10 foods that support weight loss

Best Foods For Weight Loss | jpeei clinic


Overview.

Losing weight (weight loss) needs commitment and is not a single stream goal to achieve. It needs a multiple tasks. Your aim should be targeting foods that support losing weight and  be strong on exercises. Foods alone does little about weight loss because physiologically your body may adapt to your new eating habits thereby reducing basal metabolic rate.
While no one food is a magic bullet for weight loss, there are certain foods that can help you achieve your weight-loss goals. Most of the foods included as part of a weight-loss diet have a few things in common: they're high in fiber (which helps keep you feeling fuller longer) and have a low energy density-meaning that you can eat a decent-sized portion without overdoing it on calories. Include the following weight-loss foods as part of a healthy overall diet, and you may find it's easier to achieve your weight-loss goals.


See also  : 20 steps to lose belly fat


Here are the 10 foods that support weight loss:



1. Vegetables


Vegetables are low in calories and high in volume that will make you feeling full with little calories thereby achieving your weight loss scheme.

They're also packed with all kinds of beneficial nutrients and plant compounds that make them an important part of a healthy diet.

Furthermore, they're high in water and fiber, both of which help fill you up.

Research shows that salads, in particular, help satisfy hunger, especially when consumed before a meal.

In one study, participants who ate a salad at the start of a meal consumed 7–12% fewer calories at the meal .

Another study showed that eating a salad at the start of a meal increased vegetable consumption by 23%, compared to eating it with the main course .

In order to keep your salad low in calories, avoid adding high-calorie ingredients and dressings.

Vegetables are high in water and fiber, which may keep you full for longer. Eating low-calorie salads can help increase your vegetable consumption and decrease your calorie intake.

2. Citrus Fruits


Similarly to apples, citrus fruits are high in pectin, which can slow digestion and increase satiety.

They also have a high water content. Both oranges and grapefruit contain over 87% water, which means they're able to fill you up for very few calories.

It has often been suggested that eating grapefruit can promote weight loss.

In one study, obese participants eating grapefruit lost significantly more weight than those given a placebo .

In another study, eating half a grapefruit three times daily at mealtimes for six weeks was associated with modest weight loss and a significant reduction in waist circumference .

When combined with calorie restriction, consuming grapefruit or grapefruit juice before meals resulted in a 7.1% weight loss, a significant reduction in body fat and weight circumference .

However, these results may not be exclusive to grapefruit, as drinking water before meals had similar effects for weight loss indirectly.

Citrus fruits such as oranges and grapefruit are also weight loss friendly foods. They're high in fiber and water, which can help you feel full and consume fewer calories.

3. Legumes


Legumes, such as beans, peas and lentils, are well known for being good sources of fiber and protein.

This, combined with a relatively low energy density, makes them a filling food that may even promote weight loss .

A review of several studies indicates that beans, peas, chickpeas and lentils are 31% more filling than pasta and bread .

Legumes are high in protein and fiber, which make them very filling. They are also relatively low in calories, which makes them a weight loss friendly food.

4. Boiled Potatoes


Due to their higher carb content, many people avoid potatoes when trying to lose weight, but they shouldn't.

Whole potatoes are loaded with vitamins, fiber and other important nutrients. They also contain a certain type of starch called resistant starch .

Resistant starch contains half the calories of regular starch (2 instead of 4 calories per gram). In your digestive system, it acts a lot like soluble fiber, helping you feel full.

Because adding resistant starch to meals helps satisfy hunger, it causes people to eat fewer calories .

Interestingly, cooling potatoes after they're cooked increases their resistant starch content. In fact, studies show that cooling and reheating potatoes multiple times continues to increase their hunger-suppressing effect .

In a study that measured the ability of 38 foods to satisfy hunger, boiled potatoes ranked the highest .

While boiled potatoes were the most satisfying food tested, fried potato chips were found to be three times less filling.

Boiled potatoes, which are highly nutritious, are number one on the satiety index. Fried potato chips are three times less filling and not considered weight loss friendly.


5. Whole Eggs


Eggs are another food that has been unfairly demonized in the past. The truth is, eggs are incredibly healthy and high in several important nutrients.

Most of the nutrients, including about half of an egg's protein, are found in the yolk.

Eggs are a complete protein, meaning they contain all nine essential amino acids.

In addition, they're very filling.

Several studies found that people who ate eggs for breakfast were more satisfied and consumed fewer calories throughout the day than those who had a bagel for breakfast .

In particular, one study found that people who ate eggs for breakfast lowered their body mass index (BMI) and lost more weight than those who ate a bagel .

Eggs are a great source of nutrients, including high-quality protein. They may help you eat less for up to 36 hours after a meal.


6. Oatmeal


Oatmeal is a type of porridge, or hot cereal, that is often consumed for breakfast.

It's incredibly filling and ranks third on the satiety index .

This is mainly due to its high fiber content and ability to soak up water.

Oats are a good source of a soluble fiber called beta-glucan, which helps slow down digestion and the absorption of carbs .

When compared to ready-to-eat breakfast cereal, oatmeal was better at suppressing appetite, increasing satiety and reducing calorie intake throughout the day.

Oatmeal is high in fiber and soaks up water, which makes it incredibly filling. It is more filling than traditional breakfast cereals and may help you eat less throughout the day.


7. Popcorn


Popcorn is a whole grain and contains more fiber than many other popular snack foods.

It is also high in volume, so it takes up a lot of space in your stomach, despite being relatively low in calories.

Studies have found that popcorn will fill you up more than other popular snacks such as potato chips .

Air-popped popcorn is the healthiest. Commercially-prepared or microwave popcorn can be extremely high in calories and contain unhealthy ingredients.

To keep your popcorn low in calories, avoid adding a lot of fat to it.

Popcorn is a whole grain that is high in fiber and volume, both of which help you feel full. Studies have found that popcorn is more filling than potato chips.


8. Fish


Fish that are rich in omega-3 fatty acids may increase satiety in people who are overweight or obese .

They're also loaded with high-quality protein, which is known to be very filling.

In fact, fish scores higher than all other protein-rich foods on the satiety index and ranks second of all foods tested .

One study found the effect of fish on satiety was significantly greater than that of chicken and beef .

Another study found participants who ate fish consumed 11% fewer calories at their next meal than those who ate beef .

Fish is high in protein and omega-3 fatty acids, which may increase satiety. Fish may also be more filling than other types of protein such as chicken and beef.


9. Cottage Cheese


Cottage cheese is low in calories but very high in protein.

It is also packed with healthy nutrients, including B vitamins, calcium, phosphorus and selenium.

These characteristics make cottage cheese a weight loss friendly food.

One study found that its effect on fullness is similar to that of eggs.

Cottage cheese is high in protein and low in calories. Its effect on satiety may be comparable to that of eggs.


10. Lean Meats


Lean meats are high in protein and very filling.

In fact, higher-protein diets lead to lower overall calorie intake than lower-protein diets .

One study found that people ate 12% less at dinner after eating high-protein meat at lunch, compared to those who had a high-carb lunch .

Beef scored second highest of all protein-rich foods on the satiety index, but other lean meats such as chicken and pork are also weight loss friendly.


Meat is high in protein and very filling. Eating high-protein lean meat may help you consume fewer calories at subsequent meals.


Summary


Filling foods have certain characteristics. They're high in volume, protein or fiber and low in energy density. go for theses foods for your weight loss goal.

Including more of these foods in your diet may help you lose weight in the long run.

10 ways to prevent diseases


prevent diseases| jpeei clinic

Overview


The ways to prevent diseases depends on the type of a disease but generally the concept is to master how the disease comes about. There is a saying that if a problem is identified it means it is half way solved. Same as preventing disease if we know how it comes then avoiding it is simply stay away from the cause. There are communicable diseases and non communicable diseases, the later requires an organism to cause a disease. For example preventing malaria we need to prevent mosquito bites. Preventing burns we need to stay away from fire. In this article we will talk about more on non infectious diseases.

The following 10 considerations will help prevent non communicable diseases:

1. Choose what foods to eat


“For good health and disease prevention, avoid ultra-processed foods and eat homemade meals prepared with basic ingredients,” says Dr. Todorov.

A study published in 2019 concluded that consumption of more than 4 servings of ultra-processed food was associated with a 62% increased hazard for all-cause mortality. For each additional serving, all-caused mortality increased to 18%. These foods can cause chronic inflammation, a normal bodily process gone awry that can contribute to heart disease, diabetes and even cancer.

Ultra-processed food include:
  • Chips.
  • White bread.
  • Donuts.
  • Cookies.
  • Granola or protein bars.
  • Breakfast cereals.
  • Instant oatmeal.
  • Coffee creamers.
  • Soda.
  • Milkshakes.

“It’s crucial to read food labels carefully,” warns Dr. Todorov. “Most foods that come in a package have more than five ingredients or have ingredients that you cannot pronounce. Many foods labeled as diet, healthy, sugar free or fat free can be bad for you.”

What do all healthy diets have in common? They consist of fruits and vegetables, beans, lentils, whole grains like quinoa, brown rice and steel-cut oats, nuts and seeds and healthy oils like extra-virgin olive oil.

“A great example of a healthy eating pattern is the Mediterranean diet,” says Dr. Todorov. “Talk to your doctor or dietitian to help create a meal plan that works for you.”

2. Get your cholesterol checked


When checking your cholesterol, your test results will show your cholesterol levels in milligrams per decilitre. It’s crucial to get your cholesterol checked because your doctor will be able to advise you on how to maintain healthy levels, which in turn lowers your chances of getting heart disease and stroke.

3. Monitor your blood pressure regularly


Do you have high blood pressure? Even if you don’t think so, keep reading. Based on data published from the Centers for Disease Control and Prevention (CDC), about 45% of adults in the United States have hypertension defined as systolic blood pressure, diastolic blood pressure or are taking medication for hypertension.

Normal blood pressure is defined as blood pressure <120/80 mmHg. Having hypertension puts you at risk for heart disease and stroke, which are leading causes of death in the United States.

Even small weight loss can help manage or prevent high blood pressure in many overweight people, according to the American Heart Association.

“Start off slow and find an activity you enjoy,” says Dr. Todorov. “That can make a big difference in both your blood pressure and health.”

4. Get up and get moving


Throw away any common misconceptions about exercising like that it has to be in a gym or a structured environment. Frequency (how often), intensity (how hard) and time (how long) are what matter the most.

“Start where you are and gradually increase your physical activity,” says Dr. Todorov. “My motto is some exercise is good but more is better.”

Taking 10,000 steps a day is a popular goal because research has shown that when combined with other healthy behaviors, it can lead to a decrease in chronic illness like diabetes, metabolic syndromes and heart disease. Exercise does not need to be done in consecutive minutes. You can walk for 30 to 60 minutes once a day or you can do activities two to three times a day in 10 to 20 minute increments.

“There are so many different options for exercise available to us today,” says Dr. Todorov. “Take advantage of free gym and app trials, YouTube videos, resources from your local library and virtual gym classes. Walking in the park adds the benefit of spending time in nature.”

5. Control your body weight


“Dare to be different from the average American, who is more likely to be obese than adults in any other developed nation,” says Dr. Todorov.

To see if you are at a good weight for your height, calculate your body mass index (BMI).

The BMI scale:
Under 18.5: Underweight
18-24.9: Normal
> 25-29.9: Overweight
> 30: Obese

If you are overweight or obese, you are at higher risk of developing serious health problems, including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems and certain cancers. If you are overweight or obese, you doctor or nutritionist will be able to help you get on the right path towards your ideal body mass.

6. Mornitor and Manage blood sugar levels


For good preventive health, cut back on soda, candy and sugary desserts, which can cause blood sugar to rise. If you have diabetes, this can damage your heart, kidneys, eyes and nerves over time.

Aside from understanding what makes your blood sugar levels hike up, the American Heart Association recommends eating smart, managing your weight, quitting smoking and moving more as measures to manage your blood sugar.

“In addition, having your blood pressure, blood sugar and cholesterol in a normal range decreases your risk for heart disease,” explains Dr. Todorov. “This lowers your risk of being diagnosed with cancer.”

7. Stop smoking and reduce alcohol intake

Many non communicable disease have a relationship with alcohol. In simple terms alcohol contributes to other non communicable diseases therefore, reducing its consumption will surely help you prevent such diseases. Hypertension and others maybe fueled by alcohol intake.
If you smoke, there is probably no other single choice you can make to help your health more than quitting.

The CDC found that smokers are more likely than nonsmokers to develop heart disease, different types of cancer, stroke and more. Not only that, but smoking increases your risk of dying from cancer.

“Smokers lose at least 10 years of life expectancy compared with people who never smoked,” says Dr. Todorov. “People who quit by age 40 reduce their risk of smoking-related death by 90%.”

8. Have enough sleep


Sleep restores us and has a huge effect on how we feel. If you have trouble sleeping, try to establish a sleep routine. A good sleep routine includes going to bed and waking up at the same time every day and avoiding eating heavy meals and alcohol. It’s important to stop screen time from your devices 2 hours before bedtime, too.

To wind down before bed, Dr. Todorov recommends:
  • Listen to calming music.
  • Practice mindfulness or meditation.
  • Reflect on the positive moments of the day.
  • Read a book.
  • Have a cup of chamomile tea.
  • Practice 10 minutes of yoga.

“Research shows that daily exercise improves sleep in patients with insomnia, too,” says Dr. Todorov. “Try to avoid vigorous exercise 2 to 3 hours before bedtime.”

9. Have health screenings and vaccinations when needed


It’s no exaggeration: health screenings can save your life. They are designed to catch cancers and serious problems early for more successful treatment.

“There are screening recommendations for adults and women specifically, and varied screenings depending on your family history,” says Dr. Todorov. “Some screening recommendations have changed, so talk to your doctor.”

Making healthy lifestyle changes overnight isn’t realistic, but taking the necessary steps to ensure you’re staying on top of your health will put you ahead and help you be the healthiest you can be.


10.Read about health and fitness.

There are different health problems being discovered almost every day out there and  may  need specific measures to avoid them. The good part is that writers are also busy publishing preventive measures on such diseases therefore ,its' the matter of developing a culture of research and reading on how you can keep yourself safe from the diseases.  We have head of Covid-19 which is a new disease and has its means of prevention that we just need to adopt for our safety.

Autonomic neuropathy

autonomic Neuropathy | jpeei clinic

Overview


Autonomic neuropathy occurs when the nerves that control involuntary bodily functions are damaged. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function.

The nerve damage interferes with the messages sent between the brain and other organs and areas of the autonomic nervous system, such as the heart, blood vessels and sweat glands.


While diabetes is the most common cause of autonomic neuropathy, other health conditions — even an infection — can be to blame. Some medications also might cause nerve damage. Symptoms and treatment vary based on which nerves are damaged.

Symptoms


Signs and symptoms of autonomic neuropathy depend on the nerves affected. They might include:

  • Dizziness and fainting when standing, caused by a sudden drop in blood pressure.
  • Urinary problems, such as difficulty starting urination, incontinence, difficulty sensing a full bladder and inability to completely empty the bladder, which can lead to urinary tract infections.
  • Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men. In women, problems include vaginal dryness, low libido and difficulty reaching orgasm.
  • Difficulty digesting food, such as feeling full after a few bites of food, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn, all due to changes in digestive function.
  • Inability to recognize low blood sugar (hypoglycemia), because the warning signals, such as getting shaky, aren't there.
  • Sweating abnormalities, such as sweating too much or too little, which affect the ability to regulate body temperature.
  • Sluggish pupil reaction, making it difficult to adjust from light to dark and seeing well when driving at night.
  • Exercise intolerance, which can occur if your heart rate stays the same instead of adjusting to your activity level.

When to see a doctor


Seek medical care promptly if you begin having any of the signs and symptoms of autonomic neuropathy, particularly if you have diabetes that's poorly controlled.

If you have type 2 diabetes, the American Diabetes Association recommends annual autonomic neuropathy screening beginning when you receive your diagnosis. For people with type 1 diabetes, the association advises annual screening beginning five years after diagnosis.


Causes


Many health conditions can cause autonomic neuropathy. It can also be a side effect of treatments for other diseases, such as cancer. Some common causes of autonomic neuropathy include:
Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.


Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis and celiac disease. Guillain-Barre syndrome is an autoimmune disease that happens rapidly and can affect autonomic nerves.

An abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome) can also cause autonomic neuropathy.
Diabetes, especially with poor glucose control, is the most common cause of autonomic neuropathy. It can gradually cause nerve damage throughout the body.
Certain medications, including some drugs used in cancer chemotherapy.
Certain infectious diseases. Some viruses and bacteria, such as botulism, Lyme disease and HIV, can cause autonomic neuropathy.
Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy.

Risk factors

Factors that might increase your risk of autonomic neuropathy include:

  • Diabetes. Diabetes, especially when poorly controlled, increases your risk of autonomic neuropathy and other nerve damage. You're at greatest risk if you have difficulty controlling your blood sugar.
  • Other diseases. Amyloidosis, porphyria, hypothyroidism and cancer (usually due to side effects from treatment) also can increase the risk of autonomic neuropathy.

Prevention


While certain inherited diseases that put you at risk of developing autonomic neuropathy can't be prevented, you can slow the onset or progression of symptoms by taking care of your health in general and managing your medical conditions.

Follow your doctor's advice on healthy living to control diseases and conditions, which might include these recommendations:

  • Control your blood sugar if you have diabetes.
  • Avoid alcohol and smoking.
  • Get appropriate treatment if you have an autoimmune disease.
  • Take steps to prevent or control high blood pressure.
  • Achieve and maintain a healthy weight.
  • Exercise regularly.


Diagnosis


Autonomic neuropathy is a possible complication of a number of diseases, and the tests you'll need depend on your symptoms and risk factors for autonomic neuropathy.
When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy, such as diabetes, and have symptoms of the condition, your doctor will perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.
When you don't have risk factors for autonomic neuropathy

If you have symptoms of autonomic neuropathy but no risk factors, the diagnosis can be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.

Your doctor might recommend tests to evaluate autonomic functions, including:
Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).


Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.

A simpler test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through capsules placed on your forearm, upper and lower leg and foot, while a computer analyzes the response of your nerves and sweat glands. You might feel warmth or a tingling sensation during the test.
Thermoregulatory sweat test. You're coated with a powder that changes color when you sweat. While lying in a chamber with a slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern might help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary signs and symptoms, a series of urine and bladder tests can evaluate bladder function.
Ultrasound. If you have bladder signs and symptoms, your doctor might do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.

Treatment


Treatment of autonomic neuropathy includes:

  • Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to tightly control blood sugar to prevent autonomic neuropathy from progressing. About half of the time, no underlying cause for autonomic neuropathy is found.
  • Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms


Your doctor may recommend:

  • Diet changes. You might need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also might help. Slowly increase fiber to avoid gas and bloating.
  • Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication can cause drowsiness and isn't advised for long-term use.
  • Medications to ease constipation. Over-the-counter laxatives can help ease constipation. Ask your doctor how often you should use a laxative.
  • Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines, and over-the-counter antidiarrheal medication might be helpful.

Urinary symptoms


Your doctor may suggest:

  • Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
  • Medication to help empty the bladder. Bethanechol (Duvoid) is a medication that helps ensure complete bladder emptying. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
  • Urinary assistance (catheterization). A tube is guided through your urethra to empty your bladder.
  • Medications that decrease an overactive bladder. These include tolterodine (Detrol), oxybutynin or similar medications. Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction


For men with erectile dysfunction, your doctor might recommend:



  • Medications that enable erections. Drugs such as sildenafil (Viagra, Revatio), vardenafil (Levitra) or tadalafil (Adcirca, Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and changes in color vision.
If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
  • External vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.


For women with sexual symptoms, your doctor might recommend:

  • Vaginal lubricants to decrease dryness and make sexual intercourse more comfortable and enjoyable.
  • Flibanserin (Addyi) for premenopausal women with low sexual desire.

Heart rhythm and blood pressure symptoms


Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor might prescribe:



  • Medications to raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor might suggest fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.
Other drugs that can help raise your blood pressure include midodrine (Orvaten) and pyridostigmine (Mestinon, Regonol). Droxidopa (Northera) also can help raise blood pressure. Midodrine and droxidopa can cause high blood pressure when lying down.
  • Medication to regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
  • A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high- fluid diet can help maintain your blood pressure. This is generally only recommended for severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs and shouldn't be used in patients with heart failure.

Sweating



If you sweat too much, your doctor might prescribe:

  • A medication that decreases perspiration. Glycopyrrolate (Cuvposa, Robinul, Robinul Forte, others) can decrease sweating. Side effects can include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste and drowsiness. Glycopyrrolate can also increase the risk of heat-related illness, such as heatstroke, from a reduced ability to sweat.
  • Surgery to cut the nerves in the sweat glands. It's also possible to remove the sweat glands but only in small areas of increased sweating, such as the palms.


Lifestyle and home remedies



Posture changes. Stand up slowly, in stages, to decrease dizziness. Sit with your legs dangling over the side of the bed for a few minutes before getting up. Flex your feet and make fists with your hands for a few seconds before standing up, to increase blood flow.

Once standing, try tensing your leg muscles while crossing one leg over the other a few times to increase blood pressure.
Elevate the bed. If you have low blood pressure, it might help to raise the head of your bed by about 4 inches by placing blocks or risers under the legs at the head of the bed.
Digestion. Eat small, frequent meals to combat digestive problems. Increase fluids, and opt for low-fat, high-fiber foods, which can improve digestion. You might also try restricting foods that contain lactose and gluten.
Diabetes management. Tight blood sugar control can help lessen symptoms and help to prevent or delay the onset of new problems.

Alternative medicine


Several alternative medicine treatments might help people with autonomic neuropathy. Discuss treatments you're considering with your doctor to ensure that they won't interfere with your medical treatments or be harmful.
Alpha-lipoic acid

Research suggests this antioxidant might improve the measures of autonomic nerve function, but not necessarily the function of the nerves. More study is needed.

Acupuncture

This therapy, which involves placing numerous thin needles in specific points in the body, might help treat slow stomach emptying and erectile dysfunction. More studies are needed.
Electrical nerve stimulation

Some studies have found that this therapy, which uses low-energy electrical waves transmitted through electrodes placed on the skin, might help ease pain associated with diabetic neuropathy.

Coping and support


Living with a chronic condition presents daily challenges. Here are some suggestions to help you cope:

  • Set priorities. Accomplish the most important tasks, such as paying bills or grocery shopping, when you have the most energy and save less important tasks for later. Stay active, but don't overdo.
  • Seek and accept help from friends and family. Having a support system and a positive attitude can help you cope with your challenges. Ask for what you need. Don't shut yourself off from loved ones.
  • Talk to a counselor or therapist. Depression and impotence are possible complications of autonomic neuropathy. Seek help from a counselor or therapist in addition to your primary care doctor to discuss possible treatments.
  • Consider joining a support group. Ask your doctor about support groups in your area. If there isn't a local group for people with neuropathies, you might find a support group for your underlying condition, such as diabetes, or an online support group.

Bird flu (avian influenza)

Avian Bird Flu, Bird flu symptoms

Overview


Bird flu is caused by a type of influenza virus that rarely infects humans. More than a dozen types of bird flu have been identified, including the two strains that have most recently infected humans — H5N1 and H7N9. When bird flu does strike humans, it can be deadly.

Outbreaks of bird flu have occurred in Asia, Africa, North America and parts of Europe. Most people who have developed symptoms of bird flu have had close contact with sick birds. In a few cases, bird flu has passed from one person to another. Only sporadic human cases have been reported since 2015.

Health officials worry that a global outbreak could occur if a bird flu virus mutates into a form that transmits more easily from person to person. Researchers are working on vaccines to help protect people from bird flu.

Symptoms


Signs and symptoms of bird flu may begin within two to seven days of infection, depending on the type. In most cases, they resemble those of conventional influenza, including:

  • Cough
  • Fever
  • Sore throat
  • Muscle aches
  • Headache
  • Shortness of breath


Some people also experience nausea, vomiting or diarrhea. And in a few cases, a mild eye infection (conjunctivitis) is the only indication of the disease.

When to see a doctor

See your doctor immediately if you develop a fever, cough and body aches and have recently traveled to a part of the world where bird flu occurs. Be sure to let your doctor know if you visited any farms or open-air markets.

Causes


Bird flu occurs naturally in wild waterfowl and can spread into domestic poultry, such as chickens, turkeys, ducks and geese. The disease is transmitted via contact with an infected bird's feces, or secretions from its nose, mouth or eyes.

Open-air markets, where eggs and birds are sold in crowded and unsanitary conditions, are hotbeds of infection and can spread the disease into the wider community.

Undercooked poultry meat or eggs from infected birds can transmit bird flu. Poultry meat is safe to eat if it's been cooked to an internal temperature of 165 F (74 C). Eggs should be cooked until the yolks and whites are firm.

Risk factors

The greatest risk factor for bird flu seems to be contact with sick birds or with surfaces contaminated by their feathers, saliva or droppings. The pattern of human transmission remains mysterious. In very few instances, bird flu has been transmitted from one human to another. But unless the virus begins to spread more easily among people, infected birds present the greatest hazard.

Complications


People with bird flu may develop life-threatening complications, including:

  • Pneumonia
  • Pink eye (conjunctivitis)
  • Respiratory failure
  • Kidney dysfunction
  • Heart problems


Although bird flu may kill more than half the people it infects, the number of fatalities is still low because so few people have had bird flu. Fewer than 500 bird flu deaths have been reported to the World Health Organization since 1997.

In contrast, the Centers for Disease Control and Prevention estimates that seasonal influenza is responsible for thousands of deaths each year in the United States alone.

Prevention

Bird flu vaccine

The Food and Drug Administration has approved one vaccine to prevent infection with one strain of H5N1 bird flu virus. This vaccine isn't available to the public, but the U.S. government is stockpiling it and will distribute it in the event of an outbreak.

This vaccine could be used early in such an outbreak to provide limited protection until another vaccine — designed to protect against the specific form of the virus causing the outbreak — is developed and produced. Researchers continue to work on other types of bird flu vaccines.

Recommendations for travelers


If you're traveling to Southeast Asia or to any region with bird flu outbreaks, consider these public health recommendations:

  • Avoid domesticated birds. If possible, avoid rural areas, small farms and open-air markets.
  • Wash your hands. This is one of the simplest and best ways to prevent infections of all kinds. Use an alcohol-based hand sanitizer containing at least 60 percent alcohol when you travel.
  • Ask about a flu shot. Before traveling, ask your doctor about a flu shot. It won't protect you specifically from bird flu, but it may help reduce the risk of simultaneous infection with bird and human flu viruses.

Poultry and egg products


Because heat destroys avian viruses, cooked poultry isn't a health threat. Even so, it's best to take precautions when handling and preparing poultry, which may be contaminated with salmonella or other harmful bacteria.
Avoid cross-contamination. Use hot, soapy water to wash cutting boards, utensils and all surfaces that have come into contact with raw poultry.
Cook thoroughly. Cook chicken until the juices run clear, and it reaches a minimum internal temperature of 165 F (74 C).
Steer clear of raw eggs. Because eggshells are often contaminated with bird droppings, avoid foods containing raw or undercooked eggs.

Diagnosis

Laboratory tests


Samples of fluids from your nose or throat can be tested for evidence of bird flu virus. These samples must be taken within the first few days after symptoms appear.

Imaging tests


X-rays may be useful in assessing the condition of your lungs, which can help determine the proper diagnosis and the best treatment options for your signs and symptoms.

Treatment


Many influenza viruses have become resistant to the effects of a category of antiviral drugs that includes amantadine and rimantadine (Flumadine). Health officials recommend the use of oseltamivir (Tamiflu) or, if oseltamivir can't be used, zanamivir (Relenza). These drugs must be taken within two days after the appearance of symptoms

X-linked agammaglobulinemia

X-linked agammaglobulinemia bruton

Overview


X-linked agammaglobulinemia— also called XLA, Buton's  agammaglobulinemia— is an inherited (genetic) immune system disorder that reduces your ability to fight infections. People with XLA might get infections of the inner ear, sinuses, respiratory tract, bloodstream and internal organs.


XLA affects males almost exclusively, although females can be genetic carriers of the condition. Most people with XLA are diagnosed in infancy or early childhood, after they've had repeated infections. Some people aren't diagnosed until adulthood.

Symptoms


Babies with XLA generally appear healthy for the first few months because they're protected by the antibodies they got from their mothers before birth. When these antibodies clear from their systems, the babies begin to develop often severe, recurrent bacterial infections — such as of the ears, lungs, sinuses and skin — that can be life-threating.

Male infants born with XLA have:

  • Very small tonsils
  • Small or no lymph nodes

Causes


X-linked agammaglobulinemia is caused by a genetic mutation. People with the condition can't produce antibodies that fight infection. About 40% of people with the condition have a family member who has it.

Complications


People with XLA can live relatively normal lives and should be encouraged to participate in regular activities for their ages. However, recurrent infections related to XLA will likely require careful attention and aggressive treatment. They can cause organ damage and be life-threatening.

Possible complications include:

  • Chronic lung disease
  • Increased risk of certain cancers
  • Infectious arthritis
  • Increased risk of central nervous system infections from live vaccines

Diagnosis


Your doctor will take a medical history to document recurrent infections and do a physical exam. He or she will order blood tests and possibly recommend genetic testing to confirm the diagnosis.

Treatment

There's no cure for XLA. The goal of treatment is to boost the immune system, preventing infections and aggressively treating infections that occur.

Medications


Medications to treat XLA include:


Gammaglobulin. This is a type of protein found in blood that contains antibodies against infections. It's given by infusion into a vein every two to four weeks or by weekly injection.

Reactions to gammaglobulin can include headache, chills, backache and nausea. Reactions are more likely to occur during a viral infection.
Antibiotics. Some people with XLA receive continuous antibiotics to prevent infections. Others take antibiotics for bacterial infections longer than people without XLA do.

Your doctor will likely recommend that you have follow-up visits every six to 12 months to screen for complications of XLA. You'll also likely be advised to not get live vaccines, such as live polio, measles-mumps-rubella or chickenpox vaccines.
See: bruton agammaglobulinemia

Dry mouth or xerostomia

Dry Mouth

Overview


Dry mouth, or xerostomia (zeer-o-STOE-me-uh), refers to a condition in which the salivary glands in your mouth don't make enough saliva to keep your mouth wet. Dry mouth is often due to the side effect of certain medications or aging issues or as a result of radiation therapy for cancer. Less often, dry mouth may be caused by a condition that directly affects the salivary glands.


Saliva helps prevent tooth decay by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. Saliva also enhances your ability to taste and makes it easier to chew and swallow. In addition, enzymes in saliva aid in digestion.


Decreased saliva and dry mouth can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth and gums, as well as your appetite and enjoyment of food.

Treatment for dry mouth depends on the cause.

Symptoms


If you're not producing enough saliva, you may notice these signs and symptoms all or most of the time:


  • Dryness or a feeling of stickiness in your mouth
  • Saliva that seems thick and stringy
  • Bad breath
  • Difficulty chewing, speaking and swallowing
  • Dry or sore throat and hoarseness
  • Dry or grooved tongue
  • A changed sense of taste
  • Problems wearing dentures


In addition, dry mouth may result in lipstick sticking to the teeth.

Causes


Dry mouth is caused when the salivary glands in the mouth don't make enough saliva to keep your mouth wet. These glands may not work properly as the result of:


  • Medications. Hundreds of medications, including many over-the-counter drugs, produce dry mouth as a side effect. Among the more likely types to cause problems are some of the drugs used to treat depression, high blood pressure and anxiety, as well as some antihistamines, decongestants, muscle relaxants and pain medications.
  • Aging. Many older people experience dry mouth as they age. Contributing factors include the use of certain medications, changes in the body's ability to process medication, inadequate nutrition, and having long-term health problems.
  • Cancer therapy. Chemotherapy drugs can change the nature of saliva and the amount produced. This may be temporary, with normal salivary flow returning after treatment is completed. Radiation treatments to your head and neck can damage salivary glands, causing a marked decrease in saliva production. This may be temporary or permanent, depending on the radiation dose and area treated.
  • Nerve damage. An injury or surgery that causes nerve damage to your head and neck area can result in dry mouth.
  • Other health conditions. Dry mouth can be due to certain health conditions, such as diabetes, stroke, yeast infection (thrush) in your mouth or Alzheimer's disease, or due to autoimmune diseases, such as Sjogren's syndrome or HIV/AIDS. Snoring and breathing with your mouth open also can contribute to dry mouth.
  • Tobacco and alcohol use. Drinking alcohol and smoking or chewing tobacco can increase dry mouth symptoms.
  • Recreational drug use. Methamphetamine use can cause severe dry mouth and damage to teeth, a condition also known as "meth mouth." Marijuana also can cause dry mouth.


Complications


If you don't have enough saliva and develop dry mouth, this can lead to:


  • Increased plaque, tooth decay and gum disease
  • Mouth sores
  • Yeast infection in your mouth (thrush)
  • Sores or split skin at the corners of your mouth, or cracked lips
  • Poor nutrition from having problems with chewing and swallowing


Diagnosis


To determine the cause of your dry mouth, your doctor likely will review your medical history and all medications you're taking, including over-the-counter medications, and examine your mouth.

Sometimes you may need blood tests, imaging scans of your salivary glands or tests that measure how much saliva you produce to identify the cause of your dry mouth. If your doctor suspects your dry mouth is caused by Sjogren's syndrome, a small sample of cells (biopsy) taken from salivary glands in your lip may be sent for testing.

Treatment


Your treatment depends on the cause of your dry mouth. Your doctor or dentist may:


  • Change medications that cause dry mouth. If your doctor believes medication to be the cause, he or she may adjust your dosage or switch you to another medication that doesn't cause a dry mouth.
  • Recommend products to moisturize your mouth. These can include prescription or over-the-counter mouth rinses, artificial saliva or moisturizers to lubricate your mouth. Mouthwashes designed for dry mouth, especially ones with xylitol, can be effective, such as Biotene Dry Mouth Oral Rinse or Act Dry Mouth Mouthwash, which also offer protection against tooth decay.
  • If you have severe dry mouth, your doctor or dentist may:
  • Prescribe medication that stimulates saliva. Your doctor may prescribe pilocarpine (Salagen) or cevimeline (Evoxac) to stimulate saliva production.
  • Protect your teeth. To prevent cavities, your dentist might fit you for fluoride trays, which you fill with fluoride and wear over your teeth at night. Your dentist may also recommend weekly use of a chlorhexidine rinse to control cavities.


Lifestyle and home remedies


In addition to the advice from your doctor, these tips may help relieve your dry mouth symptoms:


  • Sip water or sugar-free drinks or suck ice chips throughout the day to moisten your mouth, and drink water during meals to aid chewing and swallowing.
  • Chew sugar-free gum or suck on sugar-free hard candies. Products that contain xylitol may also help prevent cavities. However, in some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause gas or diarrhea if consumed in large amounts.
  • Try over-the-counter saliva substitutes that contain xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or that contain carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene OralBalance Moisturizing Gel.
  • Breathe through your nose, not your mouth. You may need to seek treatment for snoring if it causes you to breathe through your mouth during the night.
  • Add moisture to the air at night with a room humidifier.
  • Moisturize your lips to soothe dry or cracked areas.


Avoid products that can make your symptoms worse. These include:


  • Caffeine and alcohol. These products can cause dryness and irritation. Don't use a mouthwash that contains alcohol.
  • All tobacco. If you smoke or chew tobacco, stop, because tobacco products can dry and irritate your mouth.
  • Over-the-counter antihistamines and decongestants. These can worsen your dry mouth.
  • Sugary or acidic foods and candies. These increase the risk of tooth decay. Also avoid spicy or salty food because they can cause irritation.


Saliva is important to maintain the health of your teeth and mouth. Taking these steps to protect your teeth may also help your dry mouth condition:


  • Brush with a fluoride toothpaste and floss your teeth. Ask your dentist if you might benefit from prescription fluoride toothpaste, toothpaste containing betaine, or a tooth gel to neutralize bacteria acids.
  • Use a fluoride rinse or brush-on fluoride gel before bedtime.
  • See your dentist at least twice yearly to have your teeth examined and plaque removed, to help prevent tooth decay.

Metabolic syndrome

Metabolic Syndrome

Overview

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

Having just one of these conditions doesn't mean you have metabolic syndrome. But it does mean you have a greater risk of serious disease. And if you develop more of these conditions, your risk of complications, such as type 2 diabetes and heart disease, rises even higher.


Metabolic syndrome is increasingly common, and up to one-third of U.S. adults have it. If you have metabolic syndrome or any of its components, aggressive lifestyle changes can delay or even prevent the development of serious health problems.

Symptoms


Most of the disorders associated with metabolic syndrome don't have obvious signs or symptoms. One sign that is visible is a large waist circumference. And if your blood sugar is high, you might notice the signs and symptoms of diabetes — such as increased thirst and urination, fatigue, and blurred vision.

Causes


Metabolic syndrome is closely linked to overweight or obesity and inactivity.


It's also linked to a condition called insulin resistance. Normally, your digestive system breaks down the foods you eat into sugar. Insulin is a hormone made by your pancreas that helps sugar enter your cells to be used as fuel.

In people with insulin resistance, cells don't respond normally to insulin and glucose can't enter the cells as easily. As a result, your blood sugar levels rise even as your body churns out more and more insulin to try to lower your blood sugar.


Risk factors

The following factors increase your chances of having metabolic syndrome:


  • Age. Your risk of metabolic syndrome increases with age.
  • Ethnicity. In the United States, Hispanics— especially Hispanic women — appear to be at the greatest risk of developing metabolic syndrome.
  • Obesity. Carrying too much weight, especially in your abdomen, increases your risk of metabolic syndrome.
  • Diabetes. You're more likely to have metabolic syndrome if you had diabetes during pregnancy (gestational diabetes) or if you have a family history of type 2 diabetes.
  • Other diseases. Your risk of metabolic syndrome is higher if you've ever had nonalcoholic fatty liver disease, polycystic ovary syndrome or sleep apnea.


Complications


Having metabolic syndrome can increase your risk of developing:

Type 2 diabetes. If you don't make lifestyle changes to control your excess weight, you may develop insulin resistance, which can cause your blood sugar levels to rise. Eventually, insulin resistance can lead to type 2 diabetes.

Heart and blood vessel disease. High cholesterol and high blood pressure can contribute to the buildup of plaques in your arteries. These plaques can narrow and harden your arteries, which can lead to a heart attack or stroke.

Prevention


A lifelong commitment to a healthy lifestyle may prevent the conditions that cause metabolic syndrome. A healthy lifestyle includes:


  • Getting at least 30 minutes of physical activity most days
  • Eating plenty of vegetables, fruits, lean protein and whole grains
  • Limiting saturated fat and salt in your diet
  • Maintaining a healthy weight
  • Not smoking


Diagnosis


The National Institutes of Health guidelines define metabolic syndrome as having three or more of the following traits, including traits you're taking medication to control:


  • Large waist — A waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men
  • High triglyceride level — 150 milligrams per deciliter (mg/dL), or 1.7 millimoles per liter (mmol/L), or higher of this type of fat found in blood
  • Reduced "good" or HDL cholesterol — Less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of high-density lipoprotein (HDL) cholesterol
  • Increased blood pressure — 130/85 millimeters of mercury (mm Hg) or higher
  • Elevated fasting blood sugar — 100 mg/dL (5.6 mmol/L) or higher


Treatment


If aggressive lifestyle changes such as diet and exercise aren't enough, your doctor might suggest medications to help control your blood pressure, cholesterol, and blood sugar levels.


Lifestyle and home remedies


If you've been diagnosed with metabolic syndrome or any of its components, making healthy lifestyle changes can help prevent or delay serious health problems, such a heart attack or stroke. A healthy lifestyle includes:

Regular physical activity

Health experts recommend getting at least 30 minutes of exercise, such as brisk walking, daily. But you don't have to do that activity all at once. Look for ways to increase activity any chance you get, such as walking instead of driving and using the stairs instead of an elevator.

Weight loss

Losing 7 to 10 percent of your body weight can reduce insulin resistance and blood pressure and decrease your risk of diabetes. It's also important to maintain your weight loss. If you're struggling with taking off weight and keeping it off, talk to your doctor about what options might be available to help you, such as medications or weight-loss surgery.

Healthy diet

Healthy-eating plans, such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet, emphasize eating:


  • Vegetables
  • Fruits
  • High-fiber whole grains
  • Lean protein
And healthy-eating plans tend to recommend limiting:
  • Sugar-sweetened beverages
  • Alcohol
  • Salt
  • Sugar
  • Fat, especially saturated fat and trans fat
  • Stopping smoking


Giving up cigarettes greatly improves your overall health. Talk to your doctor if you need help quitting.

Reducing or managing stress


Physical activity, meditation, yoga and other programs can help you handle stress and improve your emotional and physical health.

Autoimmune hepatitis

Autoimmune Hepatitis

Overview


Autoimmune hepatitis is liver inflammation that occurs when your body's immune system turns against liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and enviromental factors appear to interact over time in triggering the disease.

Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.

A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or in cases of advanced liver disease.

Symptoms


Signs and symptoms of autoimmune hepatitis vary from person to person and may come on suddenly. Some people have few, if any, recognized problems in the early stages of the disease, whereas others experience signs and symptoms that may include:

  • Fatigue
  • Abdominal discomfort
  • Yellowing of the skin and whites of the eyes (jaundice)
  • An enlarged liver
  • Abnormal blood vessels on the skin (spider angiomas)
  • Skin rashes
  • Joint pains
  • Loss of menstrual periods



Causes


Autoimmune hepatitis occurs when the body's immune system, which ordinarily attacks viruses, bacteria and other pathogens, instead targets the liver. This attack on your liver can lead to chronic inflammation and serious damage to liver cells. Just why the body turns against itself is unclear, but researchers think autoimmune hepatitis could be caused by the interaction of genes controlling immune system function and exposure to particular viruses or drugs.

Types of autoimmune hepatitis


Doctors have identified two main forms of autoimmune hepatitis.
Type 1 autoimmune hepatitis. This is the most common type of the disease. It can occur at any age. About half the people with type 1 autoimmune hepatitis have other autoimmune disorders, such as celiac disease, rheumatoid arthritis or ulcerative colitis.

Type 2 autoimmune hepatitis. Although adults can develop type 2 autoimmune hepatitis, it's most common in children and young people. Other autoimmune diseases may accompany this type of autoimmune hepatitis.

Risk factors

Factors that may increase your risk of autoimmune hepatitis include:

  • Being female. Although both males and females can develop autoimmune hepatitis, the disease is more common in females.
  • A history of certain infections. Autoimmune hepatitis may develop after you're infected with the measles, herpes simplex or Epstein-Barr virus. The disease is also linked to hepatitis A, B or C infection.
  • Heredity. Evidence suggests that a predisposition to autoimmune hepatitis may run in families.
  • Having an autoimmune disease. People who already have an autoimmune disease, such as celiac disease, rheumatoid arthritis or hyperthyroidism (Graves' disease or Hashimoto's thyroiditis), may be more likely to develop autoimmune hepatitis.

Complications


Autoimmune hepatitis that goes untreated can cause permanent scarring of the liver tissue (cirrhosis). Complications of cirrhosis include:

  • Enlarged veins in your esophagus (esophageal varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels — mainly those in your stomach and esophagus. The blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the esophagus or stomach from these blood vessels is a life-threatening emergency that requires immediate medical care.
  • Fluid in your abdomen (ascites). Liver disease can cause large amounts of fluid to accumulate in your abdomen. Ascites can be uncomfortable and may interfere with breathing and is usually a sign of advanced cirrhosis.
  • Liver failure. This occurs when extensive damage to liver cells makes it impossible for your liver to function adequately. At this point, a liver transplant is needed.
  • Liver cancer. People with cirrhosis have an increased risk of liver cancer.


Diagnosis


Tests and procedures used to diagnose autoimmune hepatitis include:

  • Blood tests. Testing a sample of your blood for antibodies can distinguish autoimmune hepatitis from viral hepatitis and other conditions with similar symptoms. Antibody tests also help pinpoint the type of autoimmune hepatitis you have.
  • Liver biopsy. Doctors perform a liver biopsy to confirm the diagnosis and to determine the degree and type of liver damage. During the procedure, a small amount of liver tissue is removed, using a thin needle that's passed into your liver through a small incision in your skin. The sample is then sent to a laboratory for analysis.

Treatment


Regardless of which type of autoimmune hepatitis you have, the goal of treatment is to slow or stop the immune system attack on your liver. This may help slow the progression of the disease. To meet this goal, you'll need medications that lower immune system activity. The initial treatment is usually prednisone. A second medication, azathioprine (Azasan, Imuran), may be recommended in addition to prednisone.

Prednisone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, thinning bones (osteoporosis), broken bones (osteonecrosis), high blood pressure, cataracts, glaucoma and weight gain.

Doctors typically prescribe prednisone at a high dose for about the first month of treatment. Then, to reduce the risk of side effects, they gradually reduce the dose over the next several months until reaching the lowest possible dose that controls the disease. Adding azathioprine also helps you avoid prednisone side effects.

Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued. Depending on your situation, you may require lifelong treatment.

Liver transplant


When medications don't halt the progress of the disease or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.

During a liver transplant, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a portion of a healthy liver from a living donor. Both livers begin regenerating new cells almost immediately.

Spinal cord injury

Spinal Cord Injury | Types of Spinal Cord Injuries

Overview


A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) — often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you've recently experienced a spinal cord injury, it might seem like every aspect of your life has been affected. You might feel the effects of your injury mentally, emotionally and socially.


Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with spinal cord injuries to lead productive, independent lives.


Your ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest normal part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called "the completeness" and is classified as either of the following:
Complete. If all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, your injury is called complete.
Incomplete. If you have some motor or sensory function below the affected area, your injury is called incomplete. There are varying degrees of incomplete injury.

Additionally, paralysis from a spinal cord injury may be referred to as:

  1. Tetraplegia. Also known as quadriplegia, this means that your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury.
  2. Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.


Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Signs and Symptoms


Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

  • Loss of movement
  • Loss or altered sensation, including the ability to feel heat, cold and touch
  • Loss of bowel or bladder control
  • Exaggerated reflex activities or spasms
  • Changes in sexual function, sexual sensitivity and fertility
  • Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
  • Difficulty breathing, coughing or clearing secretions from your lungs

Emergency signs and symptoms


Emergency signs and symptoms of a spinal cord injury after an accident may include:

  • Extreme back pain or pressure in your neck, head or back
  • Weakness, incoordination or paralysis in any part of your body
  • Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
  • Loss of bladder or bowel control
  • Difficulty with balance and walking
  • Impaired breathing after injury
  • An oddly positioned or twisted neck or back

When to see a doctor

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proved otherwise because:

  • A serious spinal injury isn't always immediately obvious. If it isn't recognized, a more severe injury may occur.
  • Numbness or paralysis may occur immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord.
  • The time between injury and treatment can be critical in determining the extent and severity of complications and the possible extent of expected recovery.


If you suspect that someone has a back or neck injury:

  • Don't move the injured person — permanent paralysis and other serious complications may result
  • Call your local emergency medical assistance number
  • Keep the person still
  • Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
  • Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck



Spinal cord injuries may result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It may also result from a gunshot or knife wound that penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.

Your brain and central nervous system


The central nervous system consists of the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between your brain and the rest of your body. Motor tracts carry signals from your brain to control muscle movement. Sensory tracts carry signals from body parts to your brain relating to heat, cold, pressure, pain and the position of your limbs.

Damage to nerve fibers


Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site.

A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. A neck (cervical) injury affects the same areas in addition to affecting movements of your arms and, possibly, your ability to breathe.
Common causes of spinal cord injuries

The most common causes of spinal cord injuries in the United States are:

  • Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost half of new spinal cord injuries each year.
  • Falls. A spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause about 31% of spinal cord injuries.
  • Acts of violence. Over 13% of spinal cord injuries result from violent encounters, most commonly involving gunshot wounds. Knife wounds also are common.
  • Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10% of spinal cord injuries.
  • Alcohol. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
  • Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.

Risk factors


Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:
Being male. Spinal cord injuries affect a disproportionate number of men. In fact, females account for only about 20% of traumatic spinal cord injuries in the United States.
Being between the ages of 16 and 30. You're most likely to suffer a traumatic spinal cord injury if you're between the ages of 16 and 30. The average age at time of injury is 43 years.
Being older than 65. Falls cause most injuries in older adults.
Engaging in risky behavior. Diving into too-shallow water or playing sports without wearing the proper safety gear or taking proper precautions can lead to spinal cord injuries. Motor vehicle crashes are the leading cause of spinal cord injuries for people under 65.
Having a bone or joint disorder. A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your bones or joints, such as arthritis or osteoporosis.

Complications


At first, changes in the way your body functions may be overwhelming. However, your rehabilitation team will help you develop the tools you need to address the changes caused by the spinal cord injury, in addition to recommending equipment and resources to promote quality of life and independence. Areas often affected include:


Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may not be able to control your bladder as well because the message carrier (the spinal cord) has been injured.

The changes in bladder control increase your risk of urinary tract infections. The changes may also cause kidney infections and kidney or bladder stones. During rehabilitation, you'll learn new techniques to help empty your bladder.
Bowel control. Although your stomach and intestines work much like they did before your injury, control of your bowel movements is often altered. A high-fiber diet may help regulate your bowels, and you'll learn techniques to optimize your bowel function during rehabilitation.


Skin sensation. Below the neurological level of your injury, you may have lost part of or all skin sensations. Therefore, your skin can't send a message to your brain when it's injured by certain things such as prolonged pressure, heat or cold.

This can make you more susceptible to pressure sores, but changing positions frequently — with help, if needed — can help prevent these sores. You'll learn proper skin care during rehabilitation, which can help you avoid these problems.


Circulatory control. A spinal cord injury may cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes may also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to address these problems if they affect you.


Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen.

Your neurological level of injury will determine what kind of breathing problems you may have. If you have a cervical and thoracic spinal cord injury, you may have an increased risk of pneumonia or other lung problems. Medications and therapy can help prevent and treat these problems.
Muscle tone. Some people with spinal cord injuries experience one of two types of muscle tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity).


Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes.

A dietitian can help you eat a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.

Sexual health. Sexuality, fertility and sexual function may be affected by a spinal cord injury. Men may notice changes in erection and ejaculation; women may notice changes in lubrication. Physicians specializing in urology or fertility can offer options for sexual functioning and fertility.

Pain. Some people experience pain, such as muscle or joint pain, from overuse of particular muscle groups. Nerve pain can occur after a spinal cord injury, especially in someone with an incomplete injury.

Depression.Coping with all the changes a spinal cord injury brings and living with pain causes some people to experience depression.

Prevention


Following this advice may reduce your risk of a spinal cord injury:



  • Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car.

  • Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.
  • Check water depth before diving. To make sure you don't dive into shallow water, don't dive into a pool unless it's 12 feet (about 3.7 meters) or deeper, don't dive into an aboveground pool, and don't dive into any water of which you don't know the depth.
  • Prevent falls. Use a step stool with a grab bar to reach objects in high places. Add handrails along stairways. Put nonslip mats on tile floors and in the tub or shower. For young children, use safety gates to block stairs and consider installing window guards.
  • Take precautions when playing sports. Always wear recommended safety gear. Avoid leading with your head in sports. For example, don't slide headfirst in baseball, and don't tackle using the top of your helmet in football. Use a spotter for new moves in gymnastics.
  • Don't drink and drive. Don't drive while intoxicated or under the influence of drugs. Don't ride with a driver who's been drinking




Diagnosis


In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.


These tests may include:

  • X-rays. Medical personnel typically order these tests on people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
  • Computerized tomography (CT) scan. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
  • Magnetic resonance imaging (MRI). MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is very helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord.


A few days after injury, when some of the swelling may have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

Treatment


Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Emergency actions


Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.
Early (acute) stages of treatment

In the emergency room, doctors focus on:

  • Maintaining your ability to breathe
  • Preventing shock
  • Immobilizing your neck to prevent further spinal cord damage
  • Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities


If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

  • Medications. Intravenous (IV) methylprednisolone (Solu-Medrol) has been used as a treatment option for an acute spinal cord injury in the past. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.
  • Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.
  • Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
  • Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, doctors may lower the body temperature significantly — a condition known as hypothermia — for 24 to 48 hours to help prevent damaging inflammation. Ask your doctor about the availability of such treatments.

Ongoing care


After the initial injury or condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

The length of your hospitalization depends on your condition and the medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

Rehabilitation


Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills, and learning adaptive techniques to accomplish day-to-day tasks.

You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life and independence.

You'll be taught many new skills, and you'll use equipment and technologies that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

Medications

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

New technologies


Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

  • Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.
  • Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they're difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.
  • Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
  • Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation systems, and they use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.
  • Robotic gait training. This emerging technology is used for retraining walking ability after a spinal cord injury.

Prognosis and recovery


Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.

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