Alcoholism

Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking. If you have alcoholism, you can't consistently predict how much you'll drink, how long you'll drink, or what consequences will occur from your drinking.

It's possible to have a problem with alcohol, even when it has not progressed to the point of alcoholism. Problem drinking means you drink too much at times, causing repeated problems in your life, although you're not completely dependent on alcohol.

Binge drinking — a pattern of drinking where a male consumes five or more drinks in a row, or a female downs at least four drinks in a row — can lead to the same health risks and social problems associated with alcoholism. The more you drink, the greater the risks. Binge drinking, which often occurs with teenagers and young adults, may lead to faster development of alcoholism.

If you have alcoholism or you have a problem with alcohol, you may not be able to cut back or quit without help. Denying that you have a problem is usually part of alcoholism and other types of excessive drinking.

SYMPTOMS

Alcoholism signs and symptoms include those below. You may:

Be unable to limit the amount of alcohol you drink Feel a strong need or compulsion to drink Develop tolerance to alcohol so that you need more to feel its effects Drink alone or hide your drinking Experience physical withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink Not remember conversations or commitments, sometimes referred to as a \"black out\" Make a ritual of having drinks at certain times and become annoyed when this ritual is disturbed or questioned Be irritable when your usual drinking time nears, especially if alcohol isn't available Keep alcohol in unlikely places at home, at work or in your car Gulp drinks, order doubles or become drunk intentionally to feel good, or drink to feel \"normal\" Have legal problems or problems with relationships, employment or finances due to drinking Lose interest in activities and hobbies that used to bring you pleasure

If you binge drink or have other problems with alcohol, you may have many of the signs and symptoms above, although you may not feel as much of a compulsion to drink compared with someone who has alcoholism. Also, you may not have physical withdrawal symptoms when you don't drink. But this pattern of drinking can still cause serious problems and lead to alcoholism. As with alcoholism, you may not be able to quit problem drinking without help.

What is considered one drink?

One standard drink is:

12 ounces (355 milliliters) of regular beer (about 5 percent alcohol) 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol) 5 ounces (148 milliliters) of wine (about 12 percent alcohol) 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol)

What about my drinking?

If you've ever wondered whether your drinking crosses the line into problem drinking or alcoholism, ask yourself these questions:

If you're a man, do you ever have five or more drinks in a day? If you're a woman, do you ever have four or more drinks in a day? Do you ever need a drink to get you started in the morning? Do you feel guilty about your drinking? Do you think you need to cut back on how much you drink? Are you annoyed when other people comment on or criticize your drinking habits?

If you answered yes to even one of these questions, you may have a problem with alcohol.

If you feel that you sometimes drink too much or your family is concerned about your drinking, talk with your doctor. See your doctor even if you don't think you have alcoholism, but you're concerned about your drinking or it's causing problems in your life. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous.

Because denial is common, you may not feel like you have a problem with drinking or that you need help to stop. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to family members, friends or co-workers when they ask you to examine your drinking habits or to seek help.

CAUSES

Alcoholism is influenced by genetic, psychological, social and environmental factors that have an impact on how it affects your body and behavior.

The process of becoming addicted to alcohol occurs gradually, although some people have an abnormal response to alcohol from the time they start drinking. Over time, drinking too much may change the normal balance of chemicals and nerve tracks in your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in your craving alcohol to restore good feelings or remove negative ones.

Risk factors for alcoholism include:

Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can produce a physical dependence on alcohol. Age. People who begin drinking at an early age are at a higher risk of problem drinking or physical dependence on alcohol. Family history. The risk of alcoholism is higher for people who have a parent or other close relatives who have problems with alcohol. Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression or bipolar disorder to have problems with alcohol or other substances. Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcoholism. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. Mixing medication and alcohol. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or even make them dangerous.

COMPLICATIONS

Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Alcohol lowers your inhibitions and affects your thoughts, emotions and judgment.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death.

If you have problems with alcohol, you're more likely to also have problems with other substances.

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, such as:

Motor vehicle accidents and other types of accidents Domestic problems Poor performance at work or school Increased likelihood of committing violent crimes

Health problems caused by excessive drinking can include:

Liver disease. Heavy drinking can cause alcoholic hepatitis — an inflammation of the liver. After years of heavy drinking, hepatitis may lead to irreversible destruction and scarring of liver tissue (cirrhosis). Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas — which produces hormones that regulate your metabolism and enzymes that help digestion — and lead to inflammation of the pancreas (pancreatitis). Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level. Sexual function and menstruation. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation. Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). Birth defects. Alcohol use during pregnancy may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime. Bone loss. Alcohol may interfere with the production of new bone. This can lead to thinning bones (osteoporosis) and an increased risk of fractures. Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia and short-term memory loss. Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, making you more susceptible to illnesses. Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.

Alcohol use leads to serious consequences for many teens and young adults. In this age group:

Alcohol-related motor vehicle accidents are a major cause of deaths. Alcohol is often a cause in other deaths, including drowning, suicides and homicides. Drinking makes it more likely they'll become sexually active, have sex more frequently, engage in risky, unprotected sex, and become victims of sexual abuse or date rape compared with those who don't drink. Alcohol use can lead to accidental injury, assault and property damage.

DIAGNOSIS

A doctor who suspects you have an alcohol problem will ask you several questions regarding drinking habits and may have you fill out a questionnaire. The doctor may ask for permission to speak with family members or friends. Family members may also contact the doctor on their own to discuss their concerns. However, confidentiality laws prevent your doctor from giving out any information about you without your consent.

There are no specific tests to diagnose alcoholism, but you may need other tests for health problems that may be linked to your alcohol use.

To be diagnosed with alcoholism, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. These include a pattern of alcohol use leading to serious problems, as indicated by three or more of the following at any time during one 12-month period:

Tolerance, indicated by an increase in the amount of alcohol you need to feel drunk (intoxicated). As alcoholism progresses, the amount leading to intoxication can also decrease as a result of damage to your liver or central nervous system. Withdrawal symptoms when you cut down or stop using alcohol. These can include tremors, insomnia, nausea and anxiety. You may drink more alcohol in order to avoid those symptoms, sometimes drinking throughout the day. Drinking more alcohol than you intended or drinking over a longer period of time than you intended. Having an ongoing desire to cut down on how much you drink or making unsuccessful attempts to do so. Spending a good deal of time drinking, getting alcohol or recovering from alcohol use. Giving up important activities, including social, occupational or recreational activities. Continuing to use alcohol even though you know it's causing physical and psychological problems.

TREATMENT

Many people with alcoholism hesitate to get treatment because they don't recognize they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about a friend or family member who drinks too much, talk to a professional for advice on how to approach that person.

Various treatments may help. Depending on the circumstances, treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay.

The first step is to determine if you have a problem with alcohol. If you haven't lost control over your use of alcohol, treatment may involve reducing your drinking. If you have become addicted, simply cutting back is ineffective. Working to stop the use of alcohol to improve quality of life is the main treatment goal.

Treatment for alcoholism may include:

Detoxification and withdrawal. Treatment for alcoholism may begin with a program of detoxification, which generally takes two to seven days. You may need to take sedating medications to prevent shaking, confusion or hallucinations (delirium tremens), or other withdrawal symptoms. Detoxification is usually done at an inpatient treatment center or a hospital. Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcoholism. You may benefit from couples or family therapy — family support can be an important part of the recovery process. Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won't cure alcoholism or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol dependence to use consistently. Continuing support. Aftercare programs and support groups help people recovering from problem drinking or alcoholism to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group such as Alcoholics Anonymous. Treatment for psychological problems. Alcoholism commonly occurs along with other mental health disorders. You may need talk therapy (psychotherapy or psychological counseling), medications, or other treatment for depression, anxiety or another mental health condition, if you have any of these conditions. Medical treatment for other conditions. Common medical problems related to alcoholism include high blood pressure, high blood sugar, liver disease and heart disease. Many alcohol-related health problems improve significantly once you stop drinking. Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcoholism or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.

Residential treatment programs

For a serious alcohol problem, you may need a stay at a residential treatment facility. Many residential treatment programs include individual and group therapy, participation in alcoholism support groups such as Alcoholics Anonymous, educational lectures, family involvement, activity therapy, and working with counselors, professional staff and doctors experienced in treating alcoholism.

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Anxiety

Anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. A person can have more than one anxiety disorder.

Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help.

SYMPTOMS
Common anxiety signs and symptoms include:

Feeling nervous,Feeling powerless,Having a sense of impending danger, panic or doom,Having an increased heart rate, Breathing rapidly (hyperventilation)Sweating,Trembling, Feeling weak or tired, Trouble concentrating or thinking about anything other than the present worry

Several types of anxiety disorders exist:

Separation anxiety disorder is a childhood disorder characterized by anxiety that is excessive for the developmental level and related to separation from parents or others who have parental roles.Selective mutism is a consistent failure to speak in certain situations, such as school, even when you can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, heart palpitations or chest pain.Agoraphobia is anxiety about, and often avoidance of, places or situations where you might feel trapped or helpless if you start to feel panicky or experience embarrassing symptoms, such as losing control.Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is usually out of proportion to the actual circumstance, is difficult to control and interferes with your ability to focus on current tasks. It often occurs along with other anxiety disorders or depression.Substance-induced anxiety disorder is characterized by prominent symptoms of anxiety or panic that are a direct result of abusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.Anxiety disorder due to a medical condition includes prominent symptoms of anxiety or panic that are directly caused by a physical health problem.Specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.
See your doctor if:
You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your lifeYour fear, worry or anxiety is upsetting to youYou feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxietyYou think your anxiety could be linked to a physical health problemYou have suicidal thoughts or behaviors — seek emergency treatment immediately

Your worries may not go away on their own, and they may actually get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It may be easier to treat if you get help early.

CAUSES
As with many mental health conditions, the exact cause of anxiety disorders isn't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to becoming anxious. Inherited traits also can be a factor.

Medical causes

For some people, anxiety is linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order lab tests and other tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart diseaseDiabetesThyroid problems, such as hypothyroidism or hyperthyroidismAsthmaDrug abuse or withdrawalWithdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medicationsIrritable bowel syndromeRare tumors that produce certain \"fight-or-flight\" hormonesPremenstrual syndrome

Sometimes anxiety can be a side effect of certain medications.

It's more likely that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorderYou didn't have an anxiety disorder as a childYou don't avoid certain things or situations because of anxietyYou have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

COMPLICATIONS
Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical health conditions, such as:

Depression (which often occurs with anxiety disorder) Substance abuse Trouble sleeping (insomnia) Digestive or bowel problemsHeadachesSuicide Poor quality of life

DIAGNOSIS
To help diagnose an anxiety disorder and rule out other conditions, your doctor or mental health provider may have you fill out a psychological questionnaire. Your doctor will probably do a physical exam to look for signs that your anxiety might be linked to a medical condition.

To be diagnosed with an anxiety disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Symptoms and diagnostic criteria differ for each type of anxiety disorder. However, they all share the features of excessive fear and problems with functioning as a result. Anxiety disorders often occur along with other mental health problems — such as depression or substance abuse — which can make diagnosis and treatment more challenging.

In cases where anxiety is caused by or occurs with a medical illness, a doctor also performs a physical exam during the initial evaluation. A child and adolescent psychologist and a psychiatrist who specialize in anxiety disorders staff the clinic. This staffing allows for an integrated medical and psychological understanding of your child's symptoms.

TREATMENT
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.

Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.

Medications

Several types of medications are used to treat anxiety disorders, including those below. Talk with your doctor about benefits, risks and possible side effects.

Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat anxiety disorders include fluoxetine (Prozac, Sarafem), imipramine (Tofranil), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and venlafaxine (Effexor XR). Citalopram (Celexa) and escitalopram (Lexapro) also can be effective, but dosages of 40 milligrams (mg) a day of citalopram or 20 mg a day of escitalopram warrant discussion of risks versus benefits. Your doctor also may recommend other antidepressants.Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.Benzodiazepines. In limited circumstances, your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.

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Alzheimer's disease

Alzheimer's disease is a progressive disease that destroys memory and other important mental functions.

It's the most common cause of dementia — a group of brain disorders that results in the loss of intellectual and social skills. These changes are severe enough to interfere with day-to-day life.

In Alzheimer's disease, the brain cells themselves degenerate and die, causing a steady decline in memory and mental function.

Current Alzheimer's disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer's disease maximize function and maintain independence.

But because there's no cure for Alzheimer's disease, it's important to seek supportive services and tap into your support network as early as possible.

SYMPTOMS
At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person.

If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

Memory

Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:

Repeat statements and questions over and over, not realizing that they've asked the question beforeForget conversations, appointments or events, and not remember them laterRoutinely misplace possessions, often putting them in illogical locationsEventually forget the names of family members and everyday objects

Disorientation and misinterpreting spatial relationships

People with Alzheimer's disease may lose their sense of what day it is, the season, where they are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.

Speaking and writing

Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Thinking and reasoning

Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.

Making judgments and decisions

Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

Planning and performing familiar tasks

Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior

Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

DepressionAnxietySocial withdrawalMood swingsDistrust in othersIrritability and aggressivenessChanges in sleeping habitsWanderingLoss of inhibitionsDelusions, such as believing something has been stolen

Many important skills are not lost until very late in the disease. These include the ability to read, dance and sing, enjoy old music, engage in crafts and hobbies, tell stories, and reminisce.

This is because information, skills and habits learned early in life are among the last abilities to be lost as the disease progresses. Capitalizing on these abilities can allow you to continue to have successes and maintain a high quality of life even when you are into the moderate phase of the disease.

CAUSES
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease.

Although the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear. Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.

As more and more brain cells die, Alzheimer's leads to significant brain shrinkage. When doctors examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:

Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of brain-cell death in Alzheimer's isn't known, the collection of beta-amyloid on the outside of brain cells is a prime suspect.

Tangles. Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau.

In Alzheimer's, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also strongly implicated in the decline and death of brain cells.

Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not a part of normal aging, but your risk increases greatly after you reach age 65. Nearly half of those older than age 85 have Alzheimer's.

People with rare genetic changes that virtually guarantee they'll develop Alzheimer's begin experiencing symptoms as early as their 30s.

Family history and genetics

Your risk of developing Alzheimer's appears to be somewhat higher if a first-degree relative — your parent or sibling — has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer's. But these mutations account for less than 5 percent of Alzheimer's disease.

Most genetic mechanisms of Alzheimer's among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APOE e4). Other risk genes have been identified but not conclusively confirmed.

Sex

Women may be more likely than are men to develop Alzheimer's disease, in part because they live longer.

Mild cognitive impairment

People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia.

Those with MCI have an increased risk — but not a certainty — of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.

Past head trauma

People who've had a severe head trauma or repeated head trauma appear to have a greater risk of Alzheimer's disease.

Lifestyle and heart health

There's no lifestyle factor that's been conclusively shown to reduce your risk of Alzheimer's disease.

However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you'll develop Alzheimer's. Examples include:

Lack of exerciseSmokingHigh blood pressureHigh blood cholesterolElevated homocysteine levelsPoorly controlled diabetesA diet lacking in fruits and vegetables

These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart — and may also help reduce your risk of Alzheimer's disease and vascular dementia.

Lifelong learning and social engagement

Studies have found an association between lifelong involvement in mentally and socially stimulating activities and reduced risk of Alzheimer's disease.

Factors that may reduce your risk of Alzheimer's include:

Higher levels of formal educationA stimulating jobMentally challenging leisure activities, such as reading, playing games or playing a musical instrumentFrequent social interactions

Scientists can't yet explain this link. One theory is that using your brain develops more cell-to-cell connections, which protects your brain against the impact of Alzheimer-related changes.

COMPLICATIONS
Memory and language loss, impaired judgment, and other cognitive changes caused by Alzheimer's can complicate treatment for other health conditions. A person with Alzheimer's disease may not be able to:

Communicate that he or she is experiencing pain — for example, from a dental problemReport symptoms of another illnessFollow a prescribed treatment planNotice or describe medication side effects

As Alzheimer's disease progresses to its last stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:

Pneumonia and other infections. Difficulty swallowing may cause people with Alzheimer's to inhale (aspirate) food or liquid into their airways and lungs, which can lead to pneumonia.

Inability to control emptying of the bladder (urinary incontinence) may require placement of a tube to drain and collect urine (urinary catheter). Having a catheter increases your risk of urinary tract infections, which can lead to more-serious, life-threatening infections.

Injuries from falls. People with Alzheimer's become increasingly vulnerable to falling. Falls can lead to fractures. In addition, falls are a common cause of serious head injuries.

DIAGNOSIS
There's no specific test today that confirms you have Alzheimer's disease. Your doctor will make a judgment about whether Alzheimer's is the most likely cause of your symptoms based on the information you provide and results of various tests that can help clarify the diagnosis.

Doctors can nearly always determine whether you have dementia, and they can often identify whether your dementia is due to Alzheimer's disease. Alzheimer's disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals the characteristic plaques and tangles.

To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely on the following types of tests.

Physical and neurological exam

Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:

ReflexesMuscle tone and strength Ability to get up from a chair and walk across the roomSense of sight and hearingCoordinationBalance

Lab tests

Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.

Mental status testing

Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. Short forms of mental status testing can be done in about 10 minutes.

Neuropsychological testing

Your doctor may recommend a more extensive assessment of your thinking and memory. Longer forms of neuropsychological testing, which can take several hours to complete, may provide additional details about your mental function compared with others' of a similar age and education level.

This type of testing may be especially helpful if your doctor thinks you may have a very early stage of Alzheimer's disease or another dementia. These tests may also help identify patterns of change associated with different types of dementia and can help doctors estimate your ability to safely manage important activities, such as financial and medical decision-making.

Brain imaging

Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer's.

Brain-imaging technologies include:

Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images. MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise.

MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer's disease has occurred.

Computerized tomography (CT). For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images (slices) of your brain. It's currently used chiefly to rule out tumors, strokes and head injuries.

Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a low-level radioactive tracer. You'll lie on a table while an overhead scanner tracks the tracer's flow through your brain.

The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions. This can show which parts of your brain aren't functioning well. New PET techniques may be able to detect your brain level of plaques and tangles, the two hallmark abnormalities linked to Alzheimer's.

Future diagnostic tests

Researchers are working with doctors to develop new diagnostic tools to help definitively diagnose Alzheimer's. Another important goal is to detect the disease before it causes the symptoms targeted by current diagnostic techniques — at the stage when Alzheimer's may be most treatable as new drugs are discovered. This stage is called preclinical Alzheimer's disease.

New tools under investigation include:

Additional approaches to brain imagingMore-sensitive tests of mental abilitiesMeasurement of key proteins or protein patterns in blood or spinal fluid (biomarkers)

TREATMENT
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:

Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell communication chemical depleted in the brain by Alzheimer's disease. Most people can expect to keep their current symptoms at bay for a time.

Less than half of those taking these drugs can expect to have any improvement. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances.

Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease. It's sometimes used in combination with a cholinesterase inhibitor.

Creating a safe and supportive environment

Adapting the living situation to the needs of a person with Alzheimer's is an important part of any treatment plan. For someone with Alzheimer's, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.

You can take these steps to support a person's sense of well-being and continued ability to function:

Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don't become lost.See if your doctor can simplify your medication regimen to once-daily dosing, and arrange for your finances to be on automatic payment and automatic deposit.Develop the habit of carrying a mobile phone with location capability so that you can call in case you are lost or confused and people can track your location via the phone. Also, program important phone numbers into your phone, so you don't have to try to recall them.Make sure regular appointments are on the same day at the same time as much as possible.Use a calendar or white board in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed.Remove excess furniture, clutter and throw rugs.Install sturdy handrails on stairways and in bathrooms.Ensure that shoes and slippers are comfortable and provide good traction.Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing or frightening.

Exercise

Regular exercise is an important part of everybody's wellness plan — and those with Alzheimer's are no exception. Activities such as a daily 30-minute walk can help improve mood and maintain the health of your joints, muscles and heart.

Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer's carries identification if she or he walks unaccompanied.

People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.

Nutrition

People with Alzheimer's may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.

Offer:

High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders (available at grocery stores, drugstores and discount retailers) or use your blender to make smoothies featuring your favorite ingredients.Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer's drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger frequent need to urinate.

Certain nutritional supplements are marketed as \"medical foods\" specifically to treat Alzheimer's disease. The Food and Drug Administration (FDA) does not approve products marketed as medical foods. Despite marketing claims, there's no definitive data showing that any of these supplements is beneficial or safe.

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Amnesia

Amnesia refers to the loss of memories, such as facts, information and experiences. Though having no sense of who you are is a common plot device in movies and television, real-life amnesia generally doesn't cause a loss of self-identity.

Instead, people with amnesia — also called amnestic syndrome — are usually lucid and know who they are, but may have trouble learning new information and forming new memories.

Amnesia can be caused by damage to areas of the brain that are vital for memory processing. Unlike a temporary episode of memory loss (transient global amnesia), amnesia can be permanent.
There's no specific treatment for amnesia, but techniques for enhancing memory and psychological support can help people with amnesia and their families cope.

SYMPTOMS
The two main features of amnesia are:

Impaired ability to learn new information following the onset of amnesia (anterograde amnesia) Impaired ability to recall past events and previously familiar information (retrograde amnesia)

Most people with amnesia have problems with short-term memory — they can't retain new information. Recent memories are most likely to be lost, while more remote or deeply ingrained memories may be spared. Someone may recall experiences from childhood or know the names of past presidents, but not be able to name the current president or remember what month it is or what was for breakfast.

Isolated memory loss doesn't affect a person's intelligence, general knowledge, awareness, attention span, judgment, personality or identity. People with amnesia usually can understand written and spoken words and can learn skills such as bike riding or piano playing. They also may understand they have a memory disorder.

Amnesia isn't the same as dementia. Dementia often includes memory loss, but it also involves other significant cognitive problems that lead to a decline in the ability to carry out daily activities. A pattern of forgetfulness is also a common symptom of mild cognitive impairment (MCI), but the memory and other cognitive problems in MCI aren't as severe as those experienced in dementia.

Additional signs and symptoms

Depending on the cause of the amnesia, other signs and symptoms may include:

False recollections (confabulation), either completely invented or made up of genuine memories misplaced in time Neurological problems such as uncoordinated movements, tremors or seizures Confusion or disorientation

Anyone who experiences unexplained memory loss, head injury, confusion or disorientation requires immediate medical attention. A person with amnesia may not be able to identify his or her location or have the presence of mind to seek medical care. If someone you know has symptoms of amnesia, help the person get medical attention.

CAUSES
Normal memory function involves many parts of the brain, and any disease or injury that affects the brain can interfere with the intricacies of memory. Amnesia can result from damage to brain structures that form the limbic system, which controls your emotions and memories. These structures include the thalamus, which lies deep within the center of your brain, and the hippocampal formations, which are situated within the temporal lobes of your brain.

Amnesia caused by brain injury or damage is known as neurological or organic amnesia. Possible causes of neurological amnesia include:

Stroke Brain inflammation (encephalitis) resulting from infection with a virus such as herpes simplex virus or as an autoimmune reaction to cancer somewhere else in the body (paraneoplastic limbic encephalitis) Lack of adequate oxygen in the brain (for example, from heart attack, respiratory distress or carbon monoxide poisoning) Long-term alcohol abuse leading to thiamin (vitamin B-1) deficiency (Wernicke-Korsakoff syndrome) Tumors in areas of the brain that control memory Degenerative brain diseases, such as Alzheimer's disease and other forms of dementia Seizures Electroconvulsive therapy, a procedure in which electrical currents are passed through the brain, sometimes used to treat certain mental illnesses Certain medications, such as benzodiazepines

Head injuries, such as those sustained in car accidents, can lead to confusion and problems remembering new information, especially in the early stages of recovery — but usually don't cause severe amnesia.

Another rare type of amnesia, called psychogenic or dissociative amnesia, stems from emotional shock or trauma, such as being the victim of a violent crime. In this disorder, a person may lose personal memories and autobiographical information, usually only briefly.


COMPLICATIONS
Amnesia varies in severity and scope, but even mild amnesia takes a toll on daily activities and quality of life. The syndrome can cause problems at work, at school and in social settings. It may not be possible to recover lost memories. Some people with severe memory problems need to live in a supervised situation or extended care facility.

DIAGNOSIS
To diagnose amnesia, a doctor will do a comprehensive evaluation to rule out other possible causes of memory loss, such as Alzheimer's disease, other forms of dementia, depression or brain tumor.

Medical history

The evaluation starts with a detailed medical history. Because the person with memory loss may not be able to provide thorough information, a family member, friend or another caregiver generally takes part in the interview as well.

The doctor will ask many questions to understand the memory loss. Issues that might be addressed include:

Type of memory loss (can the person remember recent events and remote events?) When the memory problems started and how they progressed Triggering factors, such as head injury, stroke or surgery Family history, especially of neurological disease Drug and alcohol use Other signs and symptoms, such as confusion, language problems, personality changes or impaired ability to care for self History of seizures, headaches, depression or cancer

Physical exam

The physical examination may include a neurological exam to check reflexes, sensory function, balance, and other physiological aspects of the brain and nervous system.

Cognitive tests

The doctor will test the person's thinking, judgment, and recent and long-term memory. He or she will check the person's knowledge of general information — such as the name of the current president — as well as personal information and past events. The memory evaluation can help determine the extent of memory loss and provide insights about what kind of help the person may need.

Imaging tests

Diagnostic imaging tests — including MRI, CT scan and electroencephalogram — may be ordered to look for damage or abnormalities in the brain. Blood tests can check for infection, nutritional deficiencies or other issues.

TREATMENT
Treatment for amnesia focuses on techniques and strategies to help make up for the memory problem.
Occupational therapy
A person with amnesia may work with an occupational therapist to learn new information to replace what was lost, or to use intact memories as a basis for taking in new information. Memory training may also include a variety of strategies for organizing information so that it's easier to remember and for improving understanding of extended conversation.

Technological assistance

Many people with amnesia find it helpful to use a PDA, such as a Palm Treo, BlackBerry or iPhone. With some training and practice, even people with severe amnesia can use these electronic organizers to help with day-to-day tasks. For example, they can program the PDA to remind them about important events or to take medications.

Low-tech memory aids include notebooks, wall calendars, pill minders and photographs of people and places.

Medications or supplements

No medications are currently available for treating most types of amnesia. Because Wernicke-Korsakoff syndrome involves a lack of thiamin, treatment includes replacing this vitamin and providing proper nutrition. Although treatment, which also needs to include alcohol abstinence, can help prevent further damage, most people won't recover all of their lost memory.

Researchers are investigating several neurotransmitters involved in memory formation, which may one day lead to new treatments for memory disorders. But the complexity of the brain processes involved makes it unlikely that a single medication will be able to resolve memory problems.

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Amenorrhea

Amenorrhea is the absence of menstruation — one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven't begun menstruation by age 15.

The most common cause of amenorrhea is pregnancy. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Treatment of the underlying condition often resolves amenorrhea.

SYMPTOMS
The main sign of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as:

Milky nipple dischargeHair lossHeadacheVision changesExcess facial hairPelvic painAcne

When to see a doctor

Consult your doctor if you've missed at least three menstrual periods in a row, or if you've never had a menstrual period and you're age 15 or older.

CAUSES
Amenorrhea can occur for a variety of reasons. Some are normal during the course of a woman's life, while others may be a side effect of medication or a sign of a medical problem.

Natural amenorrhea

During the normal course of your life, you may experience amenorrhea for natural reasons, such as:

Pregnancy Breast-feeding Menopause

Contraceptives

Some women who take birth control pills may not have periods. Even after stopping oral contraceptives, it may take some time before regular ovulation and menstruation return. Contraceptives that are injected or implanted also may cause amenorrhea, as can some types of intrauterine devices.

Medications

Certain medications can cause menstrual periods to stop, including some types of:

Antipsychotics Cancer chemotherapy Antidepressants Blood pressure drugs Allergy medications

Lifestyle factors

Sometimes lifestyle factors contribute to amenorrhea, for instance:

Low body weight. Excessively low body weight — about 10 percent under normal weight — interrupts many hormonal functions in your body, potentially halting ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes. Excessive exercise. Women who participate in activities that require rigorous training, such as ballet, may find their menstrual cycles interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress and high energy expenditure. Stress. Mental stress can temporarily alter the functioning of your hypothalamus — an area of your brain that controls the hormones that regulate your menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually resume after your stress decreases.

Hormonal imbalance

Many types of medical problems can cause hormonal imbalance, including:

Polycystic ovary syndrome (PCOS). PCOS causes relatively high and sustained levels of hormones, rather than the fluctuating levels seen in the normal menstrual cycle. Thyroid malfunction. An overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea. Pituitary tumor. A noncancerous (benign) tumor in your pituitary gland can interfere with the hormonal regulation of menstruation. Premature menopause. Menopause usually begins around age 50. But, for some women, the ovarian supply of eggs diminishes before age 40, and menstruation stops.

Structural problems

Problems with the sexual organs themselves also can cause amenorrhea. Examples include:

Uterine scarring. Asherman's syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after a dilation and curettage (D&C), cesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining. Lack of reproductive organs. Sometimes problems arise during fetal development that lead to a girl being born without some major part of her reproductive system, such as her uterus, cervix or vagina. Because her reproductive system didn't develop normally, she can't have menstrual cycles. Structural abnormality of the vagina. An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix.

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Transcript

Ovulation is the release of an egg from one of the ovaries. It often happens about midway through the menstrual cycle, although the exact timing may vary.

In preparation for ovulation, the lining of the uterus, or endometrium, thickens.

The pituitary gland in the brain stimulates one of the ovaries to release an egg.

The wall of the ovarian follicle ruptures at the surface of the ovary. The egg is released.

Finger-like structures called fimbriae sweep the egg into the neighboring fallopian tube.

The egg travels through the fallopian tube, propelled in part by contractions in the fallopian tube walls.

Here in the fallopian tube, the egg may be fertilized by a sperm.

If the egg is fertilized, the egg and sperm unite to form a one-celled entity called a zygote.

As the zygote travels down the fallopian tube toward the uterus, it begins dividing rapidly to form a cluster of cells resembling a tiny raspberry.

When the zygote reaches the uterus, it implants in the lining of the uterus and pregnancy begins.

If the egg isn't fertilized, it's simply reabsorbed by the body — perhaps before it even reaches the uterus. About two weeks later, the lining of the uterus sheds through the vagina. This is known as menstruation.
Factors that may increase your risk of amenorrhea may include:

Family history. If other women in your family have experienced amenorrhea, you may have inherited a predisposition for the problem.Eating disorders. If you have an eating disorder, such as anorexia or bulimia, you are at higher risk of developing amenorrhea.Athletic training. Rigorous athletic training can increase your risk of amenorrhea.

COMPLICATIONS
Complications of amenorrhea may include:

Infertility. If you don't ovulate and have menstrual periods, you can't become pregnant.Osteoporosis. If your amenorrhea is caused by low estrogen levels, you may also be at risk of osteoporosis — a weakening of your bones.

DIAGNOSIS
During your appointment, your doctor will perform a pelvic exam to check for any problems with your reproductive organs. If you've never had a period, your doctor may examine your breasts and genitals to see if you're experiencing the normal changes of puberty.

Amenorrhea can be a sign of a complex set of hormonal problems. Finding the underlying cause can take time and may require more than one kind of testing.

Lab tests

A variety of blood tests may be necessary, including:

Pregnancy test. This will probably be the first test your doctor suggests, to rule out or confirm a possible pregnancy.Thyroid function test. Measuring the amount of thyroid-stimulating hormone (TSH) in your blood can determine if your thyroid is working properly.Ovary function test. Measuring the amount of follicle-stimulating hormone (FSH) in your blood can determine if your ovaries are working properly.Prolactin test. Low levels of the hormone prolactin may be a sign of a pituitary gland tumor.Male hormone test. If you're experiencing increased facial hair and a lowered voice, your doctor may want to check the level of male hormones in your blood.

Hormone challenge test

For this test, you take a hormonal medication for seven to 10 days to trigger menstrual bleeding. Results from this test can tell your doctor whether your periods have stopped due to a lack of estrogen.

Imaging tests

Depending on your signs and symptoms — and the result of any blood tests you've had — your doctor might recommend one or more imaging tests, including:

Ultrasound. This test uses sound waves to produce images of internal organs. If you have never had a period, your doctor may suggest an ultrasound test to check for any abnormalities in your reproductive organs.Computerized tomography (CT). CT scans combine many X-ray images taken from different directions to create cross-sectional views of internal structures. A CT scan can indicate whether your uterus, ovaries and kidneys look normal.Magnetic resonance imaging (MRI). MRI uses radio waves with a strong magnetic field to produce exceptionally detailed images of soft tissues within the body. Your doctor may order an MRI to check for a pituitary tumor.

Scope tests

If other testing reveals no specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through your vagina and cervix to look at the inside of your uterus.

TREATMENT
Treatment depends on the underlying cause of your amenorrhea. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, surgery may be necessary.

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Angina

Angina

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away. 

SYMPTOMS
Angina symptoms include:

Chest pain or discomfort Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion.

The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest. If chest discomfort is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.

Characteristics of stable angina

Develops when your heart works harder, such as when you exercise or climb stairs Can usually be predicted and the pain is usually similar to previous types of chest pain you've had Lasts a short time, perhaps five minutes or less Disappears sooner if you rest or use your angina medication

Characteristics of unstable angina (a medical emergency)

Occurs even at rest Is a change in your usual pattern of angina Is unexpected Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes May not disappear with rest or use of angina medication Might signal a heart attack

Characteristics of variant angina (Prinzmetal's angina)

Usually happens when you're resting Is often severe May be relieved by angina medication

Prinzmetal's angina is uncommon — only about 2 percent of angina cases are Prinzmetal's angina. This type of angina is caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Angina in women

A woman's angina symptoms can be different from the classic angina symptoms. For example, women often experience symptoms such as nausea, shortness of breath, abdominal pain, or extreme fatigue, with or without with chest pain. Or a woman may feel discomfort in her neck, jaw or back or stabbing pain instead of the more typical chest pressure. These differences may lead to delays in seeking treatment.

If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

CAUSES
Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

Atherosclerosis

The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.


This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.

Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels.

Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.

Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain.

The following risk factors increase your risk of coronary artery disease and angina:

Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and block blood flow. Diabetes. Diabetes is the inability of your body to produce enough or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels. High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries by accelerating hardening of the arteries. High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. Personal or family history of heart disease. If you have coronary artery disease or if you've had a heart attack, you're at a greater risk of developing angina. Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults. Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program. Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue. Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

COMPLICATIONS
The chest pain that can occur with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.

Common signs and symptoms of a heart attack include:

Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw Increasing episodes of chest pain Prolonged pain in the upper abdomen Shortness of breath Sweating Impending sense of doom Fainting Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

DIAGNOSIS
To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack. Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle. While exercising, your blood pressure is monitored and your ECG readings are watched. Other tests also may be conducted while you're undergoing stress testing. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising. Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including whether there are areas of your heart not getting enough blood or heart muscle that's been damaged by poor blood flow. An echocardiogram is sometimes given during a stress test. Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream. This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the images because not as much of the radioactive substance is getting there. Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart. Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes. Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization. During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged. Cardiac MRI. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces detailed images of your heart's structure and its blood vessels.

TREATMENT
There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death.

However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.

Lifestyle changes

If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Changes include:

If you smoke, stop smoking. Avoid exposure to secondhand smoke. If you're overweight, talk to your doctor about weight-loss options. If you have diabetes, make sure that it is well controlled and that you're following an optimal diet and exercise plan. Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks. Avoid large meals. Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques. Eat a healthy diet with lots of whole grains, many fruits and vegetables and limited amounts of saturated fat. Talk to your doctor about starting a safe exercise plan.

Medications

If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue. Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first. Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina. Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries. Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina. Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

Medical procedures and surgery

Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery also are used to treat angina.

Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina. Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments. 

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Anemia

Anemia

Anemia is a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to your tissues. Having anemia may make you feel exhausted.

There are many forms of anemia, each with its own cause. Loss of blood is the most common cause of anemia. Anemia can be temporary or long term, and it can range from mild to severe.
See your doctor if you suspect you have anemia because anemia can be a sign of serious illnesses. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.

SYMPTOMS
Anemia symptoms vary depending on the cause of your anemia but may include:

Fatigue,,Pale skin,A fast or irregular heartbeat,Shortness of breath,Chest pain,Dizziness,Cognitive problems,Cold hands and feet,Headache

Initially, anemia can be so mild it goes unnoticed. But symptoms increase as anemia worsens.

Make an appointment with your doctor if you're feeling fatigued for unexplained reasons. Some anemias, such as iron deficiency anemia, are common. Fatigue has many causes besides anemia, so don't assume that if you're tired you must be anemic.

Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. Low hemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you're told that you can't donate blood because of low hemoglobin, make an appointment with your doctor.

CAUSES
Anemia occurs when your blood doesn't have enough red blood cells. This can happen if:

Your body doesn't make enough red blood cellsBleeding causes you to lose red blood cells more quickly than they can be replacedYour body destroys red blood cells

What red blood cells do

Your body makes three types of blood cells — white blood cells to fight infection, platelets to help your blood clot and red blood cells to carry oxygen throughout your body.

Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat.

Causes of common types of anemia

Common types of anemia and their causes include:

Iron deficiency anemia. Iron deficiency anemia is caused by a shortage of the element iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells. This type of anemia is often caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer, a polyp somewhere in your digestive system, and prolonged use of aspirin or drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs).Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people may eat enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency anemia.Anemia of chronic disease. Certain chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can cause anemia.Aplastic anemia. This very rare life-threatening anemia is caused by a decrease in the bone marrow's ability to produce red blood cells. Causes of aplastic anemia include infections, drugs and autoimmune diseases.Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete life-threatening shutdown of the blood-making process. Other cancers of the blood or bone marrow — such as multiple myeloma, myeloproliferative disorders and lymphoma — also can cause anemia.Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Hemolytic anemias can be inherited, or you can develop them later in life.Sickle cell anemia. This inherited and sometimes serious anemia is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells.Other anemias. There are several other rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.
These factors place you at increased risk of anemia:
A diet lacking in certain vitamins. Choosing a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of anemia.Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn's disease and celiac disease — puts you at risk for anemia. Surgical removal of or surgery to the parts of your small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.Menstruation. In general, women who haven't experienced menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. That's because menstruation causes the loss of red blood cells.Pregnancy. If you're pregnant, you're at an increased risk of iron deficiency anemia because your iron stores have to serve your increased blood volume as well as be a source of hemoglobin for your growing fetus.Chronic conditions. For example, if you have cancer, kidney or liver failure or another chronic condition, you may be at risk for what's called anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body's store of iron, leading to iron deficiency anemia.Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk for the condition.Other factors. A history of certain infections, blood diseases and autoimmune disorders, alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia.

DIAGNOSIS
To diagnose anemia, your doctor may recommend:

Physical exam. During a physical exam, your doctor may listen to your heart and your breathing. Your doctor may also place his or her hands on your abdomen to feel the size of your liver and spleen.Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values vary from one medical practice to another but are generally between 38.8 and 50 percent for men and 34.9 and 44.5 percent for women. Normal adult hemoglobin values are generally 13.5 to 17.5 grams per deciliter for men and 12 to 15.5 grams per deciliter for women.A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

Additional tests

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumors or kidney failure. Your doctor may test for these and other conditions that may be causing the anemia.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.

TREATMENT
Anemia treatment depends on the cause.

Iron deficiency anemia. This form of anemia is treated with changes in your diet and iron supplements. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.Vitamin deficiency anemias. Folic acid and vitamin C deficiency anemias are treated with dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may receive vitamin B-12 injections.Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue. Aplastic anemia. Treatment for this anemia may include

Helpful diet in Anemia

blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation. Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or immune suppressant medications can help suppress your immune system's attack on your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful.Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors may also recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia.Thalassemia. This anemia may be treated with blood transfusions, folic acid supplements, removal of the spleen (splenectomy), a bone marrow transplant or a cancer drug.

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