do not differentiate into specialized cell types. Ideally, they remain free of genetic defects and reliably produce more stem cells over time. Portions of a stem cell line can be frozen for long-term storage or shared among research teams around the world. ### What Is Stem Cell Therapy (Regenerative Medicine) and How Does It Work? Stem cell therapy — also called regenerative medicine — harnesses the body's own repair mechanisms by using stem cells or their derivatives to restore diseased, damaged, or dysfunctional tissue. Think of it as the next evolution of organ transplantation, one that uses living cells rather than donated organs, which are always in limited supply. In practice, stem cells are grown in a laboratory and then guided to specialize into specific cell types — such as heart muscle cells, blood cells, or nerve cells. These specialized cells can then be transplanted into a patient. For someone with heart disease, for example, these cells could be injected directly into the heart muscle, where the healthy transplanted cells may help repair the damaged tissue. Researchers have already demonstrated that adult bone marrow cells — guided to resemble heart cells — can help repair heart tissue in people, and ongoing studies continue to expand on these findings. ### Are Stem Cells Already Being Used to Treat Disease? Yes. Stem cell transplants — commonly known as bone marrow transplants — are already an established treatment. In these procedures, stem cells replace cells that have been damaged by chemotherapy or disease, or they help the donor's immune system target certain cancers and blood disorders, including leukemia, lymphoma, neuroblastoma, and multiple myeloma. These transplants rely on adult stem cells or umbilical cord blood. Researchers are also actively testing adult stem cells as potential treatments for other conditions, including various degenerative diseases such as heart failure. ### What Are the Potential Challenges of Using Embryonic Stem Cells in People? For embryonic stem cells to be safely and effectively used in patients, researchers must be confident that the cells will reliably develop into the specific cell types needed — and nothing else. Scientists have already made progress in learning how to direct stem cells toward specific fates, such as guiding embryonic stem cells to become heart cells. This remains an active area of research. One challenge is that embryonic stem cells can sometimes grow in unpredictable ways or spontaneously develop into unintended cell types. Researchers are working to understand — and ultimately control — these behaviors. There is also the risk that transplanted embryonic stem cells could trigger an immune response, causing the recipient's body to attack them as foreign, or that the cells might simply fail to function as intended, with unknown consequences. Scientists continue to explore ways to prevent and address these potential complications. ### What Is Therapeutic Cloning, and Why Does It Matter? Therapeutic cloning — also called somatic cell nuclear transfer — is a laboratory technique for creating versatile stem cells without the need for a fertilized egg. In this process, the nucleus (which carries the cell's genetic material) is removed from an unfertilized egg. The nucleus is also removed from a donor cell. The donor's nucleus is then inserted into the emptied egg in a process called nuclear transfer. The egg is then allowed to divide and eventually forms a blastocyst — creating a line of stem cells that is genetically identical to the donor. This is, in essence, a biological clone. Some researchers believe that stem cells created through therapeutic cloning may have advantages over those derived from fertilized eggs. Because the cloned cells are genetically matched to the donor, they are less likely to be rejected when transplanted back. Additionally, they may allow scientists to study exactly how a disease unfolds in a patient's own cells. ### Has Therapeutic Cloning in Humans Been Achieved? Not yet. Despite success in a number of other species, researchers have not been able to successfully perform therapeutic cloning in humans. However, recent studies have shown that researchers can create human pluripotent stem cells by adapting the therapeutic cloning process in new ways. Work to explore the full potential of therapeutic cloning in people is actively ongoing. **Source:** <https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117> **References:** - Stem cell information — Frequently asked questions (FAQs). National Institutes of Health. <https://stemcells.nih.gov/info/faqs.htm>. Accessed July 23, 2018. - Stem cell basics. National Institutes of Health. <https://stemcells.nih.gov/info/basics.htm>. Accessed July 23, 2018. - Nelson TJ, et al. Stem cell therapy and congenital heart disease. *Journal of Cardiovascular Development and Disease*. 2016;3:1. - Terashvili M, et al. Stem cell therapies in cardiovascular disease. *Journal of Cardiothoracic and Vascular Anesthesia*. In press. Accessed July 23, 2018. - Samsonraj RM, et al. Concise review: Multifaceted characterization of human mesenchymal stem cells for use in regenerative medicine. *Stem Cells Translational Medicine*. 2017;6:2173. - Blood-forming stem cell transplants. National Cancer Institute. <https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet>. Accessed July 23, 2018. - Abbaspanah B, et al. Advances in perinatal stem cells research: A precious cell source for clinical applications. 2018;13:595. - Routine tests during pregnancy. The American College of Obstetricians and Gynecologists. <https://www.acog.org/Patients/FAQs/Routine-Tests-During-Pregnancy>. Accessed July 23, 2018. - Stem cell facts. International Society for Stem Cell Research. <http://www.closerlookatstemcells.org/>. Accessed July 23, 2018. - Matoba S, et al. Somatic cell nuclear transfer reprogramming: Mechanisms and applications. *Cell Stem Cell*. 2018;23:1. - National Institutes of Health guidelines for human stem cell research. National Institutes of Health. <https://stemcells.nih.gov/policy/2009-guidelines.htm>. Accessed July 23, 2018. ---
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Care planStreptococcal InfectionsStrep is short for Streptococcus, a type of bacteria that can cause a range of infections — from mild sore throats to more serious illness. ## Understanding Streptococcal Infections ### There Are Two Main Types: Group A and Group B **Group A strep** is responsible for: - **Strep throat** — a sore, red throat, often with swollen tonsils that may be dotted with white patches. - **Scarlet fever** — an illness that follows strep throat and brings with it a distinctive red rash across the body. - **Impetigo** — a contagious skin infection. - **Toxic shock syndrome** - **Cellulitis and necrotizing fasciitis** (flesh-eating disease) **Group B strep** can cause life-threatening blood infections, pneumonia, and meningitis in newborns. A routine screening test during pregnancy can tell you whether you carry this bacteria. If you do, intravenous (I.V.) antibiotics given during labor can protect your baby. Group B strep in pregnancy is strictly a medically managed condition. Published research suggests that oral probiotic support containing *L. rhamnosus GR-1* and *L. reuteri RC-14* may help reduce vaginal and rectal Group B strep colonization rates in pregnant women, **but probiotics should only be considered as a secondary option alongside — not instead of — the established standard of care (antibiotics)**. The stakes for your baby's health are simply too high to rely on complementary approaches alone, and the evidence for probiotics as a primary treatment remains insufficient. **Source:** *Taiwan J Obstet Gynecol.* 2016 Aug;55(4):515–8. "Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial." Group B strep isn't just a concern during pregnancy — adults, especially older adults or those managing other health conditions, can also develop Group B strep infections. In adults, it can lead to urinary tract infections, blood infections, skin infections, and pneumonia. **Source:** NIH: National Institute of Allergy and Infectious Diseases --- ### Why Do Some Children Keep Getting Strep Throat? Scientists at the La Jolla Institute for Immunology (LJI) have discovered important clues about why certain children seem to catch Group A strep over and over again. In a study published in the journal *Science Translational Medicine* on Feb. 6, 2019, researchers examined the surgically removed tonsils of 26 children between the ages of 5 and 18 years who had recurrent tonsillitis. They also looked at the tonsils of 39 children who had their tonsils removed for other reasons, such as sleep apnea. What they discovered was striking: tonsils from children with repeat infections showed a genetically driven, weaker immune response to Group A strep bacteria. When the researchers reviewed the medical histories of these children, they confirmed that this pattern did run in some families — pointing to an inherited vulnerability. **Source:** <https://www.eurekalert.org/pub_releases/2019-02/ljif-wyk020119.php> --- ### Is Removing the Tonsils Always the Right Answer? A landmark July 2018 study examining over 1 million children found that removing the tonsils or adenoids (the immune glands located in the roof of the mouth) may carry meaningful long-term health risks. These tissues play an active and important role in building and maintaining a healthy immune system. The study found that tonsillectomy was associated with nearly triple the long-term risk of upper respiratory tract diseases. Removing the adenoids was linked with an almost doubled risk of developing a chronic obstructive lung disorder later in life. **Reference:** <https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621> --- ### Tonsil Surgery May Not Be the Answer for Most Kids Updated guidelines from 2012 advise against tonsil removal in children who have recurring sore throats, unless there are complicating factors such as obstructed breathing. While many physicians have historically recommended tonsillectomy for repeated strep throat infections, research shows that this surgery benefits only a very small number of children — and even then, those benefits tend to be short-lived. **Sources:** - <https://www.webmd.com/oral-health/news/20120913/kids-strep-throat-tonsils> - <https://www.healthline.com/health-news/why-your-kid-keeps-getting-strep-throat> --- ### How to Reduce Your Risk of Strep Infection Strep thrives in close-contact settings, which is why it spreads so easily through households, schools, and daycare centers. Fortunately, some straightforward habits can meaningfully lower your risk: thorough and frequent handwashing, covering coughs and sneezes to contain respiratory droplets, and staying home when you're sick are among the most effective ways to prevent recurrent strep infections. ---
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Care planStress> *"In the modern environment one is exposed to various stressful conditions. Stress can lead to changes in the serum level of many hormones including glucocorticoids, catecholamines, growth hormone and prolactin. Some of these changes are necessary for the fight or flight response to protect oneself. Some of these stressful responses can lead to endocrine disorders like Graves' disease, gonadal dysfunction, psychosexual dwarfism and obesity. Stress can also alter the clinical status of many preexisting endocrine disorders such as precipitation of adrenal crisis and thyroid storm."* > > **Reference:** *Indian J Endocrinol Metab.* 2011 Jan-Mar; 15(1): 18–22. doi: 10.4103/2230-8210.77573, Stress and hormones. Most of us are bombarded by stress in today's fast-paced world. Stress can be defined as any perceived physical or psychological threat that triggers a physiological response and disrupts the body's internal balance. Surveys by the American Psychological Association show that **75% of adults** experience moderate to high levels of stress in any given month, and **54%** are worried about how much stress they carry in their everyday lives. Research has shown that the brain's limbic center — its emotional command center — is the primary regulator of the stress response, with the adrenal glands playing a supporting role. The brain translates environmental and physical stressors into biochemical signals that power the classic "fight or flight" response. While some of these signals can be life-saving in the short term (acute stress), they can become harmful to your health when activated repeatedly over time (chronic or prolonged stress). Chronic stress is what happens when the body's stress response stays switched on far too long and too often. Over time, the body tries to adapt to this relentless pressure — a process called **allostasis**. But there's a cost: what begins as an overactive stress response marked by agitation and inflammation can eventually tip into an under-active state characterized by exhaustion and a weakened immune system. This downward spiral follows a predictable pattern of behavioral and physical warning signs. Calming this chronic stress response is one of the most powerful things you can do to prevent stress-related illness and support healthy aging. One of the most time-honored natural approaches to managing stress is the use of herbal supplements called **adaptogens**. Used for thousands of years across many cultures, these plant-based compounds help your body normalize the biochemical and organ changes triggered by stress — offering a safe and well-supported way to protect your health and well-being. ### Stress Looks Different for Everyone Stress doesn't affect everyone the same way, but its reach is wide — touching nearly every system in the body. It starts in the brain and ripples outward to the adrenal glands, thyroid, gut, heart, and the chemical messengers that regulate mood and thought. When stress becomes a constant companion, the body channels so much energy into simply coping that it eventually runs out of reserves — leaving you exhausted and vulnerable. **How Your Body Responds to Stress: A Head-to-Toe Cascade** - **Neurotransmitters** (your brain's chemical messengers) are released, amplifying your emotional response and affecting memory, concentration, self-control, and clear thinking. - The **adrenal glands** flood your system with a family of hormones called glucocorticoids — including cortisol, the body's primary stress hormone — which mobilize the heart, lungs, circulation, metabolism, and immune system. - The **thyroid gland**, when thrown off balance, releases hormones that push metabolism into overdrive, triggering symptoms like sleeplessness, nervousness, and deep fatigue. - **Sex hormone levels** can dip during stress, dampening libido and sexual function. In women, acute stress can also disrupt the regularity of the menstrual cycle. - **Blood sugar** can swing unpredictably under stress, as the liver releases stored glucose into the bloodstream while the pancreas pulls back on insulin production — temporarily raising blood sugar to fuel the body's stress response. - **Heart rate** climbs during stress as the heart works harder to pump blood throughout the body. - **Breathing** can change under stress — many people begin breathing faster, which can intensify feelings of anxiety. - **Digestion** often slows during stress, as the body redirects energy away from the gut, sometimes resulting in stomach discomfort, bloating, or other digestive complaints. **References:** - *Indian J Endocrinol Metab.* 2011 Jan-Mar; 15(1): 18–22. doi: 10.4103/2230-8210.77573, PMCID: PMC3079864, PMID: 21584161, Stress and hormones. - Stress in America: American Psychological Association; 2010. - McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. *Arch Intern Med.* 1993;153:2093–2101. - Groeneweg FL, Karst H, de Kloet ER, Joels M. Rapid non-genomic effects of corticosteroids and their role in the central stress response. *J Endocrinol.* 2011;209(2):153–167. - Pedersen WA, Wan R, Mattson MP. Impact of aging on stress-responsive neuroendocrine systems. *Mech Ageing Dev.* 2001;122:963–983. - Bryla CM. The relationship between stress and the development of breast cancer: a literature review. *Oncol Nurs Forum.* 1996;23:441–448. - McEwen BS. Protective and damaging effects of stress mediators: the good and bad sides of the response to stress. *Metabolism.* 2002;51:2–4. - Habib KE, Gold PW, Chrousos GP. Neuroendocrinology of stress. *Endocrinol Metab Clin North Am.* 2001;30:695–728; vii–viii. - O'Connor TM, O'Halloran DJ, Shanahan F. The stress response and the hypothalamic-pituitary-adrenal axis: from molecule to melancholia. *Qjm.* 2000;93:323–333. ---
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Care planStyA stye (medical term: **hordeolum**) is a painful, pus-filled bump that forms along the edge or inner surface of your eyelid when one of its tiny glands gets infected — usually by *Staphylococcus* bacteria. There are two types: an **internal stye**, which affects the meibomian glands deeper in the eyelid, and an **external stye**, which affects the smaller Zeis or Moll glands right along the lid margin. Styes are often linked to a chronic eyelid condition called blepharitis. The good news: they almost always clear up on their own relatively quickly — though they do have a tendency to come back. Styes are generally harmless. They may cause some minor irritation and discomfort, but they typically resolve without any special treatment. Simple home care — like applying a warm compress — can help speed things along. As tempting as it may be to hide a stye under makeup, it's best to resist that urge. Applying makeup over a stye can slow down healing, clog the area further, and potentially worsen the infection — making it more swollen and painful in the process. ### What a Stye Looks and Feels Like **Internal stye:** This type develops on the underside of the eyelid, against the surface of the eye (the conjunctiva), and may cause: - Pain - Redness - Swelling - A small yellow spot or raised bump on the inner surface of the eyelid (this is usually a pocket of infection — an abscess — that rarely breaks open on its own) **External stye:** This type forms along the visible edge of the eyelid and may cause: - Pain - Redness - Tenderness to the touch - A small firm or hardened bump - A yellow "head" that eventually forms at the tip of the bump — this is where the stye will typically drain on its own, bringing relief from pain, swelling, occasional light sensitivity, and/or watery eyes **Are styes contagious?** Not really — but the bacteria that cause them can spread in small amounts. That's why it's important to wash your hands before and after touching a stye, and to wash your pillowcase regularly. Unless you're cleaning the area or applying a warm compress, try to leave it alone to minimize both bacterial spread and additional irritation. **Source:** <https://my.clevelandclinic.org/health/diseases/17658-stye> ---
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Care planSubstance Abuse & AddictionIn 2017, 19.7 million Americans struggled with a substance use disorder, according to the National Survey on Drug Use and Health. Addiction is a devastating condition that touches countless lives every day — but there is hope. Functional medicine offers a whole-person approach to addiction management and recovery, treating not just the symptoms, but the underlying imbalances that drive them. Functional Medicine practitioners across North America are leading the way in natural approaches to pain management, helping patients avoid and safely taper off addictive pain therapies. > *"Addiction is not just a mental problem, a physical problem, or a biochemical problem. It is very much all those things and more."* > > — Turshá Hamilton, ND > *"Pain patients treated with opiates have the same biochemical and neurochemical changes that addicts do on the physical side. Addiction may be seen as an attachment to the drug from the emotional side."* > > — David Arneson, ND > *"Acutely, the naturopathic doctor must consider what the patient is going through. Insomnia, elevated blood pressure, nausea and vomiting, and body aches are just a few of the symptoms during the first stages of withdrawal."* > > — Dr. Hamilton --- ## Understanding Addiction — A Functional Medicine Perspective ### Where We Start — Initial Treatment Approaches The functional medicine approach to addiction begins with stabilizing the whole person during withdrawal and early recovery. Initial treatment approaches include: - Nutrient therapy to restore the vitamins, minerals, and amino acids depleted by addiction and the withdrawal process - Acupuncture - Hydrotherapy - Homeopathy - Herbal medicine *"In this stage, it may also be necessary to consider prescribing medications to make the withdrawal process more tolerable (with the goal of using these drugs for as short-term as possible)."* — Dr. Hamilton ### Addressing Brain Chemistry and Neurotransmitter Restoration *"**Some naturopathic doctors treat addiction by addressing alterations in brain chemistry that contribute both to addictive behavior and withdrawal symptoms.** For example, amino acid therapies can be used to support restoration of neurotransmitter pathways that are depleted by long term drug use."* — Casey Seenauth, ND *"In our experience, utilizing nutritional treatments, the initial repair work can be accomplished in three to six weeks on average. If we do not incorporate focused nutritional treatment this can take on the average six months to two years — or what we call post-acute withdrawal syndrome."* *"**It's my opinion that the best way that we can address the issue of addiction to opioid pain medication is through the proper and adequate treatment of pain."*** — Dr. Seenauth *"We've seen that therapies that only include pharmaceuticals often don't give the patient significant relief over the long term and can have very deleterious side effects. By using medical nutrition, botanical medicine, mind-body medicine, hydrotherapy, acupuncture, and homeopathy, we can offer the chronic pain patient more options that may offer them relief, resolution, and hope in a future that has less pain and sickness, and more vitality."* — Dr. Hamilton ### The Role of Diet and Inflammation *"**Starting at a fundamental level, diet plays a huge role in treating pain.**"* — Dr. Seenauth Many painful conditions are made worse by inflammation — and inflammation can be meaningfully reduced through an anti-inflammatory diet and targeted nutritional support, such as: - Optimal levels of omega-3 fatty acids - Plant-based foods - Vitamin D supplementation **Source:** <https://aanmc.org/news/naturopathic-approaches-pain-addiction/> ---
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Care planSupplements> *"We often must make decisions based on information sufficient for action, but insufficient to fully satisfy the intellect."* > > — Immanuel Kant One of the most common things we hear from patients is: > *"I follow a healthy diet — whole grains, beans, fruits, and vegetables — and avoid sugar and processed foods. Why are you recommending supplements? Shouldn't my food provide everything I need?"* It's a fair question — and the answer, rooted in both science and real-world clinical experience, might surprise you. ---
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Care planSurgery Nutritional SupportSurgery places extraordinary demands on your body. Your nutritional needs rise sharply to fuel wound healing and support your body's recovery — a state of heightened metabolic activity known as **hypermetabolism**. When your body doesn't get the nutrients it needs, the consequences are real: muscle loss, a weakened immune system, and declining levels of vital proteins. Although it seems obvious that getting the right nutrition early would be a priority for surgical patients, it is one of the most commonly overlooked aspects of surgical care. Multiple studies have shown that targeted nutritional support makes a measurable difference — helping patients maintain weight and supporting key markers of nutritional health during recovery. Dr. Jersy Meduski, MD, PhD (former head of the Burn Unit at UCLA Medical Center) found that in burn victims — as with all wound healing and surgical repair — the rate of recovery was dependent upon the availability and bioavailability of nutrients necessary for connective tissue healing and repair. Dr. Meduski observed that patients who supplemented nutrients for tissue repair healed faster, had less scarring, fewer complications from surgery, and in general did much better than non-supplementing patients. **References:** - Klein S, Kinney J, Jeejeebhoy K et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. *JPEN J Parenter Enteral Nutr.* 1997;21:133–56. - Erstad BL, Campbell DJ, Rollins CJ et al. Albumin and prealbumin concentrations in patients receiving postoperative parenteral nutrition. *Pharmacotherapy.* 1994;14:458–62. - Carr CS, Ling KD, Boulos P et al. Randomized trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. *Br Med J.* 1996;312:869–71. - Hellin-Lopez J, Baena-Fustegueras JA, Schwartz-Riera S et al. Usefulness of short-lived proteins as nutritional indicators in surgical patients. *Clin Nutr.* 2002;21:119–25. - Heyland DK, Montalvo M, MacDonald S et al. Total parenteral nutrition in the surgical patient: a meta-analysis. *Can J Surg.* 2001;44:102–11. ---
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Care planTemporomandibular Joint Disorder (TMJ or TMJD)The **temporomandibular joint (TMJ)** is the hinge-like joint that links your lower jaw (mandible) to your skull. You have one on each side of your head, just in front of your ears. These joints make it possible for your jaw to open and close — allowing you to speak, chew, and swallow. You may have heard "TMJ" used to describe jaw-related health problems, but that shorthand is giving way to more precise terms: TMD or TMJD (temporomandibular joint disorder). This distinction helps separate the joint itself from the disorders that can affect it. These disorders can cause tenderness at the joint, pain in the face, and difficulty moving the jaw. According to the National Institute of Dental and Craniofacial Research, as many as 10 million Americans suffer from TMJD. TMJD is more common among women than men. While these disorders are treatable, identifying the underlying cause can be challenging — making diagnosis a process of careful investigation. ## Understanding Temporomandibular Joint Disorder ### What Causes TMJ Disorder? In many cases, the root cause of a TMJ disorder remains unclear. Injury or trauma to the jaw or joint may be a contributing factor. A number of other health conditions may also set the stage for TMJD, including: - Arthritis - Erosion of the joint - Habitual grinding or clenching of the teeth - Structural jaw problems present at birth Several other factors are frequently linked to TMJD, though a direct cause-and-effect relationship has not yet been proven. These include: - The use of orthodontic braces - Poor posture that strains the muscles of the neck and face - Prolonged stress - Poor diet - Lack of sleep ### Recognizing the Symptoms of TMJD The symptoms of TMJ disorders vary depending on the severity and underlying cause of your condition. The most telling symptom is pain in the jaw and the muscles surrounding it. Other symptoms commonly associated with these disorders include: - Pain that can be felt in the face or neck - Stiffness in the muscles of the jaw - Limited movement of the jaw - Locking of the jaw - Clicking or popping sound from the TMJ site - Shift in the jaw, changing the way that the upper and lower teeth align (called malocclusion) Symptoms may appear on just one side of the face, or on both sides. ### How Is TMJD Diagnosed? Diagnosing a TMJ disorder can be tricky — there is no single standard test that confirms it. Your doctor may refer you to a dentist or an ear, nose, and throat (ENT) specialist to help pinpoint your condition. If you have symptoms suggestive of a TMJ disorder, your doctor will likely examine your jaw for signs of swelling or tenderness. Imaging studies may also be ordered to get a closer look. These can include: - X-rays of the jaw - CT scan of the jaw to see the bones and joint tissues - MRI of the jaw to see if there are problems with the structure of the jaw ### How Is TMJD Treated? The good news: in most cases, the symptoms of TMJ disorders respond well to simple self-care strategies at home. To ease the symptoms of TMJ you can: - Eat soft foods - Use ice to reduce swelling - Reduce jaw movements - Avoid chewing gum and tough foods (like beef jerky) - Reduce stress - Use jaw-stretching exercises to help improve jaw movement If your symptoms don't improve with these approaches, your doctor can offer additional support. Depending on your situation, they may prescribe or recommend the following: - Pain medications (such as ibuprofen) - Medications to relax the muscles of the jaw (such as Flexeril, Soma, or Valium) - Medications to help reduce swelling in the jaw (corticosteroid drugs) - Stabilization splints or bite guards to prevent teeth grinding - Botox to reduce tension in the muscle and nerves of the jaw - Cognitive behavioral therapy to help reduce stress In rare cases, your doctor may recommend surgery or a procedural intervention. Options can include: - Corrective dental treatment to improve your bite and align your teeth - Arthrocentesis, which removes fluid and debris from the joint - Surgery to replace the joint > ⚠️ **IMPORTANT NOTE:** Procedures used to treat this condition may, in some cases, make your symptoms worse. Have an open conversation with your doctor about the potential risks before proceeding. ### Can TMJD Be Prevented? While you may not be able to prevent TMJD entirely, you may be able to reduce your symptoms by bringing your stress levels down. If teeth grinding is part of your picture, addressing it directly can make a real difference. Practical solutions include wearing a mouth guard at night and taking muscle relaxants. Broader strategies to reduce stress and anxiety — such as counseling, regular exercise, and a balanced diet — may also help protect your jaw over time. ### Living with TMJ Disorders: What to Expect Your long-term outlook depends largely on what's driving your TMJ disorder. Many people find lasting relief through at-home remedies alone — things like improving posture or managing stress. However, if your condition is rooted in a chronic (long-term) disease such as arthritis, lifestyle changes may not be sufficient on their own. Arthritis can gradually wear down the joint and intensify pain over time. For most people with TMJD, the path forward involves thoughtful lifestyle adjustments, possibly paired with medications to manage pain and discomfort. Aggressive interventions are rarely necessary. Work closely with your doctor to explore your options and find the approach that fits you best. **Source:** <https://www.healthline.com/health/tmj-disorders#outlook> ---
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Care planTendinitisTendinitis is inflammation of a tendon and its surrounding protective sheath. While the sheath is usually where the trouble starts, the tendon itself almost always gets caught up in the body's inflammatory response as well. The exact cause of tendinitis isn't fully understood, but several factors are known to play a role — including repetitive or forceful movements, overexertion, systemic conditions like rheumatoid arthritis, gout, and Reiter's syndrome, as well as high cholesterol. ## Understanding Tendinitis ### What Is Tendinitis? Tendinitis occurs when a tendon — the tough cord of tissue that connects muscle to bone — becomes inflamed. The hallmark symptom is pain and tenderness just outside a joint, and it's most commonly triggered by repetitive movements over time. Tendinitis that comes on suddenly can turn into a long-lasting, chronic problem if left untreated. The most common sites are the shoulder (rotator cuff tendinitis), elbow (tennis elbow or golfer's elbow), wrist and thumb (de Quervain's disease), knee (jumper's knee), ankle (Achilles tendinitis), and hip. ### What Causes It? - Overuse, inadequate training, or poor technique in sports - Repetitive movements at work, like typing - Falls - Lifting or carrying heavy objects - Severe or repeated injury Carrying excess body weight raises your risk of tendinitis because of the added stress placed on tendons, ligaments, and bones. Certain inflammatory conditions — such as Reiter syndrome or ankylosing spondylitis — autoimmune disorders like type 1 diabetes, and some infections can also make you more susceptible. ### How Is It Treated? The mainstays of treatment are rest, ice, pain-relieving and anti-inflammatory medications, and gentle movement exercises. For most people, a flare-up will calm down within one to two months. If your pain is severe, your doctor may recommend a steroid injection directly into the affected area for faster relief. If calcium deposits have built up and need to be removed, there are a few approaches your doctor may consider: - A specialist can numb the area and use ultrasound imaging to guide needles to the deposit. The deposit is loosened, and most of it is sucked out with the needle. Your body may absorb some of the rest of the calcium. - Shock wave therapy uses sound waves from outside your shoulder focused on the calcium deposit. The sound waves break up the deposit. Your body may then absorb some of the calcium. - The calcium deposits can be removed with an arthroscopic surgery called debridement. ### Medication Options - **Nonsteroidal anti-inflammatory drugs (NSAIDs)** — such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), reduce pain and inflammation. There are also prescription NSAIDs. NSAIDs may increase the risk of stomach bleeding. - **Lidocaine or corticosteroid injections** into the tendon — cannot be used for weight-bearing tendons because of risk of rupture. - **Colchicine** — for calcific tendinitis, when calcium builds up in the joint. ### Supportive & Natural Therapies - Ice, especially right after the injury - Rest - Massage - Immobilizing the affected limb (slings, splints) - Flexibility and strengthening exercises after the inflammation goes down - Physical therapy, such as range-of-motion exercises - Ultrasonography — high-frequency sound used to heat an area and increase circulation - Transcutaneous electrical nerve stimulation (TENS) — electricity used to help relieve pain ---
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Care planTennis Elbow (Lateral Epicondylitis)Tennis elbow is an aching soreness or pain felt on the outer (lateral) side of your upper arm, near the elbow. ### What Causes Tennis Elbow? Tendons are the tough, fibrous bands that connect your muscles to your bones. Several of the muscles in your forearm are anchored to the bony bump on the outside of your elbow via these tendons. When you use those muscles repeatedly, tiny tears begin to form in the tendon over time. As those small tears accumulate, they lead to irritation and pain right where the tendon meets the bone. This condition gets its name from tennis — it's especially common in players who rely heavily on racquet sports, and the backhand stroke is the most frequent culprit. But tennis isn't the only cause. Any activity that involves repetitive twisting of the wrist — think turning a screwdriver, wielding a paintbrush, or gripping a wrench — can trigger this condition. That's why painters, plumbers, construction workers, cooks, and butchers are all at higher risk. Even prolonged computer keyboard and mouse use has been linked to tennis elbow. ### What Does It Feel Like? - Elbow pain that gradually worsens over time - Pain that radiates from the outside of the elbow down into the forearm and the back of the hand — especially when gripping or twisting - A noticeably weakened grip ---
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Care planThrombocytopeniaThrombocytopenia is a condition in which your blood doesn't have enough platelets. Platelets (also called thrombocytes) are tiny, colorless blood cells with one very important job: stopping bleeding. When a blood vessel is injured, platelets rush to the scene, clump together, and form a plug to seal the breach. Thrombocytopenia often develops as a consequence of another underlying condition — such as leukemia or an immune system disorder — or it can be a side effect of certain medications. It can affect both children and adults. For many people, thrombocytopenia is mild and causes little to no noticeable symptoms. In rare cases, however, platelet counts can drop dangerously low, triggering serious internal bleeding. The good news: effective treatment options exist. ## Understanding Thrombocytopenia ### Recognizing the Signs Thrombocytopenia can show up in a variety of ways. Signs and symptoms may include: - Easy or excessive bruising (purpura) - Tiny reddish-purple pinpoint spots on the skin — often on the lower legs — caused by superficial bleeding just beneath the surface (petechiae) - Cuts that bleed longer than expected - Bleeding from the gums or nose - Blood in the urine or stool - Unusually heavy menstrual periods - Fatigue - An enlarged spleen - Jaundice (yellowing of the skin or eyes) - Platelets becoming "trapped" in the spleen Your spleen — a fist-sized organ tucked just beneath your left rib cage — normally helps fight infection and filter your blood. When it becomes enlarged (which can happen for many reasons), it can trap too many platelets, pulling them out of active circulation and driving your platelet count down. ### When the Body Doesn't Make Enough Platelets Platelets are made in your bone marrow. When production slows or stalls, thrombocytopenia can develop. Common factors that can reduce platelet production include: - Leukemia - Certain types of anemia - Viral infections, such as hepatitis C or HIV - Chemotherapy drugs - Heavy alcohol consumption - Accelerated breakdown of existing platelets Sometimes the problem isn't production — it's destruction. Certain conditions cause the body to consume or break down platelets faster than they can be replaced, leading to a shortage in the bloodstream. These include: - **Pregnancy.** Thrombocytopenia caused by pregnancy is usually mild and improves soon after childbirth. - **Immune thrombocytopenia.** This type is caused by autoimmune diseases, such as lupus and rheumatoid arthritis. The body's immune system mistakenly attacks and destroys platelets. If the exact cause of this condition isn't known, it's called idiopathic thrombocytopenic purpura. This type more often affects children. - **Bacteria in the blood.** Severe bacterial infections involving the blood (bacteremia) may lead to destruction of platelets. - **Thrombotic thrombocytopenic purpura.** This is a rare condition that occurs when small blood clots suddenly form throughout your body, using up large numbers of platelets. - **Hemolytic uremic syndrome.** This rare disorder causes a sharp drop in platelets, destruction of red blood cells, and impairment of kidney function. Sometimes it can occur in association with a bacterial *Escherichia coli* (E. coli) infection, such as may be acquired from eating raw or undercooked meat. - **Medications.** Certain medications can reduce the number of platelets in your blood. Sometimes a drug confuses the immune system and causes it to destroy platelets. Examples include heparin, quinine, sulfa-containing antibiotics, and anticonvulsants. ### When Things Get Serious: Potential Complications Dangerous internal bleeding can occur when your platelet count falls below 10,000 platelets per microliter. Though rare, severe thrombocytopenia can cause bleeding into the brain, which can be fatal. ---
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Care planThrush / Oral Thrush (Child or Adult)**Oral thrush — also called oral candidiasis —** is a condition in which the fungus *Candida albicans* builds up on the lining of your mouth. Candida is a naturally occurring organism in your mouth, but under the right conditions it can overgrow and cause uncomfortable symptoms. While *Candida albicans* is a normal resident of your mouth, it is usually kept in check by the other microorganisms in your body. But sometimes, certain illnesses or medications — like corticosteroids or antibiotics — can throw off that delicate balance, giving the fungus an opportunity to grow out of control. That's when thrush takes hold. **Stress** can also be a trigger. So can a number of **medical conditions**, such as: - Uncontrolled diabetes - HIV infection - Cancer - Dry mouth - Hormonal changes that happen with pregnancy If you smoke or wear ill-fitting dentures, you may also have a higher chance of developing thrush. Oral thrush typically shows up as creamy white patches, most often on your tongue or inner cheeks. In some cases, it can spread to the roof of your mouth, your gums, your tonsils, or the back of your throat. Though oral thrush can affect anyone, it tends to be most common in babies, older adults, and people with weakened immune systems or certain health conditions — as well as those taking particular medications. For otherwise healthy individuals, oral thrush is usually a minor nuisance. However, if your immune system is compromised, symptoms can be more pronounced and harder to bring under control. ### Signs and Symptoms in Children and Adults Depending on the underlying cause, signs and symptoms may come on gradually or appear suddenly, and they can linger for days, weeks, or even months. Here's what to look out for: - Creamy white patches on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums, and tonsils - Slightly raised patches with a cottage cheese-like texture - Redness or soreness that may be severe enough to make eating or swallowing difficult - Minor bleeding if the patches are rubbed or scraped - Cracking and redness at the corners of your mouth (particularly common in denture wearers) - A cottony or fuzzy feeling in your mouth - Loss of taste In severe cases, the infection can spread downward into your esophagus — the long, muscular tube connecting the back of your throat to your stomach (a condition called Candida esophagitis). If this happens, you may notice difficulty swallowing or a sensation that food is getting stuck in your throat. ### Signs and Symptoms in Infants and Breastfeeding Mothers Beyond the telltale white patches in the mouth, infants with thrush may have trouble feeding or become unusually fussy and irritable. They can pass the infection to their mothers during breastfeeding — and the infection can then ping-pong back and forth between mother and baby. Mothers whose breasts are affected by candida may notice the following signs and symptoms: - Unusually red, sensitive, cracked, or itchy nipples - Shiny or flaky skin on the areola (the darker, circular area surrounding the nipple) - Unusual pain during nursing or nipple pain between feedings - Deep, stabbing pains within the breast **References:** - Candidiasis. Centers for Disease Control and Prevention. <http://www.cdc.gov/fungal/diseases/candidiasis/index.html> - Clinical practice guidelines for the management of candidiasis: 2009 Update by the Infectious Diseases Society of America. *Clinical Infectious Diseases.* 2009;48:503. - HIV/AIDS: Oral candidiasis (thrush). Womenshealth.gov. <http://www.womenshealth.gov/hiv-aids/opportunistic-infections-and-other-conditions/oral-candidiasis-thrush-and-hiv-aids.html#pubs> - Oral candidiasis (yeast infection) patient information. American Academy of Oral & Maxillofacial Pathology. <http://www.aaomp.org/public/oral-candidiasis.php> - Vaginal yeast infections — Women's health guide. U.S. Department of Veterans Affairs. <http://www.publichealth.va.gov/infectiondontpassiton/womens-health-guide/vaginal-yeast-infections.asp> - Thrush. MouthHealthy. <http://www.mouthhealthy.org/en/az-topics/t/thrush> - Diabetes. MouthHealthy. <http://www.mouthhealthy.org/en/az-topics/d/diabetes> - Is thrush causing my sore nipples? La Leche League International. <http://www.llli.org/FAQ/thrush.html> - Kauffman CA. Treatment of oropharyngeal and esophageal candidiasis. <http://www.uptodate.com/home> - Kauffman CA, et al. Candida infections in children: An overview. <http://www.uptodate.com/home> - Kauffman CA. Clinical manifestations of oropharyngeal and esophageal candidiasis. <http://www.uptodate.com/home> - Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. June 16, 2014. - Salinas TJ (expert opinion). Mayo Clinic, Rochester, Minn. July 1, 2014. ---
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Care planTics / Seizure Disorders--- ## Understanding Tics (Muscle Twitches) Tics, also known as muscle twitches, are something many children experience. According to the American Academy of Pediatrics (AAP), about 20% of children suffer from tics. They most often appear in children between seven and nine years of age, though they can show up in children as young as two. In most cases, tics are harmless and go away on their own within a few months. That said, it's worth talking to your doctor if the tics are getting in the way of your child's everyday life or if they persist for longer than a year. ### What Is a Tic? A tic is an involuntary movement or sound that happens over and over again. Tics most commonly show up in the face and neck, but can occur anywhere in the body. Motor tics involve repetitive physical movements such as blinking the eyes, raising the eyebrows, grimacing, biting the lips, twisting the neck, shrugging the shoulders, thrusting the arms, kicking the legs, and jumping. Vocal tics involve sounds or speech such as coughing, clearing the throat, grunting, snorting, moaning, humming, and even speaking words or sentences. ### Transient Tic Disorder Transient Tic Disorder is the most common tic disorder, according to the American Academy of Child and Adolescent Psychiatry. It is a benign condition and usually resolves within three months. Vocal or motor tics that persist longer than one year are classified as chronic and should be evaluated by your pediatrician. ### What Causes Tics? The cause of tics is not fully understood. They may be linked to stress, anxiety, genetics, or certain medications, such as Adderall®, Ritalin®, and Dexedrine®. In rare cases, infections can also play a role. For reasons that are not yet clear, tics are more common in males than females. ### Two Types of Tics: Simple and Complex Simple motor tics are brief, sudden movements that usually involve only one group of muscles, such as shoulder shrugging or eye blinking. Simple vocal tics are sounds such as sniffing or clearing the throat. Complex motor tics, such as touching or throwing objects, last longer than simple tics and involve more than one group of muscles. Complex vocal tics involve spoken words that are usually said suddenly and without warning. **Sources:** - American Academy of Pediatrics: Tics - American Academy of Child and Adolescent Psychiatry: Tic Disorders --- ## Understanding Tremors Tremors are unintentional trembling or shaking movements in one or more parts of your body. Most tremors occur in the hands. You can also have arm, head, face, vocal cord, trunk, and leg tremors. Tremors are most common in middle-aged and older people, but anyone can have them. Tremors originate from a problem in the parts of the brain that control muscles throughout the body or in specific areas, such as the hands. They commonly occur in otherwise healthy people. Tremors can be triggered by a wide variety of factors. **General causes of tremors include:** - Muscle fatigue - Ingesting too much caffeine - Low blood sugar levels - Stress - Aging - Injuries - Prescription medications **Medical conditions that can cause tremors include:** - Traumatic brain injury - Stroke - Parkinson's disease - Multiple sclerosis (MS) - Alcohol use disorder - Hyperthyroidism - Anxiety ### How Are Tremors Classified? Tremors are broadly classified as either resting tremors or action tremors. **Resting tremors** occur when you're sitting or lying still. Once you begin to move around, you'll notice that the tremor goes away. Resting tremors often affect only the hands. **Action tremors** occur during movement of the affected body part. Action tremors are further divided into these subclassifications: - **Postural tremor.** A postural tremor occurs when holding a position against gravity, such as keeping your arm or leg outstretched. - **Intention tremor.** An intention tremor occurs during targeted movements, such as touching your finger to your nose. - **Task-specific tremor.** A task-specific tremor occurs while performing tasks that require skill, such as handwriting or playing an instrument. - **Kinetic tremor.** A kinetic tremor occurs during voluntary movement of a body part, such as moving your wrist up and down. - **Isometric tremor.** An isometric tremor occurs when you voluntarily contract a muscle but don't otherwise move your muscle or limb, such as when you make a fist. ### What Are the Types of Tremors? Tremors are also grouped by their appearance and underlying cause. **Essential tremor** An essential tremor is the most common type of movement disorder. Essential tremors are usually postural or intention tremors. An essential tremor may be mild and not progress, or it may progress slowly over the course of a few years. It typically starts as a bilateral tremor, which means it affects both sides of the body. Essential tremors weren't traditionally thought to be associated with any disease processes. However, recent research, such as a 2015 study and a 2018 textbook, has connected them to mild degeneration in the cerebellum. **A 2019 literature review also concluded that essential tremors were associated with Parkinson's disease in some people.** More studies are needed. Essential tremors are sometimes associated with: - A family history of the condition - Mild walking difficulty - Hearing disability - Mild cognitive impairment **Parkinsonian tremor** The onset of Parkinson's typically occurs around age 60. A Parkinsonian tremor is usually a resting tremor, and it's often the first sign of Parkinson's. This type of tremor is caused by a depletion of the brain chemical dopamine in an area of the brain called the basal ganglia — a group of nerve cell clusters that help coordinate movement. While essential tremors usually begin on both sides of the body, Parkinsonian tremors typically begin in one limb or on one side before progressing to the other. **Functional tremor (psychogenic tremor)** A functional tremor, previously known as a psychogenic tremor, is characterized by: - Sudden onset and remission - Changes in the direction of your tremor and the affected body part - Greatly decreased activity when you're distracted It may present as a postural or an intention tremor. People with functional tremors often have conversion disorder (a psychological condition that produces physical symptoms) or another psychiatric condition. **Dystonic tremor** Dystonic tremors affect people who have dystonia, a movement disorder characterized by involuntary muscle contractions. The muscle contractions cause twisting and repetitive motions or abnormal postures, such as twisting of the neck. These can occur at any age. Dystonic tremors occur irregularly. Complete rest can relieve these tremors. **Cerebellar tremor** The cerebellum controls balance as well as movement. A cerebellar tremor is a type of intention tremor caused by lesions or damage to the cerebellum from: - Stroke - Tumor - A disease, such as MS It may also be the result of alcohol use disorder or overuse of certain medications. If you have alcohol use disorder or are having trouble managing medications, speak with a healthcare professional. They can help you create a treatment plan that works best for you. They can also connect you with other professional resources to help you manage your condition. **Orthostatic tremor** An orthostatic tremor usually occurs in the legs. It's a rapid, rhythmic muscle contraction that occurs immediately after you stand. This tremor is often experienced as a sense of unsteadiness, with no other obvious signs or symptoms. The unsteadiness stops when you: - Sit - Are lifted - Start walking **Physiologic tremor** A physiologic tremor affects the hands and fingers but isn't typically noticeable to the naked eye. It's a normal physical response that occurs in all individuals. A more noticeable physiologic tremor is often caused by a reaction to: - Certain drugs - Alcohol withdrawal - Medical conditions, such as hypoglycemia, electrolyte imbalance, or an overactive thyroid It will usually go away if you eliminate the cause. **Sources:** - NIH: National Institute of Neurological Disorders and Stroke - <https://www.healthline.com/health/tremor#takeaway> --- ## Understanding Seizures A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy. There are many types of seizures, ranging widely in severity. Seizure types vary by where and how they begin in the brain. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency. Seizures are more common than you might think. They can happen after a stroke, a closed head injury, an infection such as meningitis, or another illness. Many times, though, the cause of a seizure is unknown. The term "seizure" is often used interchangeably with "convulsion." Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms and no body shaking. ### Symptoms With a seizure, signs and symptoms can range from mild to severe and vary depending on the type of seizure. Seizure signs and symptoms may include: - Temporary confusion - A staring spell - Uncontrollable jerking movements of the arms and legs - Loss of consciousness or awareness - Cognitive or emotional symptoms, such as fear, anxiety, or deja vu Doctors generally classify seizures as either focal or generalized, based on how and where abnormal brain activity begins. Seizures may also be classified as unknown onset, if how the seizure began isn't known. ### Focal Seizures Focal seizures result from abnormal electrical activity in one area of your brain. Focal seizures can occur with or without loss of consciousness: - **Focal seizures with impaired awareness.** These seizures involve a change or loss of consciousness or awareness. You may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles. - **Focal seizures without loss of consciousness.** These seizures may alter emotions or change the way things look, smell, feel, taste, or sound, but you don't lose consciousness. These seizures may also result in the involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness, and flashing lights. Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy, or mental illness. ### Generalized Seizures Seizures that appear to involve all areas of the brain are called generalized seizures. Different types of generalized seizures include: - **Absence seizures.** Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or by subtle body movements, such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness. - **Tonic seizures.** Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms, and legs and may cause you to fall to the ground. - **Atonic seizures.** Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down. - **Clonic seizures.** Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face, and arms. - **Myoclonic seizures.** Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. - **Tonic-clonic seizures.** Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. ### Causes of Seizures Nerve cells (neurons) in the brain create, send, and receive electrical impulses, which allow the brain's nerve cells to communicate. Anything that disrupts these communication pathways can lead to a seizure. The most common cause of seizures is epilepsy. But not every person who has a seizure has epilepsy. Sometimes seizures happen because of: - High fever, which can be associated with an infection such as meningitis - Lack of sleep - Low blood sodium (hyponatremia), which can happen with diuretic therapy - Medications, such as certain pain relievers, antidepressants, or smoking cessation therapies, that lower the seizure threshold - Head trauma that causes an area of bleeding in the brain - Stroke - Brain tumor - Illegal or recreational drugs, such as amphetamines or cocaine - Alcohol abuse, during times of withdrawal or extreme intoxication - COVID-19 infection ### Possible Complications Having a seizure at certain times can lead to circumstances that are dangerous for you or others. You might be at risk of: - **Falling.** If you fall during a seizure, you can injure your head or break a bone. - **Drowning.** If you have a seizure while swimming or bathing, you're at risk of accidental drowning. - **Car accidents.** A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. - **Pregnancy complications.** Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and plan to become pregnant, work with your doctor so that he or she can adjust your medications and monitor your pregnancy, as needed. - **Emotional health issues.** People with seizures are more likely to have psychological problems, such as depression and anxiety. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects. **Source:** <https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711> --- ## Understanding Epilepsy (Temporal Lobe Epilepsy) Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior. ### Causes of Epilepsy Epilepsy occurs when lasting changes in brain tissue cause the brain to become overly excitable or reactive. The brain begins sending out abnormal signals, which leads to repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.) Epilepsy may be due to a medical condition or injury that affects the brain, or the cause may be unknown (idiopathic). Common causes of epilepsy include: - Stroke or transient ischemic attack (TIA) - Dementia, such as Alzheimer's disease - Traumatic brain injury - Infections, including brain abscess, meningitis, encephalitis, and AIDS - Brain problems that are present at birth (congenital brain defect) - Brain injury that occurs during or near birth - Metabolism disorders that a child may be born with (such as phenylketonuria) - Brain tumor - Abnormal blood vessels in the brain - Other illness or toxicity that damage or destroy brain tissue Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy. **Source:** National Institutes of Health (NIH) --- ## Understanding Tourette Syndrome (TS) Tourette syndrome is a neurological disorder in which you display unusual movements or make sounds over which you may have little or no control (tics). For instance, you may repeatedly blink your eyes, shrug your shoulders, or jerk your head. In some cases, you might blurt obscenities. Signs and symptoms of Tourette syndrome usually begin in childhood, typically showing up between ages 7 and 10. Males are about three to four times more likely than females to develop Tourette syndrome. Although there's no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome don't need treatment when symptoms aren't troublesome. Tics often lessen or become controlled after the teen years. ### Symptoms of Tourette Syndrome Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. They can range from mild to severe. Severe symptoms might significantly interfere with communication, daily functioning, and quality of life. Tics are classified as: - **Simple tics.** These sudden, brief, and repetitive tics involve a limited number of muscle groups. - **Complex tics.** These distinct, coordinated patterns of movements involve several muscle groups. Tics can also involve movement (motor tics) or sounds (vocal tics). Motor tics usually begin before vocal tics do. But the range of tics that people experience is diverse. Before the onset of motor or vocal tics, you'll likely experience an uncomfortable bodily sensation (premonitory urge) such as an itch, a tingle, or tension. Expressing the tic brings relief. With great effort, some people with Tourette syndrome can temporarily stop or hold back a tic. **Sources:** - National Institutes of Health (NIH) - <https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465> ---
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Care planTinea Versicolor**Tinea versicolor**, also called pityriasis versicolor, is a common fungal skin infection that disrupts the skin's normal coloring, leaving behind small patches that appear lighter or darker than the surrounding skin. This condition is most common in teenagers and young adults. Spending time in the sun may make tinea versicolor more visible. The good news: antifungal creams, lotions, or shampoos can effectively treat tinea versicolor. That said, even after the infection clears, your skin tone may stay uneven for several weeks while it returns to normal. Tinea versicolor can also come back — particularly in warm, humid climates or seasons. ### What Causes Tinea Versicolor? The fungus responsible for tinea versicolor is normally present on healthy skin, quietly living near the openings of hair follicles. Problems arise when this fungus overgrows. Several factors can trigger this overgrowth, including: - Hot, humid weather - Excessive sweating - Oily skin - Hormonal changes - Immunosuppression — when your immune system is unable to protect your body from the growth of yeast or fungus on your skin or elsewhere ### Medical Treatments and Medications For cases that are more severe or don't improve with over-the-counter antifungal products, your doctor may prescribe a stronger medication — either applied to the skin (topical) or taken by mouth (oral). Options include: **Topical (applied to the skin):** - Selenium sulfide 2.5 percent lotion - Ciclopirox (Loprox) cream, gel or lotion - Ketoconazole (Nizoral) cream or shampoo **Oral (taken by mouth):** - Ketoconazole (Nizoral) tablets - Itraconazole (Sporanox) capsules - Fluconazole (Diflucan) tablets Even after successful treatment, your skin color may remain uneven for several weeks, or even months. Also, the infection may return in warm, humid weather. In persistent cases, you may need to take a medication once or twice a month to prevent the infection from recurring. ### What You Can Do at Home For a mild case of tinea versicolor, you can start with an over-the-counter antifungal lotion, cream, ointment, or selenium-based shampoo. Most fungal infections respond well to these products, which include: - Selenium sulfide shampoo (Selsun Blue) - Miconazole (Monistat-Derm) - Clotrimazole (Lotrimin) - Terbinafine (Lamisil) Wash and dry the affected area. Then, apply a thin layer of the topical agent once or twice a day for at least two weeks. If you're using shampoo, rinse it off after waiting 5–10 minutes. If you don't see an improvement after four weeks, see your doctor. You may need a stronger medication. ### Keeping Tinea Versicolor From Coming Back Avoid applying oil or oily products to your skin or wearing tight, restrictive or nonventilated clothing. Sun exposure makes the fungal infection more apparent. To help prevent tinea versicolor from returning, your doctor can prescribe a topical or oral treatment that you take once or twice a month. **Preventive treatments include:** - Selenium sulfide (Selsun) lotion applied to the affected areas every 2–3 weeks - Ketoconazole (Nizoral) tablets once a month - Itraconazole (Sporanox) capsules once a month ---
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Care planTinnitus / Meniere's SyndromeMénière's syndrome is a condition that affects more than seven million Americans, according to the *Journal of the American Medical Association* (July 25, 1990). First described by French physician Prosper Ménière in 1861, it is widely understood to result from an abnormal buildup of fluid in the inner ear. When this fluid accumulates, the resulting pressure can trigger a range of symptoms, including: - Ringing or buzzing in the ears (tinnitus) - Pain and pressure in the head and ears - Intermittent hearing loss - Dizziness - Nausea and vomiting - Vertigo and difficulty with balance Not everyone with Ménière's syndrome experiences all of these symptoms — some people have only a few. Known triggers include fluid retention during the premenstrual cycle in women, allergies, and spasms of the tiny blood vessels that supply the inner ear. Standard medical treatment for Ménière's syndrome often involves prescription diuretics (water pills) to help reduce excess fluid in the inner ear. Because diuretics can significantly deplete potassium — an essential mineral — potassium supplementation is typically recommended alongside them. --- ## Understanding Tinnitus Tinnitus is the perception of noise or ringing in the ears when no external sound is present. It is surprisingly common, affecting roughly 1 in 5 people. Tinnitus is not a disease in itself — rather, it is a symptom pointing to an underlying issue, such as age-related hearing loss, an ear injury, or a disorder of the circulatory system. While tinnitus can be frustrating to live with, it is usually not a sign of something dangerous. For many people, it improves with the right treatment. Addressing an identifiable root cause can sometimes resolve it entirely, while other approaches work to reduce or mask the sound so that it becomes less disruptive in daily life. ### How Tinnitus Develops: Inner Ear Hair Cell Damage Inside your inner ear, microscopic hair cells sway in response to the pressure of incoming sound waves. This movement triggers an electrical signal that travels along the auditory nerve to your brain, which then interprets it as sound. When these tiny hair cells become bent or broken — through injury, aging, or prolonged noise exposure — they can begin sending random, erratic electrical signals to the brain, producing the phantom sounds of tinnitus. Tinnitus can also stem from other ear disorders, chronic health conditions, and injuries or diseases that affect the auditory nerves or the hearing centers of the brain. ### Common Causes of Tinnitus - **Age-related hearing loss.** For many people, hearing naturally declines with age — often beginning around age 60. This gradual hearing loss, known medically as presbycusis, is one of the most frequent causes of tinnitus. - **Exposure to loud noise.** Prolonged or repeated exposure to loud sounds — from heavy machinery, chainsaws, firearms, or even personal music devices played at high volume — is a leading cause of noise-related hearing damage. Tinnitus from a one-time loud event, like a concert, often fades on its own. But chronic exposure to loud noise can cause permanent harm. - **Earwax blockage.** Earwax serves a protective function, trapping debris and helping to prevent bacterial growth in the ear canal. However, when too much wax accumulates and hardens (a condition called ceruminal impaction), it can no longer clear on its own — leading to hearing loss, eardrum irritation, and tinnitus. > 📝 **NOTE:** According to Dr. Richard Osborn, Otolaryngologist — *"Most people don't know that the way we were all taught to clean our ears growing up is wrong. Because they see some wax on their cotton swab, they think they're getting it out of the ear. But, this is actually wrong. What's really happening is they're pushing the wax further into the ear, which can cause discomfort, hearing loss, infection or a ringing sensation in the ear."* - **Ear bone changes.** Abnormal bone growth in the middle ear — a condition called otosclerosis — can cause the small bones responsible for transmitting sound to stiffen, affecting hearing and contributing to tinnitus. This condition tends to run in families. ### Less Common Causes of Tinnitus - **Ménière's disease.** Doctors think this inner ear disorder is caused by abnormal inner ear fluid pressure or composition. - **Stress** and **depression.** These conditions are commonly associated with tinnitus and seem to aggravate it. - **TMJ disorders.** Problems with the temperomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus. - **Head injuries** or **neck injuries.** These neurological disorders can affect the inner ear, hearing nerves, or brain function linked to hearing. Head or neck injuries generally cause tinnitus in only one ear. - **Acoustic neuroma.** This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear. ### Pulsatile Tinnitus: Blood Vessel Disorders In rare cases, tinnitus is caused by a blood vessel disorder. This type is called pulsatile tinnitus. Causes include: - **Head and neck tumors.** A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms. - **Atherosclerosis.** With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful and sometimes more turbulent, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears. - **High blood pressure.** Hypertension and factors that increase blood pressure, such as stress, alcohol, and caffeine can make tinnitus more noticeable. - **Turbulent blood flow.** Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent blood flow, leading to tinnitus. - **Malformation of capillaries.** A condition called arteriovenous malformation (AVM), which occurs in the connections between arteries and veins, can result in tinnitus. This type of tinnitus generally occurs in only one ear. ### Medications That Can Cause or Worsen Tinnitus Certain medications have been linked to tinnitus or can make existing tinnitus worse. In general, the higher the dose, the more pronounced the ringing or noise tends to be. For many people, the sound diminishes or disappears once the medication is stopped. Medications known to cause or worsen tinnitus include: - **Antibiotics**, including chloramphenicol, erythromycin, gentamicin, vancomycin, and bleomycin - **Cancer medications**, including mechlorethamine and vincristine - **Diuretics** (water pills), such as bumetanide, ethacrynic acid, furosemide - **Quinine medications** used for malaria or other health conditions - **Chloroquine**, a malaria medication - **Aspirin / Acetaminophen / NSAIDs** ### Factors That Can Contribute to Tinnitus > *"Dietary, nutritional, chemical, hormonal, immunological, and stress factors are involved directly in neurootological problems and must be evaluated and considered in designing the treatment regimen for patients complaining of tinnitus."* > > **Reference:** Rubin, W. Nutrition, biochemistry, and tinnitus. *Int Tinnitus J.* 1999;5(2):144-5. - **Poor diet and stress.** Many nutritionally-oriented physicians believe that people with Ménière's syndrome are often deficient in B vitamins. This is not surprising — chronic stress, lifestyle habits, a poor diet, and environmental exposures can all deplete the body's supply of these essential nutrients. - **Food sensitivities** (especially to salicylates) should be evaluated as part of any comprehensive approach to managing inner ear dysfunction. - **Antibiotic use.** It has been suggested that episodes of Ménière's syndrome may be triggered in some individuals following heavy antibiotic use, as antibiotics can disrupt the beneficial bacteria that live in the gut. Adding a probiotic such as acidophilus to the diet is recommended to help restore healthy intestinal flora and improve the digestion and absorption of key nutrients. - **Hyperlipidemia.** Reduced blood flow to the brain — caused by clogged arteries and poor circulation — may be a contributing factor in some cases of tinnitus. - **Lead and aluminum toxicity.** Heavy metal accumulation may indirectly harm hearing by disrupting normal brain and sympathetic nervous system function. - **Pain relievers and hearing loss risk.** Men who regularly take aspirin, acetaminophen (Tylenol®), and/or NSAIDs (Advil®, Motrin®, etc.) — at least twice per week — significantly increase their risk of hearing loss. Increased risk of hearing loss by medication type: - Aspirin — 33% - NSAIDs — 61% - Acetaminophen — 99% **Reference:** Curhan, S. G., Eavey, R., Shargorodsky, J., & Curhan, G. C. Analgesic use and the risk of hearing loss in men. *Am J Med.* March 2010;123(3):231-7. ---
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Care planToxoplasmosisToxoplasmosis (tok-so-plaz-MOE-sis) is a disease caused by infection with *Toxoplasma gondii*, one of the most widespread parasites on Earth. Most people pick it up by eating undercooked or contaminated meat, coming into contact with infected cat feces, or — in the case of newborns — receiving it from an infected mother during pregnancy. While toxoplasmosis can cause flu-like symptoms in some people, the majority of those infected never feel sick at all. However, for babies born to infected mothers and for people with weakened immune systems, toxoplasmosis can lead to serious, even life-threatening complications. If you're generally healthy, not pregnant, and have been diagnosed with toxoplasmosis, you likely won't need anything beyond basic supportive care. If you're pregnant or immunocompromised, medical treatment becomes important to prevent serious harm. As with most infections, though, prevention is always the best medicine. ## Understanding Toxoplasmosis ### Recognizing the Symptoms The vast majority of healthy people infected with toxoplasmosis have no symptoms at all and may never even know they've been infected. Some people, however, do develop flu-like symptoms, such as: - Body aches - Swollen lymph nodes - Headache - Fever - Fatigue **When your immune system is compromised** If you have HIV/AIDS, are undergoing chemotherapy, or have recently had an organ transplant, a prior toxoplasma infection that your body had been keeping quiet may suddenly reactivate. When this happens, the symptoms can be far more serious, including: - Headache - Confusion - Poor coordination - Seizures - Lung problems that may resemble tuberculosis or *Pneumocystis jiroveci* pneumonia, a common opportunistic infection that occurs in people with AIDS - Blurred vision caused by severe inflammation of your retina (ocular toxoplasmosis) ### What It Means for Babies If you become infected with toxoplasmosis for the first time just before or during your pregnancy, you can pass the infection to your baby (known as congenital toxoplasmosis) — even if you yourself have no symptoms. Your baby faces the greatest risk of contracting toxoplasmosis if you become infected during the third trimester, and the least risk during the first trimester. That said, infections that occur earlier in pregnancy tend to cause more severe outcomes for the baby. Many early infections tragically end in stillbirth or miscarriage. Babies who survive may be born with serious health problems, such as: - Seizures - An enlarged liver and spleen - Yellowing of the skin and whites of the eyes (jaundice) - Severe eye infections Only a small number of babies with toxoplasmosis show obvious signs of illness at birth. Many infected infants appear healthy initially, but may go on to develop problems — including hearing loss, intellectual disability, or serious eye infections — during their teenage years or even later in life. ### When to Seek Medical Care If you are living with HIV or AIDS, are currently pregnant, or are planning to become pregnant, speak with your doctor about getting tested if you think you may have been exposed to toxoplasmosis. The more severe signs of toxoplasmosis — including blurred vision, confusion, and loss of coordination — require prompt medical attention, especially if your immune system is already compromised. ### How You Get Infected *Toxoplasma gondii* (T. gondii) is a microscopic, single-celled parasite capable of infecting virtually any warm-blooded animal or bird. Because the infectious form of T. gondii is shed only in cat feces, wild and domestic cats serve as the parasite's primary host. While you can't "catch" toxoplasmosis directly from an infected person, you can become infected if you: - **Come into contact with cat feces that contain the parasite.** You may accidentally ingest the parasites if you touch your mouth after gardening, cleaning a litter box, or touching anything that has come in contact with infected cat feces. Cats who hunt or who are fed raw meat are most likely to harbor T. gondii. - **Eat or drink contaminated food or water.** Lamb, pork and venison are especially likely to be infected with T. gondii. Occasionally, unpasteurized dairy products also may contain the parasite. Water contaminated with T. gondii isn't common in the United States. - **Use contaminated knives, cutting boards or other utensils.** Kitchen utensils that come into contact with raw meat can harbor the parasites unless the utensils are washed thoroughly in hot, soapy water. - **Eat unwashed fruits and vegetables.** The surface of fruits and vegetables may contain the parasite. To be safe, thoroughly wash and peel all produce, especially any you eat raw. - **Receive an infected organ transplant or transfused blood.** In rare cases, toxoplasmosis can be transmitted through an organ transplant or blood transfusion. - **When a person becomes infected with T. gondii,** the parasite forms cysts that can affect almost any part of the body — often your brain and muscle tissue of different organs, including the heart. In people with healthy immune systems, the body naturally keeps the parasites in check. They remain in an inactive, dormant state, and your immune system "remembers" the infection — effectively granting you lifelong immunity against reinfection. However, if your immune system becomes weakened by illness or certain medications, those dormant parasites can reactivate and cause serious complications. ### Who Is Most at Risk? Toxoplasmosis can affect anyone — the parasite exists all over the world. However, certain groups face a much higher risk of developing serious complications from infection: - **You have HIV/AIDS.** Many people with HIV/AIDS also have toxoplasmosis, either a recent infection or an old infection that has reactivated. - **You're undergoing chemotherapy.** Chemotherapy affects your immune system, making it difficult for your body to fight even minor infections. - **You take steroids or other immunosuppressant drugs.** Medications used to treat certain nonmalignant conditions suppress your immune system and make you more likely to develop complications of toxoplasmosis. ### Potential Complications If your immune system is functioning normally, serious complications from toxoplasmosis are unlikely — though even healthy individuals can occasionally develop eye infections that, if left untreated, may lead to blindness. For those with a weakened immune system — particularly people living with HIV/AIDS — toxoplasmosis can trigger seizures and life-threatening conditions such as encephalitis, a dangerous infection of the brain. In people with AIDS, encephalitis caused by toxoplasmosis is fatal if not treated. Even after treatment, relapse remains an ongoing concern for anyone with both toxoplasmosis and a compromised immune system. Children born with congenital toxoplasmosis may develop lasting, disabling complications, including hearing loss, intellectual disability, and blindness. ---
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Care planTrichotillomania (hair-pulling disorder)Trichotillomania (trik-o-til-o-MAY-nee-uh), also called hair-pulling disorder, is a mental health condition marked by powerful, recurring urges to pull hair from your scalp, eyebrows, or other parts of your body — even when you're trying hard to stop. Pulling hair from the scalp often leaves patchy bald spots, which can cause real distress and get in the way of everyday life, both socially and at work. Many people with trichotillomania go to great lengths to cover up the hair loss. For some people, trichotillomania is mild and relatively manageable. For others, the urge to pull feels impossible to resist. The good news: several treatment approaches have helped many people significantly reduce — or completely stop — their hair pulling. --- ## Understanding Trichotillomania ### Recognizing the Signs Common signs and symptoms of trichotillomania include: - Repeatedly pulling hair out — typically from the scalp, eyebrows, or eyelashes, though sometimes from other areas of the body; the specific sites may change over time - A growing sense of tension just before pulling, or when trying to resist the urge - A feeling of pleasure or relief after pulling hair out - Noticeable hair loss — such as shorter hair, thinning patches, or bald spots on the scalp or elsewhere, including missing or sparse eyelashes or eyebrows - Preferences for certain types of hair, rituals around hair pulling, or particular patterns of pulling - Biting, chewing, or eating pulled-out hair - Playing with pulled-out hair or running it across the lips or face - Repeatedly trying — and failing — to stop or cut back on hair pulling - Significant distress or difficulties at work, school, or in social settings because of hair pulling Many people with trichotillomania also pick their skin, bite their nails, or chew their lips. In some cases, pulling hair from pets, dolls, or fabrics like clothing or blankets may also be a sign. Most people pull hair in private and work hard to keep the condition hidden from others. Hair pulling in trichotillomania can take two forms: - **Focused.** Some people pull their hair deliberately — as a way to ease tension or distress. For example, they may pull to relieve an overwhelming urge, and some develop specific rituals around the process, like searching for just the right hair or biting the pulled strands afterward. - **Automatic.** Some people pull their hair without even noticing they're doing it — for instance, while bored, reading, or watching TV. The same person may experience both focused and automatic pulling, depending on the situation and their mood. Certain positions or habits — like resting your head on your hand or brushing your hair — can act as triggers. Trichotillomania is often closely tied to emotional states: - **Negative emotions.** For many people, hair pulling becomes a way of coping with difficult feelings — stress, anxiety, tension, boredom, loneliness, fatigue, or frustration. - **Positive feelings.** Many people find that pulling hair feels genuinely satisfying and brings a sense of relief. This reinforcing feeling can make it hard to stop, as the behavior becomes a go-to source of comfort. Trichotillomania is a long-term (chronic) condition. Without treatment, symptoms can wax and wane over time. For example, hormonal shifts during menstruation can worsen symptoms in women. For some people, symptoms may come and go over weeks, months, or even years. Only rarely does hair pulling resolve on its own within a few years of starting. ### When to Reach Out to a Doctor If you can't stop pulling your hair — or if you feel embarrassed or ashamed by how your hair looks as a result — talk to your doctor. Trichotillomania is not simply a bad habit; it's a recognized mental health condition, and it's unlikely to improve without proper treatment. ### What Causes Trichotillomania? The exact cause of trichotillomania isn't fully understood. Like many complex conditions, it most likely develops from a combination of genetic and environmental factors working together. ### Who Is at Risk? Several factors may increase the likelihood of developing trichotillomania: - **Family history.** Genetics may play a role — if a close relative has the condition, your risk may be higher. - **Age.** Trichotillomania most often begins just before or during the early teenage years — typically between ages 10 and 13 — and can persist throughout life. Infants can also pull their hair, but this is usually mild and tends to resolve on its own without treatment. - **Other mental health conditions.** People with trichotillomania may also live with depression, anxiety, or obsessive-compulsive disorder (OCD). - **Stress.** Severely stressful situations or life events can trigger trichotillomania in some individuals. While far more women than men seek treatment for trichotillomania, this difference may reflect the fact that women are more likely to seek medical help. Among young children, boys and girls appear to be equally affected. ### Potential Complications Though it might not seem serious on the surface, trichotillomania can have a profound negative impact on your quality of life. Possible complications include: - **Emotional distress.** Many people with trichotillomania describe feelings of shame, humiliation, and embarrassment. Low self-esteem, depression, anxiety, and substance use are not uncommon in those living with this condition. - **Social and professional challenges.** Self-consciousness about hair loss may cause you to pull back from social activities or avoid career opportunities. People may use wigs, creative hairstyles, or false eyelashes to conceal the effects — and some may avoid intimacy out of fear that their condition will be discovered. - **Skin and hair damage.** Repeated hair pulling can cause scarring, infections, and lasting damage to the skin in affected areas, and may permanently alter hair regrowth. - **Hairballs.** Eating pulled-out hair can lead to a large, tangled mass of hair (called a trichobezoar) in the digestive tract. Over years, this can cause weight loss, vomiting, intestinal obstruction, and in severe cases, even death. ### Getting a Diagnosis An evaluation for trichotillomania may involve: - Assessing the extent of your hair loss - A detailed conversation with your doctor about your hair loss and pulling behaviors - Ruling out other possible causes of hair loss or pulling through appropriate testing - Identifying any physical or mental health conditions that may be connected to hair pulling - Applying the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association ### Treatment Options Research on treating trichotillomania is still evolving, but several approaches have helped many people meaningfully reduce or completely stop their hair pulling. **Therapy** — Therapeutic approaches that may help include: - **Habit reversal training.** This is the primary behavioral therapy for trichotillomania. It teaches you to recognize situations where you're likely to pull and helps you substitute different behaviors in those moments. For example, you might clench your fists to counteract the urge, or consciously redirect your hand away from your hair. Other therapies can be used alongside habit reversal training for added benefit. - **Cognitive therapy.** This approach helps you identify and challenge distorted thoughts or beliefs connected to hair pulling. - **Acceptance and commitment therapy.** This therapy helps you acknowledge hair-pulling urges without acting on them — building a healthier relationship with those urges over time. Addressing other mental health conditions that often co-occur with trichotillomania — such as depression, anxiety, or substance use — is also an important part of a well-rounded treatment plan. **Medications** — While no medications are currently approved by the Food and Drug Administration specifically for trichotillomania, certain medications may help manage some symptoms. ---
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Care planTrigeminal Neuralgia (also called: Tic douloureux)Trigeminal neuralgia is a chronic pain condition involving the trigeminal nerve — the nerve responsible for carrying sensation from your face to your brain. For those living with trigeminal neuralgia, even the most gentle touch — brushing your teeth or applying makeup — can unleash a sudden, violent jolt of pain. At first, attacks may be brief and relatively mild. Over time, however, trigeminal neuralgia can escalate into longer, more frequent episodes of intense, searing pain. The condition affects women more often than men and tends to appear after age 50. The good news: trigeminal neuralgia does not have to define your life. A range of effective treatment options exists — from medications to injections to surgery — giving most people a real path toward meaningful pain relief. ## Understanding Trigeminal Neuralgia ### What Causes It? In trigeminal neuralgia — also called tic douloureux — something goes wrong with the normal function of the trigeminal nerve. In most cases, the culprit is a blood vessel (an artery or vein) pressing against the trigeminal nerve where it meets the base of the brain. That pressure disrupts the nerve's normal signaling, triggering pain. Trigeminal neuralgia can develop as a natural consequence of aging, or it may be linked to multiple sclerosis or a similar condition that erodes the protective myelin sheath surrounding the nerve. A tumor pressing on the trigeminal nerve is another possible cause. In some people, a brain lesion or other structural abnormality is responsible. In other cases, the condition can be traced back to a surgical injury, stroke, or trauma to the face. ### Recognizing the Symptoms Trigeminal neuralgia can show up in several ways. You may notice one or more of the following patterns: - Sudden, severe, shooting or stabbing pain — often described as feeling like an electric shock - Attacks that come on without warning, or are set off by everyday actions like touching your face, chewing, speaking, or brushing your teeth - Pain episodes that last anywhere from a few seconds to several minutes - Clusters of attacks that persist for days, weeks, or months — sometimes followed by pain-free stretches - A constant aching or burning sensation that may precede the more intense, spasm-like pain - Pain felt in areas served by the trigeminal nerve — most commonly the cheek, jaw, teeth, gums, and lips, and less often around the eye or forehead - Pain that typically affects only one side of the face at a time, though in rare cases both sides may be involved - Pain that is sharply localized or that radiates across a broader area - Attacks that tend to become more frequent and more severe over time ### Common Triggers Trigeminal neuralgia pain can be triggered by surprisingly ordinary activities and sensations, including: - Shaving - Touching your face - Eating - Drinking - Brushing your teeth - Talking - Putting on makeup - Feeling a breeze on your face - Smiling - Washing your face ### How Is It Diagnosed? Your doctor will piece together the diagnosis primarily from your description of the pain, paying close attention to: - **Type.** Pain related to trigeminal neuralgia is sudden, shock-like and brief. - **Location.** The parts of your face that are affected by pain will tell your doctor if the trigeminal nerve is involved. - **Triggers.** Trigeminal neuralgia-related pain is usually brought on by light stimulation of your cheeks, such as from eating, talking or even encountering a cool breeze. Your doctor may also recommend specific tests to confirm the diagnosis and uncover any underlying causes: - **A neurological examination.** Touching and examining parts of your face can help your doctor determine exactly where the pain is occurring and — if you appear to have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Reflex tests can also help your doctor determine if your symptoms are caused by a compressed nerve or another condition. - **Magnetic resonance imaging (MRI).** Your doctor may order an MRI scan of your head to determine if multiple sclerosis or a tumor is causing trigeminal neuralgia. In some cases, your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiogram). Because facial pain can stem from many different conditions, precision in diagnosis matters. Your doctor may recommend additional tests to rule out other possibilities before settling on a diagnosis. ### Treatment Options Treatment for trigeminal neuralgia typically begins with medications — and for many people, that's all that's needed. Over time, however, some people find that medications become less effective or cause troublesome side effects. When that happens, other approaches — injections or surgery — offer additional paths to relief. If an underlying condition like multiple sclerosis is driving your symptoms, your doctor will focus first on treating that root cause. **Medications** The goal of medication is to reduce or block the pain signals traveling along the trigeminal nerve to your brain. - **Anticonvulsants.** Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it's been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used include oxcarbazepine (Trileptal), lamotrigine (Lamictal), and phenytoin (Dilantin, Phenytek). Other drugs, including clonazepam (Klonopin) and gabapentin (Neurontin, Gralise, others), also may be used. If your current anticonvulsant starts to lose its effectiveness, your doctor may adjust the dose or switch you to a different medication. Common side effects include dizziness, confusion, drowsiness, and nausea. It's worth noting that carbamazepine can trigger a serious drug reaction in some people — particularly those of Asian descent — so genetic testing may be recommended before you begin taking it. - **Antispasmodic agents.** Muscle-relaxing agents such as baclofen (Gablofen, Lioresal) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea, and drowsiness. - **Botox injections.** Small studies have shown that onabotulinumtoxinA (Botox) injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition. **Surgical Options** When other treatments aren't enough, surgery can offer meaningful and lasting relief. Options include: - **Microvascular decompression.** This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. Your doctor makes an incision behind the ear on the side of your pain, then through a small hole in your skull moves any arteries in contact with the trigeminal nerve away from it and places a soft cushion between the nerve and the arteries. If a vein is compressing the nerve, your surgeon may remove it. Doctors may also cut part of the trigeminal nerve (neurectomy) during this procedure if arteries aren't pressing on the nerve. Microvascular decompression can successfully eliminate or reduce pain most of the time, but pain can recur in some people. Risks include decreased hearing, facial weakness, facial numbness, stroke, or other complications. Most people who have this procedure have no facial numbness afterward. - **Brain stereotactic radiosurgery (Gamma knife).** A surgeon directs a focused dose of radiation to the root of your trigeminal nerve to damage it and reduce or eliminate pain. Relief occurs gradually and may take up to a month. This procedure is successful in eliminating pain for the majority of people; if pain recurs, it can be repeated. Facial numbness can be a side effect. Another surgical approach is a procedure called a **rhizotomy**, in which nerve fibers are intentionally damaged to reduce pain — though this typically results in some degree of facial numbness. Types of rhizotomy include: - **Glycerol injection.** Your doctor inserts a needle through your face into an opening in the base of your skull, guiding it into the trigeminal cistern — a small sac of spinal fluid surrounding the trigeminal nerve ganglion and part of its root. A small amount of sterile glycerol is injected, which damages the trigeminal nerve and blocks pain signals. This procedure often relieves pain; however, some people experience a later recurrence, and many experience facial numbness or tingling. - **Balloon compression.** A hollow needle is inserted through your face and guided to a part of your trigeminal nerve that goes through the base of your skull. A thin, flexible tube (catheter) with a balloon on the end is threaded through the needle; the balloon is inflated with enough pressure to damage the trigeminal nerve and block pain signals. Balloon compression successfully controls pain in most people, at least for a period of time. Most people undergoing this procedure experience at least some transient facial numbness. - **Radiofrequency thermal lesioning.** This procedure selectively destroys nerve fibers associated with pain. While you're sedated, your surgeon inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that passes through an opening at the base of your skull. An electrode is inserted through the needle and sends a mild electrical current through its tip; you'll be asked to indicate when and where you feel tingling. When your neurosurgeon locates the part of the nerve involved in your pain, the electrode is heated until it damages the nerve fibers, creating a lesion. Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure. Pain may return after 3–4 years. **Source:** <https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344> ---
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Care planType 1 DiabetesType 1 diabetes is a lifelong autoimmune condition in which the pancreas can no longer produce insulin — the hormone your cells depend on to absorb glucose from the bloodstream. Managing it well means understanding the interplay between what you eat, when you eat, and how your body responds. The guidance below covers the physiology, the nutritional tools, and the daily strategies that make the biggest difference. ## Understanding Type 1 Diabetes ### What Is Type 1 Diabetes? In Type 1 diabetes, the pancreas can no longer release insulin. This matters enormously, because insulin is the key that unlocks your cells — allowing sugar (glucose) to move out of the bloodstream and into your muscles, brain, and other vital tissues, where it's burned for energy. When insulin is missing, blood sugar rises — and over time, that excess sugar silently damages the kidneys, nerves, eyes, and cardiovascular system. Meanwhile, your cells are left starving for the fuel they need to function well. The root cause of Type 1 diabetes is an attack by your own immune system. Your body mistakenly destroys the insulin-producing beta cells nestled inside the pancreas. Once those cells are gone, you must get insulin from the outside — through injections. The good news: by carefully matching your carbohydrate intake to the right insulin dose, you can keep your blood sugar steady and dramatically reduce the risk of long-term complications. Type 1 diabetes cannot be cured, but it absolutely can be managed. The lifestyle and nutrition choices you make every day will shape how your diabetes unfolds — for better or worse. Blood sugar that swings too high or too low accelerates damage to the heart and blood vessels, kidneys, eyes, nerves, skin, gums, and teeth. Your choices are that powerful. ---
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Care planType 2 Diabetes / Cardiometabolic SyndromeMetabolic diseases are sweeping across America at an alarming pace. More than 20 million Americans are living with Type 2 diabetes (T2D) today — and projections suggest that 1 in 3 of us will be diagnosed with this disease in our lifetime. Meanwhile, cardiovascular disease (CVD) claims the lives of more than 610,000 Americans every year, and heart disease diagnoses continue to climb. Together, these numbers tell a sobering story. Both of these largely preventable diseases are made worse by obesity, which is itself rising sharply across the United States. Making sustainable lifestyle changes is no longer optional — it is essential if we hope to reverse the tide of metabolic disease. One of the most powerful levers we can pull is optimizing how our bodies regulate blood sugar. Keeping blood sugar in check helps control insulin resistance, and may be a cornerstone of preventing and managing both T2D and CVD. **Metabolic Syndrome (MetS) | Cardiometabolic Syndrome (CMS) is a cluster of interconnected health problems that dramatically raise your risk for serious chronic diseases, including hardening of the arteries (atherosclerosis) and Type 2 diabetes.** - Beyond increasing your risk of heart attack and stroke, MetS also raises the odds of developing non-alcoholic fatty liver disease — a condition that is becoming increasingly common in Western countries and can progress to cirrhosis, liver cancer, or liver failure. - Certain cancers, including colorectal and prostate cancer, are more common in people with MetS. - Polycystic ovary syndrome (PCOS) — the most common hormonal disorder in women of reproductive age — is strongly linked to MetS. - Sexual dysfunction, gout, chronic kidney disease, and early signs of kidney damage (microalbuminuria) have all been associated with MetS as well. - Approximately 34% of American adults meet the criteria for a MetS diagnosis — and the risk of developing it rises sharply as we age. --- ## Understanding Blood Sugar Imbalance | Cardiometabolic Syndrome (CMS) | Type 2 Diabetes: What You Need to Know ### At the Heart of Metabolic Syndrome: Insulin Resistance At the heart of Metabolic Syndrome (MetS) / Cardiometabolic Syndrome (CMS) is **insulin resistance** — the body's inability to use insulin efficiently to process blood sugar. It frequently goes hand in hand with excess belly fat. **Here's how it develops:** The more refined carbohydrates you eat, the faster your blood sugar spikes after a meal. Your body responds by flooding the bloodstream with insulin to shepherd that sugar into your cells. But insulin — a remarkably powerful hormone — also promotes fat storage, drives up blood pressure, and raises cholesterol and triglyceride levels. About 55% of Americans are overweight, which is one hallmark of metabolic syndrome. Strikingly, even 25% of people at a healthy weight have insulin resistance — the core driver of metabolic syndrome. Taken together, this means more than 65% of American adults either have metabolic syndrome or are at significant risk for it. All of this excess blood sugar and insulin activity generates a flood of damaging free radicals, which accelerate aging and lay the groundwork for heart disease, cancer, Alzheimer's disease, and other serious conditions. Given the rising rates of obesity and an aging population — and the well-established connections among MetS, Type 2 diabetes, and cardiovascular disease — the need for lasting solutions has never been more urgent. While medications are available to manage individual symptoms of MetS, lifestyle change programs remain the recommended first-line approach for preventing or managing Metabolic Syndrome / Cardiometabolic Syndrome / Type 2 Diabetes. > *"The bottom line, in my opinion, is processed food — with all the sugar, salt, fat, and endocrine-disrupting chemicals — may have changed the body weight set point that we all defend and could be the cause of the increased prevalence of type 2 diabetes and obesity. Patients must be counseled to eat "clean," meaning healthy, fresh, unprocessed foods, for healthy living and avoidance of metabolic dysfunction."* > > — Caroline Apovian, MD, Director of Nutrition and Weight Management, Professor of Medicine, Boston University School of Medicine ### Managing Type 2 Diabetes Means Lowering Your Risk of Heart Disease By 2050, an estimated 1 in 3 Americans will have Type 2 diabetes — and cardiovascular disease is already the leading cause of death among people living with this condition. Preventing heart disease in people with Type 2 diabetes is therefore one of the most important public health priorities of our time. To help guide both patients and clinicians, the American Diabetes Association (ADA), the American Heart Association (AHA), and the American College of Cardiology (ACC) have each issued scientific statements on preventing cardiovascular disease in patients with Type 2 diabetes and managing CVD risk factors. Their collective guidance was recently synthesized and published in the *Journal of the American College of Cardiology* [1]. That review focused on two key areas: (1) lifestyle management and (2) cardiovascular risk factor management. The most important takeaways are outlined below. ### Lifestyle Management: Your Most Powerful Tools - **Exercise** — ≥150 minutes/week moderate intensity over ≥3 days/week with ≤2 consecutive days without exercise. - **Walking after meals** — According to James A. Levine, MD, PhD, professor of Medicine at Mayo Clinic, research documents that walking for as little as 15 minutes after each meal significantly lowers the post-meal glycemic response. - **Diet and Nutrition** — A Mediterranean-style diet may improve blood sugar control and cardiovascular risk factors. Prioritizing fruits, vegetables, legumes, whole grains, and dairy in place of other carbohydrate sources is encouraged, along with mindful carbohydrate monitoring as a key strategy for maintaining healthy blood sugar. - **Detoxification** — A growing and compelling body of evidence from around the world links exposure to endocrine-disrupting chemicals with the development of diabetes and obesity. - **Weight management** — A 3%–5% rate of weight loss is associated with clinically meaningful health benefits. - **Smoking cessation** — Quit cigarettes, other tobacco products, or e-cigarettes. **References:** - Newman JD, et al. Primary Prevention of Cardiovascular Disease in Diabetes Mellitus. *J Am Coll Cardiol.* 2017;70(7):883–893. - Fine AM, Patrick L. Environmental medicine: exploring the pollutome for solutions to chronic diseases. *Phys Med Rehabil Clin N Am.* 2022;33(3):719–732. doi:10.1016/j.pmr.2022.04.010 - Kahn LG, Philippat C, Nakayama SF, Slama R, Trasande L. Endocrine-disrupting chemicals: implications for human health. *Lancet Diabetes Endocrinol.* 2020;8(8):703–718. doi:10.1016/S2213-8587(20)30129-7 ### How Is Metabolic Syndrome (MetS) / Cardiometabolic Syndrome (CMS) Diagnosed? **Metabolic Syndrome is a cluster of health findings that together significantly raise the risk of developing cardiovascular disease or Type 2 diabetes.** The American Heart Association and the National Heart, Lung, and Blood Institute recommend diagnosing Metabolic Syndrome when a person has three or more of the following: 1. **Elevated waist circumference:** - Men — equal to or greater than 40 inches (102 cm) - Women — equal to or greater than 35 inches (88 cm) 2. **Elevated triglycerides** — equal to or greater than 150 mg/dL 3. **Reduced HDL ("good") cholesterol:** - Men — less than 40 mg/dL - Women — less than 50 mg/dL 4. **Elevated blood pressure** — equal to or greater than 130/85 mm Hg, or use of medication for hypertension 5. **Elevated fasting blood sugar** — equal to or greater than 100 mg/dL (5.6 mmol/L), or use of medication for high blood sugar ### What Contributes to Metabolic Syndrome and Blood Sugar Imbalance? - Diet is one of the most powerful factors driving Metabolic Syndrome and blood sugar dysregulation - Obesity - Autoimmunity - Lack of exercise - A diet high in refined sugars - A diet high in unhealthy fats - Hormonal disorders (endocrinopathies) - Food sensitivities - Viral infection - Hardening of the arteries (atherosclerosis) ### The Hidden Risk of Statin Medications: Type 2 Diabetes and Cataracts For more than a decade, research has pointed to a link between statin use and the development of Type 2 diabetes. In 2012, the U.S. Food and Drug Administration updated statin drug labels to include a warning about reports of elevated blood sugar and glycosylated hemoglobin (A1c) levels associated with these medications. While that warning sparked considerable debate at the time — and has since been examined in numerous analyses and observational studies — the conclusion has largely held firm among clinicians and in major medical guidelines. The most recent study on this topic (September 2023) analyzed data from the LODESTAR randomized controlled trial, which followed 4,400 patients with coronary artery disease across 12 hospitals in Korea, comparing the risks associated with different types of statins. > *"The percentages of new-onset diabetes and cataract are in line with previous studies regarding statin therapy in patients with atherosclerotic cardiovascular disease. Additional research specifically focusing on these outcomes is required, with more frequent measurement of glucose and A1c levels to detect new-onset diabetes and regular ophthalmologic examinations to detect cataracts. When using a statin medication, we emphasize the importance of meticulous monitoring and appropriate lifestyle interventions to mitigate the risk of new-onset diabetes or cataracts."* > > — Myeong-Ki Hong, MD, PhD, Senior Author **Source:** <https://www.medscape.com/viewarticle/997884?ecd=WNL_trdalrt_pos1_231031_etid6011805&uac=149193PV&impID=6011805#vp_1> **Reference:** *BMJ.* 2023;383:e075837. doi:10.1136/bmj-2023-075837. Published 18 October 2023. Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. <https://www.bmj.com/content/383/bmj-2023-075837> ### The Toxin Problem: How Everyday Chemicals Disrupt Your Metabolism **Endocrine-disrupting chemicals (EDCs)** are substances — natural or man-made — that interfere with the body's hormonal system. EDCs are now so widespread in the air we breathe, the water we drink, the soil that grows our food, and the products we use every day that they affect the vast majority of people on the planet. Bisphenol A (BPA), one of the most common EDCs, has been detected in 96% of the general U.S. population. Even more concerning, a December 2019 study estimates that actual exposure levels to BPA may be as much as 44 times higher than previously believed. Long-term, chronic exposure to EDCs has been shown to have far-reaching effects on the body — well beyond the reproductive system. A growing body of evidence from around the world links EDC exposure to the development of both diabetes and obesity. EDCs can mimic, block, or alter hormone activity, and can even trigger reproductive disruptions that are passed down through generations via epigenetic mechanisms involving molecules called miRNA. In the context of Type 2 diabetes specifically, EDCs promote insulin resistance through actions such as blocking the transport of glucose into cells, or converting immature fat cells into fully developed fat cells by mimicking insulin. EDCs can also alter how genes are switched on and off, affecting insulin secretion in the pancreas, the growth of insulin-producing beta cells, and the expression of genes that drive inflammation. A subset of EDCs, known as metabolism-disrupting chemicals (MDCs), directly target the cells and processes that govern metabolic control — including gene expression and the production of key enzymes, hormones, and fat-signaling molecules. Exposure to MDCs can impair the function of mitochondria (the energy powerhouses of cells), setting the stage for insulin resistance and Type 2 diabetes. **Source:** <https://www.ifm.org/news-insights/endocrine-disruptors-type-2-diabetes-literature-review/> **References:** 1. Lehmler HJ, Liu B, Gadogbe M, Bao W. Exposure to bisphenol A, bisphenol F, and bisphenol S in U.S. adults and children: the National Health and Nutrition Examination Survey 2013–2014. *ACS Omega.* 2018;3(6):6523–6532. doi:10.1021/acsomega.8b00824 2. Gerona R, Vom Saal FS, Hunt PA. BPA: have flawed analytical techniques compromised risk assessments? *Lancet Diabetes Endocrinol.* 2020;8(1):11–13. doi:10.1016/S2213-8587(19)30381-X 3. Fine AM, Patrick L. Environmental medicine: exploring the pollutome for solutions to chronic diseases. *Phys Med Rehabil Clin N Am.* 2022;33(3):719–732. doi:10.1016/j.pmr.2022.04.010 4. Kahn LG, Philippat C, Nakayama SF, Slama R, Trasande L. Endocrine-disrupting chemicals: implications for human health. *Lancet Diabetes Endocrinol.* 2020;8(8):703–718. doi:10.1016/S2213-8587(20)30129-7 5. Legler J, Fletcher T, Govarts E, et al. Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union. *J Clin Endocrinol Metab.* 2015;100(4):1278–1288. doi:10.1210/jc.2014-4326 6. Chevalier N, Fénichel P. Obésité, diabète de type 2 et perturbateurs endocriniens. *Presse Med.* 2016;45(1):88–97. doi:10.1016/j.lpm.2015.08.008 7. Brieño-Enríquez MA, Larriba E, Del Mazo J. Endocrine disrupters, microRNAs, and primordial germ cells: a dangerous cocktail. *Fertil Steril.* 2016;106(4):871–879. doi:10.1016/j.fertnstert.2016.07.1100 8. Petrakis D, Vassilopoulou L, Mamoulakis C, et al. Endocrine disruptors leading to obesity and related diseases. *Int J Environ Res Public Health.* 2017;14(10):E1282. doi:10.3390/ijerph14101282 9. Ling C, Groop L. Epigenetics: a molecular link between environmental factors and type 2 diabetes. 2009;58(12):2718–2725. doi:10.2337/db09-1003 10. Nadal A, Quesada I, Tudurí E, Nogueiras R, Alonso-Magdalena P. Endocrine-disrupting chemicals and the regulation of energy balance. *Nat Rev Endocrinol.* 2017;13(9):536–546. doi:10.1038/nrendo.2017.51 11. Marroqui L, Tudurí E, Alonso-Magdalena P, Quesada I, Nadal Á, Dos Santos RS. Mitochondria as target of endocrine-disrupting chemicals: implications for type 2 diabetes. *J Endocrinol.* 2018;239(2):R27–R45. doi:10.1530/JOE-18-0362 ### Magnesium and Metabolic Syndrome: A Missing Piece? A growing body of evidence suggests that chronically low magnesium levels may contribute to the development of metabolic problems, including excess weight and obesity, insulin resistance, Type 2 diabetes, high blood pressure, and abnormal cholesterol or triglyceride levels. **Reference:** *The Journal of Clinical Endocrinology & Metabolism*, dgae075. Published: 14 February 2024. Magnesium Depletion Score and Metabolic Syndrome in US Adults: Analysis of NHANES 2003 to 2018. <https://doi.org/10.1210/clinem/dgae075> ### Vitamin D: Why You Should Know Your Level (Ask About a Simple Blood Test) Research published online April 19, 2018 in *PLoS One* found that **people with low vitamin D levels may face a significantly higher risk of developing Type 2 diabetes**. The analysis — which followed more than 900 individuals in southern California — found that having blood levels of 25-hydroxyvitamin D (25[OH]D) above 30 ng/mL was associated with a meaningful and substantial reduction in later diabetes risk. > *"We found that participants with blood levels of 25-hydroxyvitamin D that were above 30 ng/mL had one third of the risk of diabetes, and those with levels above 50 ng/mL had one fifth of the risk of developing diabetes [compared with those whose levels were < 30 ng/mL]."* > > — Sue K. Park, MD, Lead Author **Reference:** *PLoS One.* 2018;13:e0193070. **Low Vitamin D and Painful Diabetic Nerve Damage** — Vitamin D levels are lower in patients with painful diabetic peripheral neuropathy (DPN) than in those with painless DPN, or other comparators without DPN. **Reference:** *Diabet Med.* Published online August 13, 2018. **Low Vitamin D May Be an Early Warning Sign of Heart Disease Risk in Young Adults** According to a study led by Francisco J. Amaro‑Gahete, MD, PhD, from the Department of Physiology, Faculty of Medicine, University of Granada, Spain, published January 4, 2024: **"Collectively, these findings support the idea that 25(OH)D concentrations may be used as a useful marker of CVD status, which can be easily monitored in young individuals."** **KEY TAKEAWAYS:** - Vitamin D levels correlated inversely with body mass index (BMI; β = −0.177; P = .018), fat mass index (β = −0.195; P = .011), and systolic blood pressure (β = −0.137; P = .038), after adjusting for sex. - Glucose metabolism markers (serum glucose and insulin concentrations, insulin/glucose ratio, and homeostatic model assessment of insulin resistance index) also correlated inversely with vitamin D levels. - The trend was similar for liver markers (serum γ-glutamyl transferase and alkaline phosphatase) and the anti-inflammatory marker interleukin-4. - BMI, waist/hip ratio, fat mass index, blood pressure, and levels of glucose, insulin, triglycerides, and liver markers were higher in the 44 participants with vitamin D deficiency vs. 41 participants with normal vitamin D levels. **Sources/References:** - <https://www.medscape.com/viewarticle/low-vitamin-d-levels-may-signal-cvd-risk-young-adults-2024a10001un> - *Journal of Endocrinological Investigation.* Published: 04 January 2024. Low vitamin D levels are linked with increased cardiovascular disease risk in young adults: a sub-study and secondary analyses from the ACTIBATE randomized controlled trial. <https://link.springer.com/article/10.1007/s40618-023-02272-4> ### Artificial Sweeteners: Not So Sweet for Your Heart A [2023 scientific review](https://doi.org/10.1097/HCO.0000000000001048) by researchers in Spain confirms the **negative influence of artificial sweeteners** on several key cardiovascular risk factors. It also reveals that these products offer no meaningful benefit for controlling excess body weight. Francisco Gómez-Delgado, MD, PhD, and Pablo Pérez-Martínez, MD, PhD, members of the Spanish Society of Arteriosclerosis and of the Spanish Society of Internal Medicine, **coordinated a comprehensive review of the best available scientific evidence on artificial sweeteners — and the findings are clear: far from supporting health, these substances have "negative effects for the cardiometabolic system."** **Reference:** *Current Opinion in Cardiology.* 38(4):344–351, July 2023. doi:10.1097/HCO.0000000000001048. <https://journals.lww.com/co-cardiology/abstract/2023/07000/artificial_sweeteners_and_cardiovascular_risk.12.aspx> ---
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Care planUrinary IncontinenceUrinary incontinence — the accidental leakage of urine due to loss of bladder control — is far more common than most people realize. This widespread condition is estimated to affect around 13 million Americans and 423 million people worldwide. And those numbers are almost certainly an undercount, since many people never bring it up with their doctor out of shame or embarrassment. Research has found that at least half of people living with urinary incontinence never mention it to a healthcare provider. But there is truly no reason to feel embarrassed. A leaky bladder is one of the most common health challenges people face — you are far from alone. Bladder leakage affects women and men of all ages, though it becomes more frequent as we get older. And it is absolutely worth talking about, because it can quietly chip away at so many parts of daily life — exercise, travel, social outings, and intimacy, says E. James Wright, M.D., director of urology at Johns Hopkins Bayview Medical Center. ### What Causes Urinary Incontinence? There are several distinct types of urinary incontinence, each with its own underlying cause: - **Urge incontinence:** This type involves a sudden, intense urge to urinate that leads to involuntary leakage before you can reach a bathroom. It happens when the bladder spasms and contracts — often due to a neurological condition, infection, or diabetes. Essentially, the brain, spinal cord, and bladder are not coordinating properly, so the bladder may empty without warning. You may also find yourself needing to urinate very frequently — a hallmark of what is called overactive bladder. Nervous system diseases such as multiple sclerosis or stroke can trigger this type. In men, an enlarged prostate is sometimes to blame. In many cases, the exact cause remains unknown. - **Stress incontinence:** With stress incontinence, anything that raises pressure inside the abdomen — coughing, sneezing, jumping, or lifting something heavy — can push urine past the muscle that normally keeps it in. Childbirth, smoking, and being overweight can increase the risk in women. In men, it is uncommon and is most often a side effect of prostate cancer treatment, such as radiation or surgery. - **Overflow incontinence:** This occurs when the bladder muscles are too weak to fully squeeze and empty the bladder, leading to frequent dribbling or leakage. - **Functional urinary incontinence:** In this type, the bladder itself works normally — but something else gets in the way of reaching the toilet in time, or makes it hard to recognize the urge to go. This is common among people with dementia, intellectual disabilities, or mobility challenges such as cerebral palsy. - **Mixed incontinence:** A combination of both urge and stress incontinence occurring together. > 📝 **NOTE:** It is possible to have more than one type of incontinence at the same time. ### Taking Back Control of Your Bladder Urinary incontinence can be deeply disruptive to everyday life, particularly for those experiencing it frequently. Beyond the emotional toll, it can contribute to real medical complications, including pressure sores, depression, infections, and urinary tract infections. Fortunately, there are many effective treatments available — and the right approach will depend on what is causing your incontinence and what works best for you personally. Healthcare providers typically begin with the gentlest, most natural strategies first — such as behavioral therapy, weight loss (incontinence is more common in people who carry extra weight), and [pelvic floor exercises](https://www.health.com/fitness/pelvic-floor-exercises) — before considering medications or procedures. **Here are some strategies that can make a real difference:** **Watch What You Eat and Drink** Certain foods and beverages are known bladder irritants. Cutting back on or eliminating these may help reduce leakage: - Alcohol - Artificial sweeteners - Caffeine - Carbonated beverages - Chocolate - Citrus fruits and tomatoes - Corn syrup - Honey - Spicy foods **Lose a Little Weight — and Gain a Lot of Relief** Research shows that overweight and obese women who lose weight report significantly fewer episodes of bladder leakage. **Retrain Your Bladder** Targeted exercises can help you build better bladder control: - **Pelvic floor exercises.** [Pelvic floor exercises](https://www.health.com/fitness/pelvic-floor-exercises) involve regularly tightening and releasing specific muscles in your pelvis to strengthen them — making you more resistant to leaks. [Kegel exercises](https://www.health.harvard.edu/bladder-and-bowel/step-by-step-guide-to-performing-kegel-exercises). - **The Knack.** With this technique, you perform a pelvic floor contraction at the exact moment you cough, sneeze, or do anything else that tends to trigger a leak. Both techniques take practice. You may benefit from working with your doctor or a physical therapist to make sure you are doing them correctly. ### Medical Treatment Options Depending on the type of incontinence you have, your doctor may recommend one or more of the following: - **Medications** that help your bladder hold more, ease urgency, or improve emptying. (There is even a recently approved over-the-counter patch for women with overactive bladder that helps relax the bladder muscle; the patch is available for men by prescription.) - **Botox injections** into the bladder lining to block the chemical signal that triggers unwanted muscle contractions. - **Urethral bulking injections,** where a thickening substance is injected around the urethra (the tube that carries urine out of the body) to help it better hold back urine. - **Surgery** to place a small mesh sling that supports the urethra and prevents leaks. ---
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Care planUrinary Tract Infection (UTI)A urinary tract infection (UTI) is an infection that can affect any part of your urinary system — your kidneys, ureters, bladder, and urethra. Most UTIs strike the lower urinary tract, specifically the bladder and urethra. Women are more likely to develop a UTI than men. While an infection confined to the bladder is uncomfortable and disruptive, serious complications can arise if the infection travels up to the kidneys — so it's important to take UTIs seriously and treat them promptly. ### What Does a UTI Feel Like? - A sudden, urgent need to urinate - Needing to urinate more often than usual - Pain or burning with urination These are the hallmark signs of a urinary tract infection (UTI), though interestingly, only about half of people who develop a UTI will actually feel symptoms. Women of childbearing age are among those most frequently affected. ### Understanding Your Urinary Tract The urinary tract is made up of four key players: the kidneys, bladder, urethra, and — in men — the prostate. A UTI can involve any of these structures. When the infection affects the kidneys, it's called an upper UTI; when it involves the bladder, urethra, or prostate, it's classified as a lower UTI. ### Recognizing the Signs — and What's Behind Them Also known as bladder infections or cystitis, UTIs tend to announce themselves with a familiar set of symptoms: a burning sensation when you urinate, and that maddening feeling of urgency — rushing to the bathroom, only for very little to come out — followed by the urge returning just minutes later. Bladder infections can also bring on lower abdominal pain, fever, chills, or even visible blood in your urine. In 90% of cases, UTIs are caused by the bacterium *Escherichia coli* (E. coli) — a microorganism that actually plays an important role in your intestines for healthy digestion. The trouble starts when E. coli ventures somewhere it doesn't belong, like the urethra or bladder. Normally, this bug lives at the far end of the digestive tract, but it can easily migrate to the opening of the urethra — the tube that leads up to the bladder. In women, this tube is significantly shorter and sits much closer to the rectum, which is why women are so much more vulnerable. Poor sexual hygiene is a common culprit behind many UTIs. Women who experience recurrent bladder infections should also be evaluated for other bacterial causes, particularly *Chlamydia trachomatis* — a sexually transmitted infection that often causes no symptoms whatsoever in men, making it easy to unknowingly pass along. Synthetic estrogen — found in birth control pills or postmenopausal hormone therapy — is another known irritant to the urinary tract. If you're on the pill and finding yourself with frequent UTIs, it may be time to explore other contraceptive options with your healthcare provider. Additional factors that can raise your risk of bladder infections include pregnancy, diaphragm use, and diabetes. ### How to Lower Your Risk of Infection As with most health conditions, prevention is far better than treatment. Because many UTIs are triggered by sexual activity — particularly with a new partner — good sexual hygiene is your first and most important line of defense. Here are some straightforward steps that can make a real difference: - Always wipe from front to back after using the toilet. - Steer clear of perfumed soaps or lotions in your genital area — they can irritate delicate skin and increase your susceptibility to a bladder infection. - Before sexual activity, make sure your partner has clean hands, fingernails, mouth, and genitals. - Urinate both before and after sex to help flush bacteria away from the bladder. - Drink plenty of fluids, especially clean water. Staying well-hydrated encourages frequent urination, which naturally flushes out bacteria. Fluids also dilute your urine — making it a less hospitable environment for bacteria — and keep the mucous membranes, including those lining the bladder, moist and healthy. Aim to drink one cup (8 oz.) of water for every 25 lbs. of body weight each day, ideally between meals so you don't dilute your digestive enzymes. - Wear loose-fitting clothing around your genital area, and choose 100% cotton underwear — or at minimum, underwear with a cotton lining. ---
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Care planUterine FibroidsUterine fibroids are the most common non-cancerous tumors found in women during their reproductive years. They form from muscle cells and other tissues that grow in and around the wall of the uterus. Also called leiomyomas or myomas, uterine fibroids are benign (non-cancerous) growths of the uterus that most often appear during the childbearing years — and are not linked to an increased risk of uterine cancer. Fibroids occur in 25% of women over age 35 and are often discovered incidentally during a routine pelvic exam, causing no noticeable symptoms. However, they can cause heavy menstrual bleeding and/or pelvic pain or bloating. They tend to grow during pregnancy and with estrogen therapy, and they typically shrink after menopause. Depending on where they develop, fibroids may bulge into the uterine cavity, extend into the pelvic space, or remain embedded within the uterine wall. Fibroids are the most common benign tumor of the female reproductive tract — firm, well-defined, rounded, non-cancerous growths made of smooth muscle and connective tissue within the uterine wall, and they rarely appear alone. Usually as small as an egg, they can gradually grow to the size of an orange or grapefruit. The largest fibroid on record weighed over one hundred pounds. Fibroids often cause — or coincide with — heavier-than-normal periods (hypermenorrhea), irregular bleeding between periods (metrorrhagia), and/or painful periods (dysmenorrhea). Because of their size and weight, they may also contribute to pelvic floor weakness later in life, causing the uterus to drop (a cystocele) and resulting in stress urinary incontinence. After menopause, fibroids routinely shrink. Conventional medical treatment is most often surgical. Some highly skilled surgeons can remove just the fibroid while leaving the uterus intact. Most often, however, a full hysterectomy is performed. Natural progesterone offers a meaningful alternative worth considering. Like breast fibrocysts, fibroid tumors are driven by estrogen dominance — estrogen fuels their growth, while the absence of estrogen causes them to shrink. Estrogen dominance is far more common than conventional medicine typically acknowledges. Many women in their 30s begin having cycles in which they don't ovulate. As they move through the decade before menopause, their bodies produce significantly less progesterone than expected, while estrogen levels remain normal or even increase. The result? Water and salt retention, swollen and fibrocystic breasts, weight gain (especially around the hips and midsection), depression, loss of libido, bone mineral loss — and fibroids. **These are all hallmarks of estrogen dominance, meaning a relative deficiency of progesterone.** When natural progesterone is adequately restored, fibroid tumors typically stop growing — and often shrink — and can be kept in check until menopause, when they will naturally atrophy. This is what reversing estrogen dominance looks like in practice. Cycles without ovulation can be confirmed by measuring serum progesterone levels the week after expected ovulation. A low result signals that ovulation did not occur and that natural progesterone supplementation may be warranted. The underlying cause of anovulation is not entirely clear, but likely reflects premature depletion of ovarian follicles, driven by environmental toxins and nutritional deficiencies that are increasingly common today. --- ## Understanding Uterine Fibroids ### What Contributes to Fibroids? - Impaired fatty acid conversion - Obesity - High fat/caffeine intake - Metabolic syndrome/insulin imbalance - Low fiber intake - Liver damage/dysfunction - High stress - African American women are at three to five times greater risk than Caucasian women - Women who have given birth are at *lower* risk **Diagnostic Testing:** Ultrasound; laparoscopy; D&C. ### What to Expect: Course and Prognosis Treatment is generally only recommended when fibroids are causing symptoms. For women who do not wish to become pregnant, conventional physicians typically offer a myomectomy (removal of the fibroid) or hysterectomy (removal of the uterus). ### Conditions That Can Look Like Fibroids - Ovarian cysts or carcinoma - Endometrial hyperplasia - Cervical polyps - Uterine carcinoma - Adenomyomas ### Recognizing the Symptoms Many women with uterine fibroids have no symptoms at all. When symptoms do occur, they may include: - Heavy or painful periods or bleeding between periods - Menstrual irregularities - Vaginal discharge - Uterine pain or cramps - Feeling "full" in the lower abdomen - Urinating often - Pain during intercourse - Lower back pain - Anemia - Reproductive challenges such as infertility, multiple miscarriages, or premature labor Most women with fibroids do not have trouble getting pregnant and can conceive naturally. Some may face fertility challenges, but advances in reproductive medicine continue to offer more options for these women. ---
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Care planVaccine Adverse ReactionsWhen disease-causing germs enter your body, they begin to multiply. Your immune system detects these germs as foreign intruders and springs into action, producing specialized proteins called antibodies. Their first mission is to seek out and destroy the germs making you sick. They may not move quickly enough to keep you from getting ill in the first place — but by eliminating the invaders, they help your body recover. But antibodies do something even more remarkable: they remember. Long after you've recovered, these proteins remain in your bloodstream, standing guard. If the same germ ever attempts to infect you again — even years later — your antibodies recognize it immediately and destroy it before it can make you sick again. This is immunity. It's the reason most people only get diseases like measles or chickenpox once in their lifetime, even if they're exposed again and again. --- ## Understanding How Vaccines Work ### How Do Vaccines Train Your Immune System? A healthy immune system is your body's defense force. It's made up of different types of cells that work together to identify and eliminate dangerous invaders. But here's the catch: your immune system first has to recognize that something is a threat before it can act. This is exactly where vaccines come in. A vaccine essentially runs a fire drill for your immune system — it introduces your body to a safe version of a germ, prompting your immune cells to learn how to recognize and remember it. That way, if your body ever encounters the real threat, your immune system is already trained and ready to respond quickly. Vaccines achieve this by exposing you to a harmless form of a disease. Depending on the vaccine, this might look like: - a protein or sugar taken from the surface of a germ - a dead or inactivated version of a germ - a harmless toxoid — a modified version of a toxin produced by a germ - a live but weakened version of a germ When your body responds to any of these, it builds what's called an adaptive immune response — essentially a custom-tailored defense system that's primed and ready if you encounter the real disease. Vaccines are usually given by injection. **Most vaccines contain two key parts:** - **The antigen.** This is the piece of the disease your immune system needs to learn to recognize — the "wanted poster," so to speak. - **The adjuvant.** Think of this as an alarm signal. It prompts your immune system to respond more vigorously to the antigen, as if it were a real infection — helping you build stronger, longer-lasting immunity. ### What's Actually Inside a Vaccine? Every vaccine is designed to teach your immune system to recognize a specific virus or bacterium — so that if you ever encounter it in real life, your body already knows how to fight back. **There are four main types of vaccines currently in use:** - **Killed (inactivated) vaccines** are made from a virus or bacterium that has been completely deactivated — it cannot cause disease, but it still teaches your immune system what to look for. - **Live virus vaccines** use a weakened (attenuated) form of a virus or bacterium — alive but too feeble to cause illness in a healthy person. - **Toxoid vaccines** target a harmful chemical or toxin produced by a germ, rather than the germ itself. Rather than making you immune to the germ, they protect you from the damage its toxin causes. The tetanus shot is a well-known example. - **Subunit, recombinant, polysaccharide, and conjugate vaccines** use just a specific structural piece of a virus or bacterium — enough for your immune system to learn to recognize and attack it. In addition to the active ingredients, vaccines contain other components that keep them stable and effective from the moment they're made until the moment they're administered. **These supporting ingredients include:** - **Suspending fluid.** Sterile water, saline, or similar liquids serve as the vehicle that carries the vaccine safely through production, storage, and use. - **Adjuvants or enhancers.** These ingredients boost the vaccine's effectiveness once it's injected. **Examples include mercury or aluminum gels or salts.** - **Preservatives and stabilizers.** Vaccines are often manufactured months or even years before they're used. These ingredients prevent the active components from breaking down and losing effectiveness over time. Examples of a stabilizer are monosodium glutamate (MSG) and thimerosal. - **Antibiotics.** Small amounts of a bacteria-fighting drug may be added to vaccines to prevent contamination during production and storage. ### A Closer Look: COVID-19 / Coronavirus Vaccines The Pfizer and Moderna vaccines are built on a technology called messenger RNA, or mRNA. This delivers a small piece of genetic code to your cells — essentially a recipe instructing them to make the spike protein found on the surface of the SARS-CoV-2 virus. Once your cells follow that recipe and produce the spike protein, your immune system recognizes it as foreign and mounts a response — building antibodies and other defenses to fight it if you're ever exposed to the real virus. The Johnson & Johnson vaccine takes a different approach to deliver the same instructions. It uses what's called a viral vector vaccine. In this case, a harmless adenovirus — a member of a large family of viruses, some of which cause the common cold — has been engineered to carry the genetic blueprint for the SARS-CoV-2 spike protein. Once this modified adenovirus enters your cells, they use that blueprint to produce spike proteins, triggering your immune response. **Sources:** - <https://vaccineinformation.org/how-vaccines-work/> - <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/how-do-vaccines-work> - <https://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-understand-color-office.pdf> - <https://www.statnews.com/2021/02/02/comparing-the-covid-19-vaccines-developed-by-pfizer-moderna-and-johnson-johnson/> For more information on COVID-19 vaccines, see the vaccine resource section on: **COVID-19 | Coronavirus | SARS-CoV-2** ---
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Care planVaginitisVaginitis is an inflammation and/or infection of the vagina, sometimes accompanied by irritation of the surrounding vulvar tissue. It typically arises in one of two ways: 1. **The overgrowth of a normal part of the vaginal flora, or the introduction of a foreign microorganism through sexual relations.** 2. **Reaction to an external agent causing an allergic or chemical reaction.** Microorganisms that are normally present in the vagina can sometimes cause problems: yeast (most commonly *Candida albicans*) may overgrow on its own or spread from the intestines or through sexual contact; *Hemophilus vaginalis* / *Gardnerella vaginalis* is another common culprit, sometimes called "nonspecific vaginitis." Bacterial vaginosis happens when certain bacteria that naturally live in the vagina grow out of control. Under healthy conditions, "good" bacteria (lactobacilli) far outnumber "bad" bacteria (anaerobes). When that balance tips — with too many anaerobic bacteria — the normal vaginal environment is disrupted, leading to bacterial vaginosis. Leukorrhea (or leucorrhoea in British English) refers to a thick, whitish or yellowish vaginal discharge. It has many possible causes, with hormonal (estrogen) imbalance being the most common. The amount of discharge can increase with a vaginal infection, and it may come and go over time. **Vaginitis caused by outside microorganisms:** These include *Trichomonas vaginalis* and *Neisseria gonorrhea*. In young girls, poor hygiene can allow bacteria such as *E. coli*, strep, or staph to cause infection as well. ---
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Care planVagus Nerve StimulationThe vagus nerve is the longest cranial nerve in your body — a remarkable highway of communication connecting your brain to many of your most vital organs, including your gut (intestines and stomach), heart, and lungs. The name says it all: "vagus" is Latin for "wanderer," a fitting description for a nerve that meanders throughout the body, touching so many of the systems that keep you alive and well. The vagus nerve is also a cornerstone of your parasympathetic nervous system — the part of your nervous system responsible for "rest and digest." It plays a meaningful role in regulating your breathing, digestion, and heart rate, all of which are deeply tied to your mental health and overall sense of wellbeing. One concept worth understanding is the "tone" of your vagus nerve. **Vagal tone** refers to the ongoing internal activity of the vagus nerve — think of it like fitness, but for your nervous system. The higher your vagal tone, the more efficiently your body can shift out of stress and into recovery. Actively working to increase your vagal tone helps activate your parasympathetic nervous system, allowing your body to bounce back from stress more quickly and completely. In 2010, researchers uncovered an exciting positive feedback loop: higher vagal tone supports more positive emotions and better physical health — and those improvements, in turn, further raise vagal tone. Simply put, the more you nurture your vagus nerve, the better you tend to feel, in body and mind. > *"It's almost like yin and yang. The vagal response reduces stress. It reduces our heart rate and blood pressure. It changes the function of certain parts of the brain, stimulates digestion, all those things that happen when we are relaxed."* > > — Dr. Mladen Golubic, MD, Medical Director of the Cleveland Clinic Perhaps most strikingly, research suggests that vagal tone can be passed from mother to child. Mothers who experience depression, anxiety, or significant anger during pregnancy tend to show lower vagal activity — and their newborns often reflect this, arriving in the world with similarly low vagal activity and reduced levels of dopamine and serotonin. ---
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Care planVaricose Veins**Varicose veins** are enlarged, swollen veins that bulge visibly above the skin's surface. They often appear dark purple or blue, with a twisted, rope-like appearance. Most commonly found along the back of the calves or the inner leg, varicose veins develop when tiny one-way valves inside the veins — valves whose job it is to push blood toward the heart — begin to fail. When these valves stop working properly, blood backs up and pools in the vein, causing it to swell and stretch. Beyond their appearance, varicose veins can cause a range of uncomfortable symptoms, including: - a burning or throbbing sensation in the legs - legs that feel persistently heavy, tired, or achy - muscle cramps, often worse at night - swelling of the feet and ankles - skin over the vein that appears dry, itchy, or unusually thin Varicose veins are remarkably common — affecting 1 out of 2 people over age 50 — and are more prevalent in women than in men. You may be surprised to learn that hemorrhoids are actually a form of varicose vein. Spider veins are a milder, smaller cousin of the same condition. A number of factors can increase your risk of developing varicose veins, including family history, advancing age, biological sex, pregnancy, excess body weight, and a sedentary lifestyle. The good news is that simple daily habits can help prevent varicose veins from worsening. Staying active, maintaining a healthy weight, elevating your legs when resting, and avoiding crossing your legs while seated all make a meaningful difference. Wearing loose-fitting clothing and limiting prolonged standing can also help. If your varicose veins are painful or bothersome to you cosmetically, your doctor can discuss procedures to treat or remove them. ---
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Care planVenous InsufficiencyVenous insufficiency is a condition in which the veins struggle to pump blood from your legs back up to your heart — working against gravity with damaged or weakened "one-way valves" that are supposed to keep blood moving in the right direction. ### What Causes It? Under normal circumstances, a series of tiny valves inside your deeper leg veins act like one-way gates, ensuring blood flows steadily upward toward your heart. In chronic venous insufficiency, the walls of the veins become weakened and those valves become damaged or fail. The result? Blood pools in the veins — particularly when you're on your feet — instead of continuing its journey upward. Chronic venous insufficiency is, as the name implies, a long-term condition. It develops when a vein becomes partially blocked, or when blood is leaking backward around the faulty valves rather than advancing forward. ### Who Is at Risk? Common Risk Factors Include: - Age - Being female (related to levels of the hormone progesterone) - Being tall - Family history of this condition - History of deep vein thrombosis in the legs - Obesity - Pregnancy - Sitting or standing for long periods ### Symptoms to Watch For - Dull aching, heaviness, or cramping in legs - Itching and tingling - Pain that gets worse when standing - Pain that gets better when legs are raised - Swelling of the legs - Redness of the legs and ankles - Skin color changes around the ankles - Varicose veins on the surface (superficial) - Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis) - Ulcers on the legs and ankles - Wounds that are slow to heal on the legs or ankles ### How Is It Diagnosed? Your doctor will perform a physical examination and ask about your symptoms and medical history. A diagnosis is often made simply by observing the appearance of the leg veins while you stand or sit with your legs dangling. A duplex ultrasound of your leg may be ordered to: - Assess blood flow through the veins - Rule out other problems with the legs, such as a blood clot ### Treatment Options Your doctor may suggest the following self-care steps to help manage venous insufficiency: - Wear compression stockings to decrease swelling - Avoid prolonged sitting or standing — even small movements of the legs help keep blood flowing - Care for wounds if you have any open sores or infections - Lose weight if you are overweight If your condition is more severe, your doctor may recommend one or more of the following procedures: - **Sclerotherapy:** Salt water (saline) or a chemical solution is injected into the vein; the vein hardens and then disappears - **Ablation:** Heat is used to close off and destroy the vein; the vein disappears over time - **Vein stripping:** Small surgical cuts (incisions) are made in the leg near the damaged vein; the vein is removed through one of the incisions - **Bypass:** This is surgery to reroute blood flow around the blocked vein; a tube or blood vessel taken from your body is used to make a detour around, or bypass, the damaged vein - **Valve repair:** A small incision is made in the leg and the damaged valve is repaired - **Angioplasty and stenting:** This is a procedure to open a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to prevent it from narrowing again. **Surgery** (varicose vein stripping) or other treatments for varicose veins may be recommended if you have: - Leg pain, which may make your legs feel heavy or tired - Skin sores caused by poor blood flow in the veins - Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis) ### What to Expect Over Time Chronic venous insufficiency tends to worsen gradually over time. That said, consistent self-care steps can meaningfully ease your discomfort and slow the condition's progression. It is likely that at some point you will also benefit from one or more medical procedures to more definitively address the condition. **References:** - Freischlag, J. A., & Heller, J. A. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. *Sabiston Textbook of Surgery.* 19th ed. Philadelphia, Pa.: Elsevier Saunders; 2012: chap 65. - Word, R. Medical and surgical therapy for advanced chronic venous insufficiency. *Surg Clin N Am*. 2010;90:1195–1214. ---
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Care planVertigo-Associated DisordersVertigo is the unsettling sensation that you — or the world around you — is spinning or moving. It is often mistakenly called dizziness, but it is something distinctly different. Unlike ordinary light-headedness, vertigo creates a powerful illusion of movement. People who experience it feel as though they are genuinely spinning or tilting, or that their surroundings are rotating around them. ## Understanding Vertigo ### What Causes Vertigo? There are two main types of vertigo, each rooted in a different part of the body: - **Peripheral vertigo** occurs if there is a problem with the part of the inner ear that controls balance (vestibular labyrinth or semicircular canals) or with the vestibular nerve, which connects the inner ear to the brainstem. - **Central vertigo** occurs if there is a problem in the brain, particularly in the brainstem or the back part of the brain (cerebellum). **Vertigo originating in the inner ear may be caused by:** - Benign positional vertigo (also called benign paroxysmal positional vertigo) - Drugs called aminoglycoside antibiotics - Injury (such as head injury) (see **[Concussion / Brain Injury / Traumatic Brain Injury](/plans/b1cda336-947b-59bb-a24b-fa04f3327338)**) - Labyrinthitis - Ménière's disease (see **[Tinnitus / Meniere's Syndrome](/plans/6f84626b-548f-5fd9-a1b9-ead12e23bcdd)**) **Vertigo originating from the vestibular nerve may be caused by:** - Inflammation (neuronitis) (see **[Peripheral Nerve Disorders](/plans/cf0b3e0f-69dd-55ab-afec-5e1913f0b8b3)**) - Nerve compression (usually a noncancerous tumor such as a meningioma or schwannoma) **Vertigo originating in the brainstem may be caused by:** - Blood vessel disease (see **[Peripheral Artery (Arterial) Disease (PAD) and Claudication / Atherosclerosis](/plans/f4ea8570-503a-5696-ab1a-f3d916402bd6)**) - Drugs / Medications (anticonvulsants, antidepressants, aspirin, alcohol, etc. — see below) - Migraine (see **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)**) - Multiple sclerosis (see **Multiple Sclerosis (MS)**) - Seizures (rarely) (see **[Tics / Tremors / Seizures / Epilepsy / Tourette Syndrome](/plans/e74bd2a4-e716-5b6b-aadb-83d44c876499)**) ---
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Care planVisual DisturbancesVisual disturbances are any abnormal changes in the way you see — and they can range from mildly annoying to genuinely alarming. Many are temporary and respond well to treatment, while others may be long-lasting or permanent. Understanding what's behind them is the first step toward protecting your sight. ## Understanding Visual Disturbances ### What Kinds of Visual Disturbances Are There? The most common visual disturbances include: - Double vision, or diplopia - Partial or total blindness - Color blindness - Blurred vision - Halos - Pain --- ### Diplopia: Seeing Double If you're seeing two objects when there's really only one, you're experiencing diplopia — more commonly known as double vision. This is more than just a nuisance; it can be a sign of a serious underlying health problem. It's important to see your doctor as soon as symptoms start. **Double vision comes in two distinct forms:** - **Monocular:** Double vision that affects only one eye is called monocular diplopia. It can result from a physical change to the lens over your eye, the cornea, or the retinal surface. This type of double vision occurs with only one eye open. - **Binocular:** Double vision that only happens with both eyes open may be the result of poorly aligned eyes. It could also be nerve damage, which prevents your brain from properly layering the images your eyes are seeing. Double vision can be a result of a communication breakdown in your brain — your brain simply can't merge the two slightly different images your two eyes are sending it. This can happen for many reasons, and it's often seen in conditions that affect the eye muscles or the nerves that control them. **Common causes of double vision include:** - **An autoimmune condition, such as myasthenia gravis,** which prevents your nerves from activating your eye muscles - **Cataracts,** which is clouding of your eye's lens — see **[Cataracts](/plans/00851524-3b23-54e6-9d2f-7ec241ed3aa6)** - **Corneal scarring or infection** - **Diabetes** — see **[Blood Sugar Dysregulation / Cardiometabolic Syndrome (CMS) / Type II Diabetes](/plans/938e59a3-3081-550f-b1ca-0289b0d6ac50)** - **Hypertension** — see **[Hypertension (High Blood Pressure)](/plans/bac6d212-7cb2-5519-b6d4-9e557525e109)** - **Injury or irregularity affecting the lens or cornea of the eye** - **Muscle weakness** - **Nerve conditions, such as multiple sclerosis (MS) and Guillain-Barré syndrome** — see **Multiple Sclerosis (MS)** or **Autoimmune Diseases** **When double vision comes on suddenly,** it may be caused by: - Stroke - Migraine - Brain tumor - Aneurysm --- ### Eye Floaters: Those Drifting Spots in Your Vision Eye floaters are a common complaint, especially as we get older. They appear as tiny drifting specks, threads, or cobwebs in your field of vision and are caused by the breakdown of the gel-like vitreous body inside your eye as it slowly pulls away from the retina and optic nerve over time. They tend to be more noticeable in bright light or when you strain — for instance, during a bowel movement. While they can be annoying, they're usually harmless. Most of the time, floaters don't meaningfully interfere with your sight. Occasionally, a particularly large floater may cast a faint shadow across your vision, but this usually only happens in certain lighting conditions. Most people learn to live with eye floaters and, over time, simply stop noticing them. They often improve on their own over months to years. Only rarely do floaters become bothersome enough to warrant treatment. **That said, floaters can sometimes signal a more serious problem.** Seek immediate medical attention if you notice a sudden surge in the number of floaters you're seeing. This is especially urgent if the floaters are accompanied by flashes of light or a loss of peripheral vision. If you experience these symptoms together, see an eye doctor right away — without prompt treatment, permanent vision loss can result. These symptoms may be caused by: - Retinal detachment - Retinal tear - Bleeding within the eye > 📝 **NOTE:** See **[Eye Floaters (Benign)](/plans/7fcd6409-9ebb-59f2-8d10-952c6f290f97)** --- ### Blindness: Partial and Total Partial blindness means you can still detect light and perceive some of your surroundings. Total blindness means you can no longer perceive light at all. People with vision below 20/200 are considered legally blind. In some cases, vision can be improved with: - Glasses - Surgery - Contact lenses In many cases, however, people with partial or complete blindness are not able to restore their sight. **Blindness has many causes. The most common include:** - Accidents or trauma to the eyes - Advancing age - Cataracts — see **[Cataracts](/plans/00851524-3b23-54e6-9d2f-7ec241ed3aa6)** - Diabetes — see **[Blood Sugar Dysregulation / Cardiometabolic Syndrome (CMS) / Type II Diabetes](/plans/938e59a3-3081-550f-b1ca-0289b0d6ac50)** - Glaucoma — see **[Glaucoma](/plans/84b744b1-77d6-582b-a3cb-832a70e7a70c)** - Hereditary condition - Macular degeneration — see **[Macular Degeneration](/plans/01d8515a-57c3-5735-8959-dd97cb2106c9)** - Optic neuritis, or inflammation of the optic nerve - Stroke - Tumors --- ### Color Blindness: When Colors Don't Look Quite Right People who are colorblind don't see colors the same way that people with typical vision do. Most people with color vision problems are only partially affected — they have difficulty telling certain shades apart rather than being unable to see color altogether. Complete color blindness, where a person sees only shades of gray, is quite rare. Color blindness is more common in men than in women. The most common form is red-green color deficiency. **Common causes of color vision problems include:** - Advancing age - Certain medications, such as those used to treat high blood pressure, erectile dysfunction, and psychological disorders - Diabetes — see **[Blood Sugar Dysregulation / Cardiometabolic Syndrome (CMS) / Type II Diabetes](/plans/938e59a3-3081-550f-b1ca-0289b0d6ac50)** - Exposure to certain chemicals, such as fertilizers — see **[Detoxification](/plans/85f07fee-b34a-57a3-8936-2b1829ed61c2)** - Glaucoma — see **[Glaucoma](/plans/84b744b1-77d6-582b-a3cb-832a70e7a70c)** - Heredity - Macular degeneration, or inflammation of the optic nerve — see **[Macular Degeneration](/plans/01d8515a-57c3-5735-8959-dd97cb2106c9)** - Optic neuritis - Parkinson's disease — see **[Parkinson's Disease](/plans/24c5c071-5e68-513a-8634-6645ba292847)** - Sickle cell anemia --- ### Blurred Vision: When the World Goes Out of Focus Blurred vision may simply reflect a change in your eyesight, or it may be a symptom pointing to another underlying condition. When the eyes no longer align properly, they can't accurately receive and process visual information. Corrective glasses or contact lenses resolve most cases of blurry vision. If an underlying condition is responsible, that condition will need to be addressed. If blurry vision comes on quickly, treat it as an eye emergency and see a doctor right away. **Blurred vision can be caused by one or more of the following:** - Cataract — see **[Cataracts](/plans/00851524-3b23-54e6-9d2f-7ec241ed3aa6)** - Corneal abrasion or infection - Glaucoma — see **[Glaucoma](/plans/84b744b1-77d6-582b-a3cb-832a70e7a70c)** - Inadequate prescription glasses or contact lenses - Macular degeneration — see **[Macular Degeneration](/plans/01d8515a-57c3-5735-8959-dd97cb2106c9)** - Migraine — see **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)** - Optic nerve problems - Trauma or injury to the eye - Tumor - Stroke --- ### Halos: Rings of Light Around Objects Halos appear as glowing rings or circles of light around objects — like a halo around a streetlight at night. They can be a sign of several different eye conditions and should be evaluated by an eye doctor. **Halos can be caused by any of the following:** - Cataract — see **[Cataracts](/plans/00851524-3b23-54e6-9d2f-7ec241ed3aa6)** - Damage or disease that affects your eye's cornea - Glaucoma — see **[Glaucoma](/plans/84b744b1-77d6-582b-a3cb-832a70e7a70c)** - Migraine — see **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)** - Ocular migraine — see **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)** --- ### Eye Pain: Discomfort That Demands Attention Eye pain can take many forms depending on what's causing it. You might notice a gritty or scratching sensation every time you blink, or a persistent, throbbing ache that doesn't let up even when your eyes are closed. There are many possible causes of eye pain. A few of the most common are listed here: - Bacterial infection — see **[Sty / Eye Infection](/plans/ab33f4f4-519a-5038-89f4-5939c45a3e6d)** - Conjunctivitis, or pink eye — see **[Conjunctivitis (Pink Eye)](/plans/532074b2-5649-586f-83e9-495567eb8291)** - Glaucoma — see **[Glaucoma](/plans/84b744b1-77d6-582b-a3cb-832a70e7a70c)** - Injury or inflammation in the eyelids - Migraine headache — see **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)** - Optic neuritis, or inflammation of the optic nerve - Problems with contact lenses - Sinus headache or sinus infection — see **[Sinus Infections (Sinusitis) — Chronic Sinusitis / Chronic Nasal-Drip](/plans/05c8cf81-03b2-58c2-b735-92c0df2f692e)** - Sty, an inflamed oil gland that develops on your eyelids — see **[Sty / Eye Infection](/plans/ab33f4f4-519a-5038-89f4-5939c45a3e6d)** Eye pain always warrants a medical evaluation, as some of its causes can lead to irreversible damage if left untreated. --- ### Visual Disturbances Caused by Migraines According to the American Migraine Foundation, 25 to 30 percent of migraine sufferers experience visual aura symptoms. Importantly, these symptoms usually occur in both eyes. This can be disorienting, because the disturbance may only seem to affect one side of your visual field — say, the right side. A simple way to check: close one eye, look for the disturbance, then switch to the other eye. If the disturbance only appears when one specific eye is open, it may be pointing to something more serious than a migraine. **Here are some of the visual disturbances a migraine can produce:** - **Photopsia:** This is when you see flashes of light, like a bright bulb flashing in your vision. - **Fortification spectra / teichopsia:** These are bright, jagged lines that shimmer. They vaguely resemble battlements or fortifications, hence the name. - **Metamorphopsia / Alice in Wonderland syndrome (AiWS):** This is when images distort in shape, size, and/or color, producing an often bizarre visual effect some feel is reminiscent of Lewis Carroll's work. - **Scotoma / partial loss of vision:** This effect is categorized by spots in the field of vision or a tunnel vision effect. - **Amaurosis fugax:** More commonly due to decreased blood flow from a narrowing in the carotid artery, this effect can still occur with migraines. It appears like a loss of vision spreading from the top down, not unlike a shade being pulled. **Migraine-related visual symptoms fall into three broad categories:** - **Positive symptoms:** These are visual disturbances where you see something that is not there. - **Negative symptoms:** These are the opposite of positive symptoms, where you have blind spots in your vision. - **Distorted or altered visual symptoms:** This category includes many of the symptoms associated with Alice in Wonderland syndrome. Your vision is distorted or strange, such as colors or sizes being wrong, or it appears as if you are looking through water, heat waves, or other phenomena. With migraines, visual disturbances of any kind typically occur for 10 to 30 minutes, and they rarely last over an hour. They usually come before a headache begins, but they may also occur during one. Your experience of migraines may shift as you age. Some people — particularly those around age 50 or older — may develop migraine-related visual symptoms without ever getting a headache. > 📝 **NOTE:** See **[Headaches (Nonvascular and Vascular / Migraine)](/plans/16ce3d56-c27e-5457-9f9f-becffb13f104)** --- ### Retinal Detachment: A True Eye Emergency Usually triggered by trauma to the head or eye, retinal detachment is typically preceded by what people describe as a "shower of sparks" in one area of the visual field, followed by the sensation of a curtain falling across the eye. It can also occur as a degenerative process with aging. --- ### Scotomas: Blind Spots and Flashing Lights A scotoma is an area of reduced or absent vision within your visual field. A negative scotoma is a true blind spot — one that often goes unnoticed unless it falls in the center of your vision. A positive scotoma, by contrast, is perceived as a bright spot or shimmering flash, and occurs when some part of the visual system is abnormally stimulated — as happens, for example, during the warning phase of a migraine. --- ### Myopia (Nearsightedness): Seeing Up Close, Struggling at a Distance Myopia occurs when the visual image focuses in front of the retina rather than directly on it — usually because the eyeball is slightly too long or the eye's focusing power is too strong. The result: nearby objects look clear, but distant objects appear blurry. --- ### Hyperopia (Farsightedness): Seeing Far Away, Struggling Up Close Hyperopia is the opposite of myopia — the visual image focuses behind the retina rather than on it, due to an eyeball that's slightly too short or a lens that doesn't have enough focusing power. It's actually the most common refractive error. People with hyperopia can see distant objects clearly but struggle with things that are close. Presbyopia is a form of hyperopia that develops with age as the lens gradually loses its flexibility. --- ### Astigmatism: An Uneven Focus In astigmatism, the eye doesn't focus light evenly in all directions, causing distorted or blurred vision at any distance. Refractive errors — including astigmatism — are typically corrected with glasses, contact lenses, or targeted eye exercises. In the vast majority of cases, even those that fall short of "legally blind," 20/20 vision can be restored. Retinal detachment, on the other hand, is a medical emergency — prompt surgical intervention dramatically improves the odds of preserving vision. --- ### Anisometropia: When Each Eye Has Its Own Prescription Anisometropia simply means that each eye has a different refractive error — one eye may need a much stronger correction than the other. --- ### Strabismus (Crossed Eyes): When the Eyes Don't Point Together Strabismus occurs when one eye drifts out of alignment and doesn't point in the same direction as the other. When this condition is present from birth, the brain learns to ignore the signals from the misaligned eye to avoid double vision — a process called suppression. Over time, this suppression leads to amblyopia, or reduced visual sharpness in that eye. The good news: when caught early, strabismus is treatable. --- ### When a Visual Disturbance May Be a Warning Sign Visual disturbances can sometimes point to dangers that are more serious than they first appear. As discussed above, floaters can occasionally signal significant eye disease or even retinal detachment. New visual disturbances — particularly those that affect only one eye — should always be taken seriously. Painless dark spots or new floaters, especially when accompanied by flashes of light or sudden vision loss, may indicate a retinal or vitreous detachment. See an ophthalmologist right away — the longer you wait, the greater the risk of permanent vision loss. Temporary vision loss in one eye can be a warning sign of stroke or inflamed blood vessels. These episodes typically last about 30 minutes and are not associated with headache. They are particularly concerning in anyone over 45 years old. If this happens to you, seek immediate evaluation from an ophthalmologist, neuro-ophthalmologist, or neurologist. **Sources:** - <https://www.healthline.com/health/visual-disturbances#risks> - <https://www.nvisioncenters.com/education/visual-disturbances/> - [Anatomy of the Eye](https://www.umkelloggeye.org/conditions-treatments/anatomy-eye). University of Michigan. - [Visual Disturbances: Related to Migraine or Not?](https://americanmigrainefoundation.org/resource-library/visual-disturbances-related-to-migraine-or-not/) (February 5, 2016). American Migraine Foundation. - [Diagnosis and Treatment of Visual Disturbances in Multiple Sclerosis](https://ijmsc.org/doi/pdf/10.7224/1537-2073-12.3.106). (2010). *International Journal of MS Care.* - [Visual Disturbances](https://headaches.org/2007/10/25/visual-disturbances/). National Headache Foundation. - [Visual Aura and Scotomas: What Do They Indicate?](https://www.reviewofoptometry.com/article/visual-aura--and-scotomas-what-do-they-indicate) (September 15, 2015). *Review of Optometry.* - [Floaters, Spots, and Flashes](https://www.nzao.co.nz/sites/default/files/FloatersSpotsFlashes.pdf). The NZ Association of Optometrists. ---
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Care planVitiligo**Vitiligo** is a condition that causes the skin to lose its color in patches. Over time, these patches typically grow larger and can appear anywhere on the body — including the hair and the lining of the mouth. Normally, skin and hair get their color from a pigment called melanin, which is made by specialized cells. In vitiligo, those cells either die or stop working. While vitiligo can affect anyone regardless of skin tone, it tends to be more visible in people with darker complexions. The condition is neither dangerous nor contagious — but it can take a real emotional toll and affect how you feel about yourself. Treatment may help bring some color back to affected areas, though it cannot fully prevent new patches from appearing or old ones from returning. ## Understanding Vitiligo ### What Does Vitiligo Look Like? Common signs of vitiligo include: - Patchy loss of skin color, which usually first appears on the hands, face, and areas around body openings and the genitals - Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows, or beard - Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes) Vitiligo can develop at any age, but most often appears before age 30. Depending on which type of vitiligo you have, it may involve: - **Universal vitiligo** — discoloration affects nearly all skin surfaces. - **Generalized vitiligo** — the most common type; discolored patches often progress similarly on corresponding body parts (symmetrically). - **Segmental vitiligo** — affects only one side or part of the body; tends to occur at a younger age, progress for a year or two, then stop. - **Localized (focal) vitiligo** — affects one or only a few areas of the body. - **Acrofacial vitiligo** — affected skin is on the face and hands, and around body openings such as the eyes, nose, and ears. Predicting how vitiligo will progress is difficult. Sometimes patches stop appearing on their own without any treatment. In most cases, however, the loss of pigment gradually spreads to cover more of the skin — though occasionally, some color does return naturally. ### When Should You See a Doctor? If you notice areas of your skin, hair, or mouth lining losing color, it's worth scheduling a visit with your doctor. While there is no cure for vitiligo, treatment can help slow or stop further color loss — and may even restore some pigment to affected areas. ### What Causes Vitiligo? Vitiligo happens when pigment-producing cells (melanocytes) die or stop making melanin — the pigment that gives your skin, hair, and eyes their color. As a result, affected areas of skin turn lighter or white. The exact reason these cells fail or die is not fully understood, but the cause may be related to: - A disorder of the immune system (autoimmune condition) - Family history (heredity) - A trigger event, such as stress, severe sunburn, or skin trauma — such as contact with a chemical ### Potential Complications People with vitiligo may be at increased risk of: - Social or psychological distress - Sunburn - Eye problems - Hearing loss ### Getting a Diagnosis Your doctor will review your medical history and examine your skin — sometimes using a special ultraviolet lamp to see the affected areas more clearly. You may also need a skin biopsy or blood tests to help confirm the diagnosis. ---
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Care planWartsCommon warts are skin growths caused by a virus called the human papillomavirus (HPV). This virus triggers a rapid overgrowth of cells in the outer layer of your skin. Common warts are not moles, and they are not cancerous. In fact, they're usually harmless and often go away on their own. That said, you may find common warts annoying or embarrassing — and you may want help getting rid of them. Common warts tend to grow on your hands or fingers. Treating them helps prevent the virus from spreading to other parts of your body or to other people. Keep in mind, though, that even after treatment, warts can come back — and for some people, they can be a stubborn, recurring problem. Common warts most often appear on your hands. They may show up alone or in clusters. If picked or cut, warts may bleed, and they often contain one or more tiny black dots — sometimes called wart "seeds," though they're actually small, clotted blood vessels. ## Understanding Common Warts ### Warts Can Show Up in Other Places, Too Different strains of HPV tend to cause warts in different areas of the body: - **Plantar warts.** These grow on the soles of your feet. They usually appear as flesh-colored or light brown bumps with tiny black dots inside — again, those are small, clotted blood vessels. - **Genital warts.** A sexually transmitted infection, genital warts can appear on your genitals, in your pubic area, or in your anal canal. In women, genital warts can also develop inside the vagina. - **Flat warts.** These smaller warts usually appear on your face or legs, and tend to have a smoother surface than other types of warts. ### What Causes Warts? Warts are caused by the human papillomavirus (HPV). There are more than 100 known strains of HPV. Some are relatively benign — responsible for nothing more than a common wart — while others can cause serious disease, including cervical cancer. Different strains of HPV cause different types of warts. ### How Do Warts Spread? Like other infections, warts spread from person to person. You can also pick up the wart virus indirectly — by touching a towel or object used by someone who is infected. After exposure, it can take anywhere from two to six months for a wart to actually appear. Everyone's immune system responds to HPV differently, which is why not everyone who comes into contact with the virus develops warts. If you already have warts, it's possible to spread the virus to other areas of your own body. Warts typically enter through small breaks in the skin, like a hangnail or a scrape. Biting your nails can also spread warts to your fingertips and the skin around your nails. ### How to Help Prevent Warts From Spreading Here are some practical steps to lower the risk of getting or spreading warts — for yourself and your children: - Avoid brushing, clipping, combing, or shaving over areas where warts are present, since these actions can spread the virus. - Don't use the same nail file or nail clipper on your warts as you use on your healthy nails. - If you have warts near your fingernails, resist the urge to bite your nails. - Don't pick at warts — picking can spread the virus to other areas. Try covering warts with an adhesive bandage as a reminder not to touch them. - Keep your hands as dry as possible, since warts are harder to control in a moist environment. - Always wash your hands thoroughly after touching your warts. - Wear footwear in public showers and locker rooms. ---
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Care planWest Nile VirusWest Nile virus (WNV) is an infectious disease that first appeared in the United States in 1999. The virus belongs to a family of disease-causing viruses called flaviviruses, which are typically spread through the bites of ticks or mosquitoes. Other well-known diseases caused by flaviviruses include yellow fever, Japanese encephalitis, dengue, and Saint Louis encephalitis. ## Understanding West Nile Virus ### A Brief History WNV was first identified in Uganda in 1937. Today it is most commonly found in Africa, West Asia, Europe, and the Middle East. In 1999, it appeared in the Western Hemisphere for the first time, in the New York City area. In early spring 2000, it re-emerged in birds and mosquitoes and then spread to other parts of the eastern United States. By 2004, the virus had been detected in birds and mosquitoes in every state except Alaska and Hawaii. In 2009, WNV caused 720 cases of illness in the United States, including 32 deaths, according to the Centers for Disease Control and Prevention (CDC). Human cases have since been reported throughout the continental United States and in Canada and Mexico. ### How West Nile Virus Spreads The spread of West Nile virus begins when a mosquito bites an infected bird or animal, picking up the virus while feeding on its blood. That infected mosquito can then pass the virus along to another bird or animal the next time it feeds. Crows are particularly vulnerable to deadly infection, as are robins, blue jays, and many other bird species. Scientists have identified more than 138 bird species that can be infected and more than 43 mosquito species capable of transmitting WNV. Although the virus typically cycles between mosquitoes and birds, infected female mosquitoes can also transmit WNV through their bites to humans and other "incidental hosts," such as horses. Because so many animals can carry the virus — and so many types of mosquitoes can spread it — WNV has moved rapidly across the United States. Most cases of human illness occur in older adults and in people with weakened immune systems. WNV can also be transmitted through blood transfusions and organ transplants from donors who are infected. Health experts also believe it is possible for WNV to be passed from a mother to her unborn child, as well as through breast milk. ### Recognizing the Symptoms Most people who contract West Nile virus experience only mild symptoms — fever, headache, body aches, skin rash, and swollen lymph nodes. However, if WNV reaches the brain, it can cause life-threatening encephalitis (swelling of the brain) or meningitis (swelling of the protective lining surrounding the brain and spinal cord). ---
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Care planWhiplash (Neck Strain)Whiplash is an injury that occurs when a sudden force or movement strains your neck and spine, damaging bone, muscle, ligaments, and nerves. It's most common in car crashes, but can happen in other situations too. Most of the time, whiplash heals well with treatment. That said, some people go on to experience lasting effects — like chronic pain — for months or even years. At its core, whiplash is what happens when a sudden, violent change in movement forces your neck (also called your cervical spine) and upper spine to move in ways they weren't designed to handle — essentially a neck sprain caused by extreme motion. While "whiplash" is a single term, it can produce a surprisingly wide range of effects. Doctors use the umbrella term **whiplash-associated disorders** to describe all the conditions that can result from this type of injury. It's also worth knowing that whiplash can result from sudden movements in any direction — not just front-to-back. Because whiplash involves the neck and spine, first responders and medical teams typically treat it as an emergency until proven otherwise. Healthcare providers will handle it with great care until they can confirm and stabilize any serious injury — or rule one out entirely. --- ## Understanding Whiplash ### Who Is at Risk? Whiplash can affect anyone at any age, but two groups face a higher risk of serious or lasting injury: older adults and women and people assigned female at birth (AFAB). In older adults (over age 65), the risk is higher because aging naturally causes muscles and bones to weaken and deteriorate, making any physical injury harder to weather. Women and people AFAB are more likely to sustain whiplash-type injuries in car crashes, likely due to several factors: - **Height.** Experts believe that women's shorter average height compared to men plays a role in their increased vulnerability. - **Spine structure differences.** Women also have a different spinal column structure than men, which affects the spacing between each vertebra — the interlocking bones that stack together to form your spine. - **Muscle differences.** Women typically have less muscle tissue than men. Since muscle acts as a natural shock absorber against sudden impact forces, having less of it means less protection when a collision strikes. - **Vehicle design.** The way modern vehicles are built may also contribute to injury risk for women. Headrests are designed to prevent your head from snapping too far backward in a collision — but because women tend to be shorter on average, the height of a seat back and headrest may not offer the same level of protection it does for taller individuals. ### How Common Is Whiplash? Whiplash is quite common, affecting millions of people around the world every year. ### What Actually Happens to Your Body During Whiplash? Whiplash comes down to a basic law of physics: inertia. Picture yourself riding in a car when the driver suddenly slams the brakes. Even though the car stops, your body keeps moving forward — that's inertia at work. The same thing happens in reverse when a driver floors the gas pedal from a standstill — your body gets pushed back into the seat. Here's the important part: just like you're a passenger in the car, your brain is a passenger inside your skull. When your head moves sharply and suddenly, your brain can slam against the inner walls of your skull, causing injury. Your neck acts as a natural shock absorber for your brain, compressing, stretching, or rotating to cushion the effect of sudden movements. Whiplash happens when inertia causes your head, neck, and body to move at different speeds. This forces your neck to compress or stretch too quickly — or in directions that push its muscles, ligaments, and bones beyond what they can handle. The sharper and more forceful the movement, the more stress your neck absorbs. That's why whiplash injuries run the gamut from minor to severe. Interestingly, even relatively low-force impacts can sometimes cause moderate or severe whiplash — something researchers are still working to fully understand. In the most serious cases, whiplash can fracture the vertebrae in your neck, putting your spinal cord and its surrounding nerve network at risk. ### What Causes Whiplash? Whiplash occurs when your speed or direction of travel changes abruptly. Some of the most common triggers include: - Motor vehicle crashes (by far the most common cause). - Contact sports (such as football, hockey, rugby, etc.). - Roller coasters. While these are the most frequent culprits, whiplash can happen in many other ways. Even a simple slip and fall can cause whiplash under the right circumstances. ---
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Care planWhooping Cough (Pertussis)Whooping cough is a highly contagious bacterial infection known for its signature sound — the desperate, whooping gasp for air that follows a fit of violent coughing. These coughing episodes can be so intense that they trigger vomiting or leave you unable to catch your breath. While anyone can catch whooping cough, it hits infants and young children hardest. In babies, the coughing fits can be severe enough to interfere with eating, drinking, and even breathing — making this a potentially life-threatening illness in the very young. Before vaccines existed, whooping cough was one of the most feared childhood illnesses and a leading cause of childhood death in the United States. Today, thanks to both pertussis-specific vaccines and combination vaccines that protect against tetanus, diphtheria, and pertussis, cases are far less common. When whooping cough does strike, antibiotics can help — but they work best when started early.
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Care planWilson's Disease**Wilson's disease** is a rare inherited condition in which copper builds up — to potentially dangerous levels — in your liver, brain, and other vital organs. Most people are diagnosed between the ages of 5 and 35, though the disease can affect people of virtually any age. Copper plays an important role in building healthy nerves, bones, collagen, and the skin pigment melanin. Under normal circumstances, your body absorbs copper from the food you eat and eliminates any excess through bile, a substance made by your liver. In Wilson's disease, however, this elimination process breaks down — and copper accumulates to levels that can become life-threatening. The good news: when caught early, Wilson's disease is very treatable, and many people with the condition go on to live full, normal lives. --- ## Understanding Wilson's Disease ### Signs & Symptoms Wilson's disease is present from birth, but symptoms don't usually appear until enough copper has built up in the brain, liver, or another organ to cause trouble. The signs and symptoms vary depending on which parts of the body are affected, and can include: - Fatigue, loss of appetite, or abdominal pain - Yellowing of the skin and whites of the eyes (jaundice) - Golden-brown rings around the iris of the eye (Kayser-Fleischer rings) - Fluid accumulation in the legs or abdomen - Difficulty with speech, swallowing, or physical coordination - Uncontrolled movements or muscle stiffness ### What Causes Wilson's Disease? Wilson's disease is inherited in what's called an autosomal recessive pattern — meaning that to develop the disease, you must inherit one copy of the defective gene from each parent. If you inherit only one abnormal copy, you won't become ill yourself, but you become a carrier and can pass the gene on to your children. ### Who Is at Risk? Your risk of Wilson's disease is higher if a parent or sibling has the condition. Talk to your doctor about whether genetic testing makes sense for you. The earlier the diagnosis, the better the odds of successful treatment — so don't wait if you have a family history. ### Potential Complications Without treatment, Wilson's disease can be fatal. Serious complications include: - **Liver scarring (cirrhosis).** As the liver tries to repair damage caused by excess copper, scar tissue forms — gradually impairing the liver's ability to function. - **Liver failure.** This can happen suddenly (acute liver failure) or develop slowly over years. In some cases, a liver transplant may be necessary. - **Ongoing neurological problems.** Tremors, involuntary muscle movements, an unsteady walk, and speech difficulties often improve with treatment — but some people continue to experience neurological challenges despite therapy. - **Kidney problems.** Wilson's disease can damage the kidneys, leading to issues like kidney stones or an abnormal loss of amino acids in the urine. - **Psychological and emotional changes.** These may include personality shifts, depression, irritability, bipolar disorder, or psychosis. - **Blood problems.** The destruction of red blood cells (hemolysis) can lead to anemia and jaundice. **Source:** <https://www.mayoclinic.org/diseases-conditions/wilsons-disease/symptoms-causes/syc-20353251> ### Treatment Overview Wilson's disease is a very **treatable** condition. With the right therapy, disease progression can be halted and symptoms can often be meaningfully improved. Treatment focuses on removing the excess copper that has accumulated and preventing it from building back up. This is a lifelong commitment — but a manageable one. **Source:** <https://www.wilsonsdisease.org/about-wilson-disease/treatments> ### Expert Perspective: Andrew Weil, MD Wilson's disease is a rare inherited disorder in which excessive amounts of copper accumulate in the liver or brain. It affects about one in every 30,000 people. Although the genetic defect is present at birth, symptoms may not appear for years, sometimes not until age 40 or older — but usually during late adolescence. These can include jaundice, abdominal swelling, vomiting blood, abdominal pain, and tremors, problems with walking, talking and swallowing as well as dramatic changes in personality. Fortunately, with proper treatment Wilson's disease can be successfully managed, allowing those affected to live a normal lifespan. Without treatment, copper continues to accumulate and the disease will prove fatal. Anyone with Wilson's disease should be cared for by a liver specialist. Treatment involves removing excess copper from the body by a procedure called chelation therapy. Two drugs, penicillamine (Cuprimine, Depen) and trientine (Synprine), are available to remove copper from the body by binding (chelating) it and allowing it to be excreted in urine. However, because both of these drugs can cause the neurological symptoms of the disease to worsen, they're no longer considered suitable for long-term use. Once the accumulated copper has been removed, a drug called Galzin (zinc acetate) which blocks absorption of copper from the intestinal tract can be substituted. The major side effects of zinc acetate are temporary stomach pain or nausea. Patients with Wilson's disease used to be warned not to eat a long list of foods containing even small amounts of copper. **With today's treatments, the only foods considered off limits are shellfish and liver — both of which contain high levels of the metal.** I cannot emphasize enough the need for expert medical treatment for patients with Wilson's disease. The main herbal remedy I recommend for liver problems is **milk thistle (*Silybum marianum*)**, which stimulates regeneration of liver cells and protects them from toxic injury. **Source:** <https://www.drweil.com/health-wellness/body-mind-spirit/liver-kidney/winning-strategy-for-wilsons-disease/> --- ## Understanding Copper Toxicity Copper toxicity is a health condition caused by an excess of copper in the body. While truly severe cases are uncommon, the effects can be significant. Copper is an essential nutrient — your body needs it — but too much of it causes problems. Because copper and zinc naturally balance each other in the body, anything that drives zinc levels down can tip the scales toward copper excess, creating an unhealthy copper-to-zinc imbalance. **Acute copper poisoning has been noted in instances where beverages were stored in copper-containing containers or from contaminated water supplies.** The U.S. Environmental Protection Agency and the World Health Organization have set guideline values for copper in drinking water at 1.3 mg/liter and 2 mg/liter, respectively. **Chronic copper toxicity, arising from long-term exposure to lower doses of copper, can potentially cause liver damage.** However, in generally healthy individuals, daily doses of up to 10 mg have not been seen to result in liver damage. Consequently, the U.S. Food and Nutrition Board has set the tolerable upper intake level for copper at 10 mg/day from food and supplements. Individuals with genetic disorders affecting copper metabolism may be at risk of adverse effects of chronic copper toxicity at significantly lower intake levels. **In some instances, overconsumption has been reported, with copper intake levels as high as 7.8 mg/day over a period of 147 days.** There is a possibility that this high intake could have an adverse impact on immune function and antioxidant status. **Copper exists in two forms in the blood: approximately 85% to 95% is bound to ceruloplasmin, and the remaining is "free," loosely bound to albumin and other small molecules.** The incidence of copper poisoning varies widely by region and is uncommon in Western countries. However, it's more prevalent in South Asian countries, especially among rural populations. Newborns and infants face a higher risk due to an immature bile excretion system and enhanced intestinal absorption. ### Signs & Symptoms of Copper Toxicity **The signs and symptoms vary and depend on how the excess copper enters the body.** In cases of acute copper toxicity, symptoms might include abdominal pain, nausea, vomiting, and diarrhea — responses that may actually serve as the body's defense mechanism, discouraging further copper intake and absorption. More severe signs of toxicity can include liver damage, kidney failure, coma, and even death. **Gastrointestinal issues** are common, especially when copper toxicity results from ingestion. Symptoms can include abdominal pain, vomiting blood (hematemesis), black tarry stools (melena), jaundice (yellowing of the skin and eyes), loss of appetite (anorexia), severe thirst, diarrhea, and vomiting. The presence of blue-green material in vomit or stools can be a telltale sign. **Neurological symptoms** include an altered mental state, headaches, and a rapid heart rate (tachycardia). More severe neurological symptoms can include depression, fatigue, irritability, excitability, and difficulty focusing. **Severe symptoms:** In its most serious forms, copper toxicity can trigger a range of dangerous health problems — including rhabdomyolysis (a condition in which muscle tissue breaks down, releasing a harmful protein into the bloodstream), heart and kidney failure, an increase in a form of hemoglobin that can't carry oxygen effectively (methemoglobinemia), breakdown of red blood cells within blood vessels (intravascular hemolysis), liver cell death (hepatic necrosis), and brain dysfunction (encephalopathy). In the most severe cases, copper toxicity can be fatal. ### What Are the Possible Causes of Copper Toxicity? Copper toxicity can result from a variety of factors, including certain foods, contaminated water, environmental exposure, and specific genetic disorders. #### 🍽️ 1. High-Copper Foods and Drinks Eating foods and beverages rich in copper — such as organ meats, shellfish, nuts, seeds, and chocolate — can contribute to copper toxicity. If this is suspected, your doctor can run blood tests to check your copper levels. If levels are elevated, reducing copper-rich foods while increasing zinc intake may help restore balance. #### 🚰 2. Contaminated Water and Copper Pipes Copper can leach into your drinking water from copper plumbing, particularly if the water is acidic or flowing at high pressure. You can have your water tested to check copper levels. If levels are too high, installing a water filtration system or replacing copper pipes with pipes made from other materials may be necessary. #### 🏭 3. Environmental Exposure Living near a copper mine or smelter can raise your risk of copper toxicity. #### 🌱 4. Copper in Agriculture Copper-based pesticides and fertilizers can cause copper to accumulate in soil and the crops grown in it. Soil testing can reveal whether copper levels are problematic. If they are, reducing the use of copper-based agricultural products and adding appropriate soil amendments can help bring levels down. #### 🔧 5. Occupational Hazards Working in industries such as mining, smelting, or electronics manufacturing may expose you to elevated levels of copper on a regular basis. #### ⚖️ 6. Zinc Deficiency Zinc and copper exist in a careful balance in the body — too much of one can push the other out. As a result, zinc deficiency can allow copper levels to climb too high. Zinc deficiency itself can stem from a variety of causes, including inadequate meat intake, excessive consumption of phytates (found in legumes, seeds, soy products, and whole grains), high intake of oxalates (found in spinach, okra, nuts, and tea), and chronic illnesses such as gastrointestinal diseases, diabetes, liver disease, sickle cell disease, kidney disease, excessive alcohol use, HIV infection, or persistent infections. #### 🧬 7. Genetic Disorders Certain inherited conditions — most notably Wilson's disease and Menkes disease — disrupt how the body processes copper, increasing the risk of toxicity. If you have one of these conditions, managing your copper levels will likely be a lifelong endeavor involving medication, dietary adjustments, and regular monitoring. ---
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Care planWorms / Yeast-FungusThe trillions of microorganisms living in and on our bodies actually outnumber our own cells by 10 to 1. A typical person carries as many as six pounds of microbes, all living in a delicate, symbiotic balance amongst each other. These microbes can work for us — or against us. And when any one species grows out of control, the result can be a full-blown parasitic infection in the intestines.¹ ## Understanding Intestinal Parasites ### What They Are and Where They Come From Beyond the microorganisms that naturally call our bodies home, we can also pick up harmful parasites from the world around us. Eating undercooked meat and handling pets are the two most common ways these unwanted guests find their way in. Because parasitic infections are surprisingly common, knowing how to recognize the warning signs early is key to getting ahead of them fast. The most frequent offenders include candida, giardia, hookworms, tapeworms, and pinworms. ### Hookworms: Tiny Worms With a Big Impact Hookworms are centimeter-sized worms that latch onto the inner walls of the intestines. Once established, they grow, reproduce, and rob their host of vital nutrients — essentially intercepting what your body needs before it ever reaches your cells. Hookworm larvae can burrow directly through the skin, and their eggs can be swallowed or inhaled. The most common sources are animal feces and undercooked meat. It's worth knowing that pets groom themselves with their tongues, which means hookworm larvae and eggs can easily end up in their fur — making petting, kissing, and nuzzling your animals a surprisingly common route of infection. **Watch for these signs of a hookworm infection:** - Blood in stool - Blood in cough - Diarrhea - Gas and bloating - Nausea and vomiting - Pale skin - Loss of appetite² ### Candida Overgrowth: When a Normal Fungus Becomes a Problem Candida is a fungus that naturally lives in the urinary, genital, and digestive tracts. Under normal circumstances, it coexists peacefully with the rest of your microbiome — but when it's given the right conditions to multiply unchecked, it can trigger inflammation and real tissue damage. A study from the University of Palermo in Italy found that candida species thrive in environments rich in sucrose, glucose, and fructose.³ The typical Western diet is loaded with exactly these kinds of simple refined sugars — found in high concentrations in sodas and energy drinks, and in white breads, white pastas, and white rice. On top of that, the widespread use of antibiotics in Western medicine can inadvertently clear out the "good" bacteria in the gut, leaving candida free to expand without competition.⁴˒⁵ The most recognizable symptoms of candida overgrowth are chronic inflammation, persistent low-grade fever, and food allergies — all stemming from candida's ability to erode the intestinal lining. The fungus releases alcohols and enzymes that break down proteins and antibodies in host cells, allowing it to slip into the bloodstream and begin suppressing the immune system. Because candida feeds on simple sugars, cutting those foods out during an active overgrowth can actually trigger temporary withdrawal-like symptoms.⁷ This happens because the fungus is absorbing sugar from your diet before your own cells can use it — so when the sugar disappears, your cells send distress signals to the brain asking for more. And since foods high in refined sugar are harmful to your health in general, candida overgrowth can also indirectly fuel weight gain and the many other problems that come with a high-sugar diet. ---
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Care planWound HealingMost of us take wound healing for granted. If you get a small cut, you may clean it and let it open to the air or cover it with a bandage, and move on with your life. Yet under that bandage or in the open air, the body orchestrates a complex cascade of events designed to heal wounds big and small. ## Understanding Wound Healing ### The Four Stages of Wound Healing **Stage 1: Stopping the Bleeding (Hemostasis)** When your skin is cut, scraped, or punctured, bleeding begins almost immediately — but your body springs into action within seconds. Special blood cells called platelets rush to the scene and clump together to form a clot, sealing the wound and preventing further blood loss. As the clot dries, it becomes the scab you see on the surface. Woven throughout that clot is a protein called fibrin, which acts like a net to hold everything securely in place. **Stage 2: Inflammation — Your Body's Clean-Up Crew** Once the clot has sealed the wound, your blood vessels open slightly to deliver a fresh supply of oxygen and nutrients — two things your body absolutely needs to begin repairs. The amount of oxygen matters, too: too much or too little can actually slow healing. At this stage, a specialized white blood cell called a macrophage moves in to fight off infection and coordinate the repair effort. You may notice some clear fluid around the wound — this is completely normal and is your body's way of flushing out debris. Macrophages also release chemical messengers called growth factors that give the signal to start rebuilding. **Stage 3: Rebuilding — Laying Down New Tissue** Now the real construction begins. Oxygen-rich red blood cells and other repair cells flood the area, and chemical signals instruct them to produce collagen — the structural protein that serves as scaffolding for new tissue. As this new tissue forms, you may notice a reddish scar beginning to develop. Over time, that scar will gradually fade. **Stage 4: Strengthening — The Long Game** In the final stage, your newly formed tissue gradually gains strength. You might notice the skin around the wound stretching, itching, or puckering — all signs that remodeling is actively underway. Healing progresses quickly during the first 6 weeks, and by about 3 months, the repaired tissue reaches roughly 80% of its original strength. It's worth knowing that a healed wound will never fully return to 100% of its pre-injury strength. Depending on the size and severity of the wound, the entire process can take up to a couple of years to complete. ### When Healing Gets Derailed As elegant as this process is, wound healing is genuinely complex — a long chain of precisely timed chemical signals. When something disrupts that chain, healing can slow dramatically or even stall altogether. One of the most significant factors is poor blood supply to the wound. Without adequate blood flow, the oxygen and nutrients needed for repair simply can't get through — and a wound that isn't receiving enough blood may take at least twice as long to heal, if it heals at all. These are known as chronic wounds, and they are far more common in older adults and in people living with diabetes, high blood pressure, obesity, or other conditions affecting the blood vessels. Smoking is also a major risk factor for impaired wound healing. If your wound isn't healing within a reasonable timeframe, don't wait — schedule an appointment with your healthcare provider. And if your wound appears to be getting worse — more swollen, warm or hot to the touch, increasingly painful, or draining pus — seek care right away. If you smoke, talk to your provider about resources to help you quit. **Source:** Johns Hopkins Medicine <https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-wounds-heal> ---
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