A “brain attack” commonly referred to as a stroke is the third most common cause of death and leading cause of physical deformity in the world. A stroke is a degenerative disease that affects the arteries leading to the brain. When a part of the brain is damaged or dies from a stroke, the parts of the body it controls are affected and temporary or permanent disability can occur. A stroke can happen to anyone and at any age.
A stroke is caused when your blood supply to the brain is greatly reduced, interrupted, blocked, or when a blood vessel bursts. This deprives the brain of oxygen and nutrients causing brain cells to die. A stroke can cause death or significant disabilities like speech difficulties, paralysis, or emotional problems. There are three main causes of a stroke; cerebral thrombosis, cerebral embolus, and cerebral hemorrhage (Crowley). Cerebral thrombosis is due to atherosclerosis (hardening and blockage of arteries due to plaque, cholesterol, and fatty buildup) of the cerebral artery. Cerebral embolus is when an emboli (a moving clot in a blood vessel) from thrombi (a stationary clot in a vessel) in the carotid artery or in the heart. Cerebral hemorrhage also known as hemorrhagic stroke is a rupture of the cerebral artery due to high blood pressure. Now that I have discussed the causes of a stroke, I will talk about the five types of strokes mentioned by the National Stroke Association.
In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to your brain. Once in your brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke.
In the second type of blood clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain. The process leading to this blockage is known as thrombosis. Blood clot strokes can also happen as the result of unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol. Your body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. So your body reacts to these injuries just as it would if you were bleeding from a wound; it responds by forming clots. Two types of thrombosis can cause stroke: large vessel thrombosis and small vessel disease.
Large Vessel Thrombosis
Thrombotic stroke occurs most often in the large arteries, so large vessel thrombosis is the most common and best understood type of thrombotic stroke. Most large vessel thrombosis is caused by a combination of long term atherosclerosis followed by rapid blood clot formation. Thrombotic stroke patients are also likely to have coronary artery disease, and heart attack is a frequent cause of death in patients who have suffered this type of brain attack.
Small Vessel Disease
Small vessel disease, occurs when blood flow is blocked to a very small arterial vessel. Little is known about the causes of small vessel disease, but it is closely linked to hypertension (high blood pressure).
Strokes caused by the breakage or “blowout” of a blood vessel in the brain are called hemorrhagic strokes. Hemorrhages can be caused by a number of disorders which affect the blood vessels, including long standing high blood pressure and cerebral aneurysms. An aneurysm is a weak or thin spot on a blood vessel wall. These weak spots are usually present at birth. Aneurisms develop over a number of years and usually don’t cause detectable problems until they break.
A stroke usually starts by having any of the following risk factors provided by the Mayo Health Clinic:
- Personal or family history of a stroke, heart attack, or transient ischemic attack aka ministroke which is a brief episode of symptoms similar to those you might have during a stroke.
- Being 55 or older
- High blood pressure
- High cholesterol
- Cigarette smoking or exposure to second hand smoke
- Physical inactivity
- Use of birth control pills or hormone therapy
- Cardiovascular disease including heart failure, heart defect, heart infection, or abnormal heart rhythm
This disease progresses as a person ages or has one or several of the previously listed risk factors. A stroke can occur in an instant without few warning signs. It is important to look for the following signs and symptoms given by the American Stroke Association if you think you or someone else might be having a stroke:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
Symptoms of a stroke may last for a few seconds to several minutes maybe longer. This is why it is important to call 911 or get to an emergency room right away or within 60 minutes to maximize the effectiveness of treatment.
To determine the best treatment for your stroke, your emergency team must figure out what type of stroke you’re having and what parts of your brain it’s affecting. Other possible causes of your symptoms, such as a brain tumor or a drug reaction, also need to be ruled out (Mayo Clinic). Your doctor may use some of the following tests listed on the Mayo clinic web site to determine your risk of stroke.
Your doctor will ask you or a family member what symptoms you’ve been having, when they started, and what you were doing when they began, and then will evaluate whether these symptoms are still present. The doctor will want to know what medications you take, and whether you have experienced any head injury. The doctor will also ask about your personal and family history of heart disease, transient ischemic attack (TIA) or stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
Various blood tests give your care team important information as how fast your blood clots and whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or if you may have an infection. Your blood’s clotting time and levels of sugar and key chemicals must be managed as part of your stroke care. Infections must also be treated.
Computerized tomography (CT)
Brain imaging plays a key role in determining if you are having a stroke and what type. Computerized tomography angiography (CTA) is a specialized CT exam in which a dye is injected into your vein and X-ray beams create a 3-D image of the blood vessels in your neck and brain.
Magnetic resonance imaging (MRI)
In this type of imaging, a strong magnetic field and radio waves generate a 3-D view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses a magnetic field, radio waves and a dye injected into your veins to evaluate arteries in your neck and brain.
This procedure can show narrowing or clotting in your carotid arteries. A wand-like device (transducer) painlessly sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images.
This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.
This ultrasound technology creates images of your heart, enabling your doctor to see if a clot (embolus) from your heart has traveled to your brain and caused your stroke.
Treatment for stroke depends on which type of stroke you are having an ischemic stroke, the most common type which is the blocking of an artery, or a hemorrhagic stroke which involves bleeding into the brain. To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. Therapy with clot busting drugs must start within 4.5 hours and the sooner, the better. Quick treatment not only improves your chances of survival, but may also reduce the complications from your stroke (Mayo Clinic). A person may be given:
- Aspirin- the best proven immediate treatment after an ischemic stroke to reduce the likelihood of having another stroke. In the emergency room it is likely you’ll be given a dose of aspirin. The dose may vary. Other blood thinning drugs, such as warfarin (Coumadin), heparin and clopidogrel (Plavix) also may be given, but they aren’t used as commonly as aspirin for emergency treatment.
- Intravenous injection of tissue plasminogen activator (TPA). Some people who are having an ischemic stroke can benefit from an injection of tissue plasminogen activator (TPA), given through a vein in the arm. TPA is a potent clot busting drug that helps people who have had a stroke recover more fully. However, intravenous TPA can be given only within a 4.5 hour window of the stroke occurring. TPA involves certain risks that your doctors will consider in assessing whether it’s the right treatment for you. TPA cannot be given to people who are having a hemorrhagic stroke.
- TPA delivered directly to the brain. Doctors may thread a catheter through an artery in your groin up to your brain, and then release TPA directly into the area where the stroke is under way. The time window for this treatment is somewhat longer than for intravenous TPA but still limited.
- Mechanical clot removal. Doctors may also use a catheter to maneuver a tiny device into your brain to physically grab and remove the clot.
Doctors also sometimes recommend these procedures to prevent a stroke. Options may include:
- Carotid endarterectomy. In this procedure, a surgeon removes plaques blocking the carotid arteries that run up both sides of your neck to your brain. The blocked artery is opened, the plaques are removed and your surgeon closes the artery. The procedure may reduce your risk of ischemic stroke. However, in addition to the usual risks associated with any surgery, a carotid endarterectomy itself can also trigger a stroke or heart attack by releasing a blood clot or fatty debris. Surgeons attempt to reduce this risk by placing filters (distal protection devices) at strategic points in your bloodstream to “catch” any material that may break free during the procedure.
- Angioplasty and stents. Angioplasty is another technique that can widen the inside of a plaque-coated artery leading to your brain, usually the carotid artery. In this procedure, a balloon-tipped catheter is maneuvered into the obstructed area of your artery. The balloon is inflated, compressing the plaques against your artery walls. A metallic mesh tube (stent) is usually left in the artery to prevent recurrent narrowing. Inserting a stent in a brain artery (intracranial stenting) is similar to stenting the carotid arteries. Using a small incision in the groin, doctors thread a catheter through the arteries and into the brain.
Emergency treatment of hemorrhagic stroke focuses on controlling bleeding and reducing pressure in your brain. Surgery may also be used to help control future risk. If you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower your blood pressure, prevent seizures or reduce your brain’s reaction to the bleeding (vasospasm). People having a hemorrhagic stroke can’t be given clot busters such as aspirin and TPA because these drugs may worsen bleeding. Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain. Your doctor may recommend one of these procedures after a stroke or if you’re at high risk of spontaneous aneurysm or arteriovenous malformation (AVM) rupture:
- Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes.
- Aneurysm clipping. A tiny clamp is placed at the base of the aneurysm, isolating it from the circulation of the artery to which it’s attached. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. The clip will stay in place permanently.
- Coiling (aneurysm embolization). This procedure offers an alternative to clipping for certain aneurysms. Surgeons use a catheter to maneuver a tiny coil into the aneurysm. The coil provides a scaffolding where a blood clot can form and seal off the aneurysm from connecting arteries.
- Surgical AVM removal. It’s not always possible to remove an AVM if it’s too large or if it’s located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain, though, can eliminate the risk of rupture, lowering the overall risk of hemorrhagic stroke.
- Stroke recovery and rehabilitation. Following emergency treatment, stroke care focuses on helping you regain your strength; recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. Harm to the right side of your brain may affect movement and sensation on the left side of your body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, if you’ve had a stroke, you may have problems with breathing, swallowing, balancing and hearing. You may also experience loss of vision and loss of bladder or bowel function. Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous program you can handle based on your age, overall health and your degree of disability from your stroke. The recommendation will also take into account your lifestyle, interests and priorities, and availability of family members or other caregivers.
INCIDENCE & MORTALITY
According to the Centers for Disease Control (CDC), stroke is the 3rd leading cause of death in the US. More than 140,000 people die every year from a stroke. Strokes are also the leading cause of serious long term disability in the U.S. While most strokes occur in people over the age of 65, one can occur at any age and the risk of having one doubles every ten years after age 55. Every year approximately 795,000 people suffer a stroke. About 600,000 of those are first time attacks and 185,000 are recurrent attacks (CDC). Risk factors such as high blood pressure are the most important factor for stroke. The risk of ischemic stroke in smokers is about double that of nonsmokers. Atrial fibrillations (AF) or abnormal heart rhythms is alone a major risk factor for stroke, increasing a person’s risk about five times more than someone who doesn’t have AF.
RESEARCH & CHARITIES
Over the past 10 years The Stroke Association has invested 21 million Euros in the UK onto research for stroke prevention, treatment, rehabilitation and long term care. The research department is based in The Stroke Associations main office in London and works closely with scientific and service committees to support, promote, and fund stroke research (The Stroke Association). The following is a link to make a donation furthering the support of this research: http://www.stroke.org.uk/research/about_research/
Research is the key to eliminating the impact of stroke. The following link http://www.thegoddessfund.org is a website interested in prevention, treatment, and rehabilitation of strokes in women. The Goddess Fund’s research strategy is to develop young investigators who will dedicate their careers to finding the answers. Through grant funding and mentorship programs that partner senior stroke investigators with young researchers, The Fund seeks to build the foundation for tomorrow’s research community dedicated to women’s stroke. The Goddess Funds intent is to fund research programs that have great potential to change the medical care of women at risk for or suffering stroke. The research may be basic or clinical, focused on such areas as mechanisms of ischemic brain injury, neuroprotective treatments, primary or secondary stroke prevention, epidemiological studies, educational programs for patients or healthcare providers, rehabilitation and outcomes research.
You can also further support this disease research by donating directly to The National Stroke Association which strives to make a difference in the lives of people affected by stroke by offering educational programs and support services to stroke survivors, caregivers and family members of survivors, healthcare providers and the public. Your financial support will help this organization achieve their mission in reducing the incidence and impact of stroke. If you would like to make a contribution in tribute of a special person, in remembrance of a loved one, or in celebrations of a special occasion, click on the following link and go to the Donate tab http://www.stroke.org/site/PageNavigator/HOME
With 795,000 people suffering from strokes each year in the U.S. you are not alone. The National Stroke Association’s web site provides social opportunities and support groups where you can meet other stroke survivors or caregivers who can understand what you may be going through in the recovery process. These support groups promote wellness by helping members with making difficult decisions, problem solving and locating local resources such as educational programs, group therapy, rehabilitation, self help, and more (The Stroke Association). To find support near you click on the following link http://www.stroke.org/site/PageServer?pagename=support_groups#find
The American Heart Association and The American Stroke Association’s web site provides information and support for a life after a stroke for affected family members, caregivers, and stroke survivors. The following link gives information about topics such as healthy living after a stroke, regaining independence, local support groups, and inspirational stories from survivors to help with your recovery process http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/FindingSupportYouAreNotAlone/Stroke-Support-Groups_UCM_310232_Article.jsp
Crowley. Essentials of Human Disease. 2011. Sudbury, MA.
This is a blog that will be covering the pathogenesis, etiology, diagnosis, treatment, incidence and mortality, and resources about the autoimmune disease hyperthyroidism. Hyperthyroidism is normally an autoimmune disease, because of the autoantibodies that will target the thyroid cells. Hyperthyroidism falls into the category of a metabolic disease. Hyperthyroidism is a condition where there is an overproduction of the thyroid hormone. This will then cause levels of the thyroid hormone in the blood to be high. It is important to check the thyroid levels because the thyroid gland is such an important part in our bodies. The thyroid gland is in charge of secreting the hormones into the bloodstream.
Hyperthyroidism is initiated by secreting too much thyroid hormone from the thyroid. Hyperthyroidism is an autoimmune disease. The autoantibodies will target the thyroid cells. This autoimmune disease falls under the category of the metabolic disease.
Signs and Symptoms of hyperthyroidism:
- Nervousness or irritability
- Fatigue or muscle weakness
- Trouble sleeping
- Heat intolerance
- Hand tremors
- Rapid and irregular heartbeat
- Frequent bowel movements or diarrhea
- Weight loss
- Mood swings
- Bulging eyes
Hyperthyroidism can develop in both women and men. It is more likely to develop in women instead of men. Women can get diagnosed with this easier than men because they go and get blood tests that will detect the thyroid problems. According to http://endocrine.niddk.nih.gov/pubs/Hyperthyroidism/#causes the factors to increase your chances of developing thyroid disorders are as followed:
- Have had thyroid problem before
- Have had previous anemia
- Have had a family history of thyroid disease
- Eat large amounts of food containing iodine
- Are older than 60 years of age
- Have been pregnant or delivered a baby in the last 6 months
Hyperthyroidism can be resolved depending on the severity of the disease. Different treatments can be done for each type of hyperthyroidism.
There are several difference causes of hyperthyroidism. Hyperthyroidism is can be caused by Graves’ disease, thyroid nodules, thyroiditis, taking in too much iodine, or over medicating with synthetic thyroid hormone.
The hyperthyroidism that is caused by Graves’ disease can be also called toxic diffuse goiter. This is the most common cause of hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism because of the immune system that makes an antibody that will then mimic the TSH (thyroid stimulating hormone) and cause the thyroid to make too much thyroid hormone.
The hyperthyroidism that is caused by the thyroid nodules is where there are lumps in the thyroid. When someone hears that there are lumps in the thyroid they are normally thinking that they could be cancerous. However, with these nodules that are noncancerous. These nodules will become overactive and produce too much hormone.
The hyperthyroidism that is caused by thyroiditis- Thyroiditis is noted when there is inflammation of the thyroid gland. When people think about hyperthyroidism they normally think that it is caused by overproducing of the thyroid hormone. In this condition, stored thyroid hormone will leak out of the inflamed gland and can cause the hormone levels in the blood to rise.
The hyperthyroidism that is caused by taking in too much iodine can be dangerous. Most people don’t realize that your thyroid gland needs iodine to make the thyroid hormone. When you take in too much iodine, it will cause your thyroid to make too much thyroid hormone. It is important to pay attention to the medications that you are taking in. It is common to have an increased amount of iodine in medications which could lead to hyperthyroidism.
The hyperthyroidism that is caused by overmedicating with thyroid hormone is caused by people who take too much medication (overdose) the amount of thyroid hormone they take into their body. It is important to make sure that you check with your doctors about your thyroid hormone levels.
There are different tests that you can take for hyperthyroidism. There are a few tests that you can take to diagnose that you have hyperthyroidism. These tests include a thyroid-stimulating hormone test and a thyroid hormone tests. They thyroid-stimulating hormone test is a blood tests that detects the levels of TSH. When you have low levels of TSH, the doctor will want you to take more tests. The thyroid hormone tests are blood tests that measure your levels of type different types of thyroid hormones. These two hormones are the T3 and T4. When you have high levels of thyroid hormone, that means that you have hyperthyroidism.
There are tests that you take when you are being treated for hyperthyroidism. It is important that you have your doctor check the levels of your TSH and thyroid hormone frequently to make sure that they are where they should be. After you have hyperthyroidism you may take the antithyroid antibody test, radioactive thyroid scan, and radioactive iodine uptake tests. The antithyroid antibody tests checks to see if you have the antibodies that will attack the thyroid tissue. This test is also commonly used to help diagnose Graves’ disease and the autoimmune thyroiditis. The radioactive thyroid scan and radioactive iodine uptake tests are tests that use radiation to detect what causes hyperthyroidism. The radioactive iodine uptake test will detect the amount iodine that is in the thyroid.
Treatment for hyperthyroidism varies from human to human. There are different severities of hyperthyroidism, depending on the severity of your disease will determine which type of treatment you can use. There are three common treatment options that are available. These options include medications, radioiodine therapy, and surgery.
Medications: It is common for a doctor to prescribe a drug with a beta blocker. The beta clovker is used to reduce your symptoms until other treatments take effect. They relieve different symptoms like tremors, rapid heartbeat, and nervousness. The beta blockers do not stop thyroid hormone production, they are only used to help relieve symptoms and ease the tension. Antithyroid drugs will interfere with the thyroid hormone. Doctors prescribe methimazole and propylthiouracil. Antithyroid drugs can not treat thyroiditis. When you take antithyroid drugs you can get side effects. These may include allergic reactions, decrease in white blood cells, or liver failure.
Radioiodine Therapy: This is a treatment where the radioactive iodine collects in the thyroid and acts as regular iodine. Then it will slowly destroy the cells that are in the thyroid gland.
Thyroid Surgery: Surgery is the least common route used to treat hyperthyroidism. This may seem weird and unusual but we have to remember that hyperthyroidism is not cancer. During the surgical process the surgeons will remove part of the thyroid. The surgeon can remove part or all of your thyroid. Depending on the amount that they remove, will determine what kind of post treatment will take place. If the entire thyroid was removed, the patient will have to take thyroid hormones the rest of their life. If they removed only part of the thyroid, there is risk for hypothyroidism.
Incidence and Mortality
The incidence of hyperthyroidism according to www.ncbi.nlm.nih.gov was 13.5/100,00 per year seen in 1999. Mortality rate increases in the elderly but is uncommon in most cases.
Research, Charities, and Support Groups
Current research is being studied about hyperthyroidism through the website www.ClinicalTrials.gov. For more information on the current studies they are doing about hyperthyroidism, please visit the listed website.
http://www.wellspan.org/body.cfm?id=1710 is a website that is there to help people with hyperthyroidism. They do charity care. They have provided 17.2 million in free care to patients who participated in their charity care program.
http://www.allthyroid.org/research/summaries/archive/hyperthyroidism/02_07_antithyroid.html is a website that is doing current research on hyperthyroidism. They are studying the antithyroid drug and seeing if the therapy is effective in patients with amiodarone-induced hyperthyroidism.
Essentials of Human Disease by Leonard V. Crowley
First thought to be a symptom of tuberculosis in the early 1800’s, we now know Muscular Dystrophy, or MD, is an inherited disorder. It was first described in 1830 by Sir Charles Bell in a small publication about young boys plagued by progressive weakness. More articles were published in the 1850’s, further describing the disorder. A few years later, a French neurologist named Guillaume Duchenne published his work about a very severe and, unfortunately, very common form of the disease, which now shares his name. Besides Duchenne Muscular Dystrophy, there are nine other groups of the disease; Becker MD, Congenital MD, Emery-Dreifuss MD, Fascioscapulohumeral MD, Limb-girdle MD, Distal MD, Myotonic MD, and Oculopharyngeal MD. Each is characterized by progressively weakened and degenerated muscles.
Muscular Dystrophy is an inherited disease, meaning that it is passed down from parents to children. Genes are responsible for a persons traits and characteristics, including the formation of proteins. The genes code for the dystrophin protein, and others, of people with muscular dystrophy are defective. The defective genes that are passed down do not allow for the proper formation of dystrophin or significant quantities of it. Lack of this structural protein it the cause of the signs and symptoms of muscular dystrophy. A few symptoms of MD are poor balance, lack of ability to walk, restrained array of movement, and respiratory problems.
After a thorough medical and family history review, there are several tests that can be done to confirm muscular dystrophy. Muscle biopsies, taking samples of muscle tissue, are used to confirm the diagnosis, while a DNA test can be done to find the specific form of the disorder. Blood and urine tests can gather information to help the doctor confirm his diagnosis. These tests check for certain enzymes, aldolase and creatine kinase, and proteins, myoglobin, at abnormal levels. Exercise tests can detect levels of certain chemicals and help determine what kind of MD is presenting.
Since MD is genetic it cannot be cured. The goal of treatment is to keep the patient as independent and to prevent complications. Physical therapy helps improve range of motion and keeps muscles as strong as possible. Wheelchairs and other orthopedic appliances help with mobility and sometimes surgery can help too. In some cases, corticosteroids are taken to keep children walking as long as possible. Many times respiratory assistance is needed, especially with more severe forms of the disease.
The incidence and severity of MD depends on the type. Some, like Duchenne MD, are deadly, while others, such as some forms of Congenital MD, allow for a fairly normal, long life. Duchenne MD accounts for almost 50 percent of all MD cases, affecting one in 3,500 male births.
Broad programs of research are underway to help better understand MD and its causes. There are several drug and gene therapy researches being conducted by the National Institutes of Health and other institutions. In 2001, George W. Bush signed into law the Muscular Dystrophy Community Assistance, Research and Education Amendment Act which paved the way for the Wellstone Muscular Dystrophy Research Network. Perhaps the best known MD research and support organization is the Muscular Dystrophy Association (MDA). MDA is more than just the telethons, they sponsor many events across the country and are the worlds largest non-governmental sponsor researching cures for neuromuscular diseases. Other, more specific, support groups are Muscular Dystrophy Family Foundation, Parent Project Muscular Dystrophy, Cure CMD, Fascioscapulohumeral Muscular Dystrophy Society, Coalition to Cure Caplain 3, International Myotonic Dystrophy Association, and Jane Foundation.
Osteoporosis, a systemic skeletal disease, is characterized by low bone mass and deterioration of bone tissue that can affect almost the entire skeleton. Unfortunately, this disease does not usually become clinically present until a fracture occurs. Osteoporosis is the most common metabolic bone disease in the United States and needs to be detected early if possible. I will explain in more detail the pathogenesis, etiology, diagnosis, treatment, incidence and mortality, and research and charity groups available for more information and support.
Normal bone is composed of collagen, calcium, and protein, all of which provide strength to the bones. Osteoporosis is a condition characterized by a decrease in bone density of bone. This decreases bone strength and results in fragile bones, leading to fractures. It does this by turning bone into porous bone that is compressible like a sponge. Calcium and phosphate ate two minerals that are essential for normal bone formation. As you grow, the body uses these minerals to produce bones. If there is not enough calcium, or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer. As we age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes them weak. This makes the bones break more easily to relatively minor injuries whereas normal bones would not break. The loss of bone usually occurs gradually over years, depending on the stage, osteoporosis can be maintained or slowed or stop bone loss. Usually, osteoporosis doesn’t cause symptoms until a bone fracture. Therefore, patients may not be aware of their condition until a serious, painful bone fracture. Symptoms the develop in late stages of the disease include bone pain or tenderness, fractures with little or no trauma, loss of height, low back pain (due to fractures in the spine), neck pain, and stooped posture. Some risk factors include advanced age, female sex, genetic factors, thin build, late menarche, early menopause, physical inactivity, alcohol and tobacco use, and calcium deficiency.
Primary osteoporosis occurs in patients in whom a secondary cause cannot be identified. This includes juvenile, type I, (postmenopausal), and type II (age-associated or senile). The leading cause of osteoporosis is a drop in estrogen levels in women at the time on menopause, type I. For men, their testosterone levels drop, type II. Women over the age of 50 and men over the age of 70 are more at risk. Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis. These can include being confined to a bed, chronic rheumatoid arthritis, chronic kidney disease, eating disorders, corticosteroid medications or antiseizure drugs, hyperparathyroidism, and vitamin D deficiency. A family history of osteoporosis also provides a greater risk of developing osteoporosis.
A bone mineral density test can be done to measure how much bone you have. This test measures bone density in the spine, wrist, and hip. Those are the most common sites of fractures. This can provide information or predict your risk for bone fractures in the future, detect low bone density before a fracture, and determine your rate of bone loss or monitor the effects of treatment. A special type of spine CT can be done to show loss of bone mineral density in rare cases. In severe cases, a spine or hip x-ray may show fractures, however, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis. Other blood and urine tests are done if the cause is due to a medical condition, rather than the bone loss seen with older age.
The goals of osteoporosis treatment are to control the pain, slow or stop bone loss, prevent bone fractures, and minimize the risk of falls leading to fractures. Lifestyle changes may need to be made to help with this disease. Some examples would be diet and exercise. High calcium foods such a cheese, ice cream, low-fat milk, salmon, tofu, and yogurt are a few choices. Exercising regularly can reduce the likelihood of bone fractures like walking, dancing, free weights, stationary bicycle, and yoga to help with balance. Medications are used when osteoporosis has been diagnosed by a bone density study or osteopenia (thin bones) has been diagnosed. Bisphosphonates are used to prevent and treat osteoporosis in postmenopausal women. They are only taken once a week or once a month. Calcitonin is used to slow the rate of bone loss and relieves bone pain. This is a nasal spray or comes as an injection but is less effective than bisphosphonates. Hormone replacement therapy can also be used, but rarely used anymore; it does treat patients who already been diagnosed with the condition. Parathyroid hormone is used more often for postmenopausal women who have severe osteoporosis; this medicine is given through daily shots underneath the skin. One more medication used to prevent and treat this disease is raloxifene. This is similar to the breast cancer drug tamoxifen. It can reduce the risk of spinal fractures but does not appear to prevent other fractures. All treatment options will be discussed with your doctor and based on individual cases.
Incidence and Morality
Osteoporosis is an increasing worldwide problem, as both the world population grows and age increases. Lifetime risk for osteoporotic fractures in women is 30-50% worldwide, and 15-30% in men. One in three women over the age of fifty will suffer from a fracture due to osteoporosis. With that number, this increases to one in two over the age of sixty. One in five men over the age of fifty will suffer from osteoporosis and increases to one in three over the age of sixty.
Approximately 1.6 million hip fractures occur each year global, and the incidence is set to increase to 6.3 million by the year 2050. The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke, and breast cancer.
The mortality of this disease does not usually lead to death, although, about 10% of osteoporosis cases do. In most cases, osteoporosis can cause other problems or lead someone to bed rest.
Research, Charities and Support Groups
Most of the research taking place right now is determining the cause of osteoporosis and its specific affects, and treatment. Researchers are finding a specific gene and possible programmed cell death could lead to osteoporosis. As far as treatment, researchers are looking at different studies. A low-dose estrogen study has been done as showed good preventative results. Molecules called peptidomimetics block the bone resorption process have been studies, and also calcium supplements may show some helpful progression. For more information click on the link below.
Because this disease is popular and common in the elderly, there are also many support groups and charities out there that provide helpful information and support for people who suffer with this disease. There are many charities worldwide who donate and provide scholarly articles and information for people to better understand and cope with the disease. Below are a couple charities that I thought were beneficial to this disease.
As for support groups, look into local areas or hospitals that may hold a support group near you. It is nice to know and be around other people that share the same disease to discuss and relate to one another. If there are not any local groups by you there are many online support groups available to anyone. You are able to blog or just read about others who share about osteoporosis. Online support groups can provide more anonymous information, or very public, it is up to you how you want to share your information. Below are some links to maybe get you started or look into and get your foot in the door.
Essentials of Human Disease by Leonard V. Crowley
As we get age we seem to have more health related complications. One of these complications is osteoarthritis, which is the most common joint disorder and is a degenerative disease. It is due to aging and wear and tear of joints. Osteoarthritis is also known as degenerative arthritis and almost everyone has symptoms by the time they are 70, although some maybe be more severe than others. The cartilage in joints tends to break down as you age and the bones will start rubbing together causing discomfort and pain. In this post I will go over the cause, the signs, how OA can be diagnosed, and its treatment.
Osteoarthritis is a degenerative disease that causes pain in the joints. As we age the pressure that we have put on joints starts to catch up with us. Everything from walking to playing sports causes wear and tear on the cartilage in our joints, which allows bones to glide over one another. As we age the cartilage starts to break down and then the bones rub against one another. This can cause ligaments and muscles around the joint to become stiff. The most common symptom of OA is stiffness and pain in joints especially after exercise. As it progresses your joints may seem to hurt most of the time even when you are resting and may even wake you at night. The signs of osteoarthritis are cracking or grating during joint movement, swelling of joints, and limited range of motion. Osteoarthritis does not resolve although some days may be better than others, the cartilage that is lost is unable to replace itself.
The cause of osteoarthritis is unknown but is linked with aging and some investigators believe that mechanical stress on joints underlies all OA. There are factors that can increase your risk of osteoarthritis such as genetics. Studies have shown that there is a greater prevalence of the disease in siblings and identical twins showing that it runs in families. Being overweight also causes an earlier on set of OA due to the extra pressure put on the joints. Fractures or other injuries to joints can also increase risk. Jobs that involve kneeling or squatting for more than an hour a day put you at a high risk, also playing sports that involve direct impact on joints such as football and basketball.
Many times a physician will do a physical exam and will check for cracking when a joint is moved, this is called crepitation. They will also check for joint swelling, limited range of motion, tenderness when joint is pressed on. Blood tests are not helpful when diagnosing OA but x-rays can show a loss in joint space in effected joints.
Unfortunately osteoarthritis cannot be cured and will most likely get worse over time, but there are some lifestyle changes that can control the symptoms. Staying active can help maintain joint movement, water exercises such as swimming are especially helpful. Other lifestyle changes can include, applying hot and cold, eating a balanced diet, getting rest, and maintaining a healthy weight. Physical therapy may also have benefits by strengthening muscles and the motion of stiff joints. Physical Therapists have many techniques for treating OA. Braces may also be used to help protect weakened joints but should not be used unless recommended by a doctor. As far as medications go, Tylenol is recommended to relieve pain. Other medications may included a corticosteroid injected into the joint to reduce swelling and Zosterix, a skin cream that can relieve pain. Surgery may also be an option if other treatments have not worked. Arthroscopic surgery can be preformed to trim torn and damaged cartilage. Changing the alignment of bones may also relieve some of the pain. Or totally joint replacement can be an option.
Incidence and Mortality
Osteoarthritis is the most prevalent from of arthritis in the United States, effecting more than 70% of people between the ages of 55 and 78. So, about 20 million people in the US currently are suffering from OA which is the leading cause of disability in the over 65 years of age population. People with osteoarthritis do not die from it, but many times it is accompanied by high blood pressure, diabetes, and obesity.
Research, Charities, and Support Groups
OARSI is the premier international organization for scientists and health care professionals focused on the prevention and treatment of osteoarthritis through the promotion and presentation of research, education and the worldwide dissemination of new knowledge. And they are the only organization whose sole concern is OA.
You can donate to the Arthritis Foundation, who not only help fund research but also help families suffering for OA and the doctors who help them.
You can also join a support group at everydayhealth.com which can help you to deal with your symptoms by reading others comments and ideas.
Named after Dr. Burrill B. Crohn, Crohn’s Disease is defined as a chronic inflammation and ulceration of the bowel mucosa with marked thickening and scarring of the bowel wall. A form of Inflammatory Bowel Disease (IBD) , Crohn’s can be both painful and debilitating, and may lead to life-threatening complications. Crohn’s disease may occur in people of all ages, but is primarily a disease of adolescents and young adults ages 15-35. Being a person with a family member living with Chron’s, I became more interested in the scope of the disease, and wanted to learn more about it. For people suffering from, and living with Crohn’s disease, learning about it is an important step toward taking charge of the illness. The more informed you are, the better you will be able to conform and adapt to the disease. As you continue to read you will learn about the causes, symptoms, diagnostics, treatments, and some research and support groups to help inform and support the patient and family members living with Crohn’s Disease.
Crohn’s Disease is a chronic disorder that causes inflammation of the digestive or gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. In Crohn’s disease, the inflammation of the GI tract can cause pain and can make the bowel empty frequently, resulting in diarrhea. Chronic inflammation may produce scar tissue that builds up inside of the intestine, creating a narrowed passageway that can slow the movement of food through the intestine. A stricture, as this narrowing is called, can cause pain or cramping. Although it can affect any area of the GI tract from the mouth to the anus, Crohn’s most commonly affects the last part of the small intestine (ileum) and/or the colon.
Crohn’s disease is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation and irritation to the intestines. This disease, and Chronic ulcerative colitis are often grouped together under IBD. Both diseases tend to be chronic, with periodic flare-ups involving cramplike abdominal pain and diarrhea, followed by periods of the disease in an inactive state. Approximately 10 percent of colitis cases are unable to be pinpointed as either ulcerative colitis, or crohn’s disease and are called indeterminate colitis (Crohn’s and Colitis Foundation of America). Pictured below is a healthy colon verse a diseased colon.
The symptoms and complications of crohn’s disease can be different, depending on what part of the GI tract is affected. Based on the area involved, Crohn’s is divided into five different types:
Ileocolitis: This is the most common form of Crohn’s. It affects the ileum and colon (as stated previously), and can cause cramping or pain in the right lower part or middle of the abdomen. It can also be accompanied by significant weight loss.
Ileitis: This form only affects the ileum. The symptoms of this form can be comparable to those of Ileocolitis. In this form, fistulas or inflammatory abscesses may form in the right lower quadrant of the abdomen.
Gastroduodenal Crohn’s Disease: This form affects the stomach and the duodenum, which is the first part of the small intestine. Symptoms include weight loss, nausea, and loss of appetite. If vomiting occurs, this may indicate that narrowed segments of the bowel are obstructed (stricture).
Jejunoileitis: This form produces patch areas of inflammation in the jejunum. The jejunum is the upper half of the small intestine. Symptoms of this type include abdominal pain (ranging from mild to severe), cramps following meals, and diarrhea. Fistulas have also been known to form in some cases.
Crohn’s (granulomatous) colitis: This form affects the colon only. Symptoms include diarrhea, rectal bleeding, and disease around the anus (abscesses, fistulas, and ulcers). Skin lesions are more common in this form that in any other forms of Crohn’s disease.
All of the signs and symptoms of crohn’s can range from mild to severe, and can develop gradually or suddenly, without warning. There may also be periods of time when you have no signs or symptoms. However, when the disease is active, the main signs and symptoms may include:
- Abdominal pain and cramping
- Bloody stools
- Reduced appetite and weight loss
- pain with passing stool (tenesmus)
- Eye inflammation
- Mouth sores
- Skin disorders
- Inflammation of the liver or bile ducts
- Delayed growth in sexual development (in children)
Although considerable progress has been made in IBD research, the cause of crohn’s disease is still not known (Crohn’s and colitis foundation of America). Researchers believe is is the result of an abnormal reaction by the body’s immune system. In a normal, healthy person, the immune system would protect them from infection by identifying and destroying bacteria, viruses, and other harmful substances. Researchers feel that in a person with crohn’s disease, the immune system attacks bacteria, food and other substances that are actually harmless, or even beneficial to the body. During this process, white blood cells accumulate in the lining of the intestines, and can produce chronic inflammation leading to ulcers, sores, or injury (National Digestive Diseases Information Clearinghouse).
What is known about crohn’s disease is that it is an autoimmune disorder. This is a condition in which your body’s immune system mistakenly attacks and destroys healthy body tissue. The following seem to play a role in Crohn’s disease:
- Enviromental factors
- Body over-reacting to normal flora in the intestines
Some risk factors include:
- A family history of Crohn’s. Studies have shown that about 20-25 percent of patients may have a close relative with either Crohn’s or Ulcerative colitis.
- Jewish people
- Age (most people are diagnosed before they are 30)
- Where you live- Urban or industrialized areas are more common for Crohn’s disease, possibly due to enviromental factors or a diet high in fat or refined foods
There is no single test that can establish the diagnosis of Crohn’s disease with complete certainty. Doctors must use a combination of information from the patient’s history and a physical exam to evaluate the patient. A physical exam done by a medical doctor would include blood tests and stool tests. Blood tests can be used to look for anemia caused by the bleeding. These tests may also uncover a high white blood cell count, which is a common sign of inflammation or infection somewhere in the body. A stool test is commonly used to rule out other causes of GI diseases, such as infection. They can also show if there is bleeding in the intestines.
Other tests may be performed by a gastroenterologist. This is a doctor who specializes in digestive diseases. These tests are usually performed at a hospital or outpatient center:
Flexible sigmoidoscopy and colonoscopy: These tests help diagnose Crohn’s and help to determine how much of the GI tract is affected. A colonoscopy is the most commonly used test to specifically diagnose Crohn’s. It is used to view the ileum, rectum, and the entire colon, while flexible sigmoidoscopy is used to view just the lower colon and rectum. These tests are performed while the patient is in a twilight state. Cramping or bloating may occur during the first hour after the test, but a full recovery is expected by the next day.
These tests are performed at a hospital or outpatient center by an x-ray technician, and the images would be interpreted by a radiologist:
Computerized Tomography (CT) Scan: This method uses a combination of x-rays and computer technology to create 3-D images. The person must drink a barium solution, and must be injected with a special dye prior to the scan.
Upper GI series: This may be done to look at the small intestine. Again, the patient must drink barium liquid prior to the test. This will coat the small intestine, making signs of Crohn’s disease show up more clearly on x-rays.
Lower GI series: This may be done to look at the large intestine. After the patient is instructed to follow a clear, liquid diet for 1-3 days prior to the procedure, and given an enema to flush the bowel, the large intestine is filled with barium. This makes signs of Crohn’s disease show up more clearly on x-rays.
Some other common tests used to diagnose Crohn’s are Magnetic Resonance Imaging (MRI), Capsule Endoscopy, Double Balloon Endoscopy, or Enteroscopy.
There is currently no cure for Crohn’s Disease and there is no single treatment that works for everyone. The goal of the medical treatment, however, is to suppress the inflammatory response. It is also to improve long-term prognosis by limiting complications. In best cases, this may lead not only to symptom relief but also to long-term remission. There are two goals to accomplish in treatment of Crohn’s disease. The first goal, to bring the inflammatory symptoms under control, is known as inducing remission. Secondly, medical therapy is used to decrease the frequency of disease flares. This is known as maintaining remission, or maintenance.
Inflammatory drugs are often the first step in treatment of IBD, or Crohn’s disease. These include:
- Corticosteroids (used for short-term and to induce remission, have many side effects)
Immune System repressors are also drugs that reduce inflammation, but they target your immune system rather than directly treating inflammation. When you suppress the immune response, inflammation is also reduced. These drugs include:
- Infliximab (Remicade)
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Methotrexate (Rheumatrex)
- Natalizumab (Tysabri)
Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Frequently prescribed antibiotics include:
- Metronidazole (Flagyl)
- Ciprofloxacin (Cipro)
These following medications are also used to relieve signs and symptoms:
- Pain relievers
- Iron Supplements
- Nutrition via feeding tube
- Vitamin B-12 Shots
- Calcium and Vitamin D supplements
Aside from medications, a well-balanced healthy diet is a key component in treatment of Crohn’s disease. It is important to get enough calories, protein, and essential nutrients from a variety of food groups. To help ease symptoms, a person could eat small amounts of food throughout the day, drink lots of water, avoid high-fiber foods, avoid fatty or greasy foods and sauces, limit dairy products, and avoid food known to cause gas (such as beans).
If medications do not work, a type of surgery known as a bowel resection may be needed to remove a damaged or diseased part of the intestine. This however, still does not cure the condition. A surgery may be indicated in the following situations:
- Bleeding or hemorrhaging
- Failure to grow (in children)
- Narrowing of intestine (stricture)
Incidence and Mortality
Crohn’s disease usually has a chronic course regardless of the site of involvement. A 15 year survival rate of 93.7% has been reported for the general population (Medscape 2011), but the risk of death and complications in Crohn’s disease increases with the duration of the illness. Over time, 10% of patients will be disabled by this disease (Medscape 2011). Although Crohn’s disease is a chronic condition with recurring relapse, those with appropriate medical treatment and surgical therapy can live a reasonably normal life. These people have an overall good prognosis and extremely low risk of fatal outcome.
According to Medscape reference in 2011, the prevalence of Crohn’s disease in the United States is approximately 7 cases per 100,000 people. The incidence and prevalence have increased steadily over the last 5 decades. The rate of this disease in women is now 1.1-1.8 times higher than that in men. In the United States in 2003, the pediatric male to female ratio was 1.6-1.
Early studies of mortality of patients with Crohn’s disease suggested that the mortality was significantly higher than the general population, especially in patients diagnosed before the age of 20 years and also in the first 3 years after diagnosis (Medscape).
RESEARCH, CHARITIES, and SUPPORT GROUPS
Get one to one education and free support from a personal patient advocate. This patient advocate will provide you with educational information about Crohn’s, information about resources available to people with Crohn’s, and advice on how to make the most of your time with your gastroenterologist. This website can provide you with information you need to know about Crohn’s, and will help you find a gastroenterologist.
The Crohn’s and Colitis Foundation of America is a non-profit, volunteer-driven organization dedicated to finding the cure for Crohn’s disease and ulcerative colitis. Four decades ago, the Crohn’s & Colitis Foundation created the field of Crohn’s disease and ulcerative colitis research. Today, the Foundation funds cutting-edge studies at major medical institutions, nurtures investigators at the early stages of their careers, and finances underdeveloped areas of research. “Take Steps” is the foundations largest fundraising event. Participants raise funds and awareness throughout the year and come together to celebrate the steps that have been taken towards a cure.
A community of friends, connected by their lives being affected by IBD – either personally or with someone they care about, and they welcome new members to the forum. They offer support, understanding, and friendship. However, please note they are not doctors, and any experiences, advice, and tips shared or given should be checked out with your medical care provider before acting upon.
This website offers an online support group for various types of medical conditions, including Crohn’s disease. This site also offers a list of doctors and health insurance companies in your area.
Medscape Reference- Crohn Disease. http://emedicine.medscape.com/
Crohn’s and Colitis Foundation of America. http://www.ccfa.org/
PubMed Health- Crohn’s Disease. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295
Mayo Clinic- Crohn’s Disease. http://www.mayoclinic.com
National Digestive Diseases Information Clearinghouse- Crohn’s Disease. http://digestive.niddk.nih.gov/ddiseases/pubs/crohns
Crowley, Leonard V. Essentials of Human Disease. Jones and Bartlett Publishers.2011