Hemolytic Anemia

Hemolytic anemia is anemia due to hemolysis , the abnormal breakdown of red blood cells either in the blood vessels (intravascular hemolysis) or elsewhere in the body (extravascular). The mechanism by which the immune system mistakes the red blood cells for a "foreign invader" varies somewhat according to the cause. It usually involves adherence of the offending agent (parasite, drug or toxin) to the surface of the red blood cells.Autoimmune hemolytic anemia can also be caused by or occur with another disease, such as systemic lupus erythematosus, and rarely it follows the use of certain drugs, such as penicillin. Though much attention has been given recently to AIHA due to evidence linking the process of vaccinating with the manifestation of this sometimes life-threatening disease, immunization is only one potential cause for this condition. In particular, a form of damaged red blood cell known as a spherocyte occurs. Finding spherocytes on a blood smear almost guarantees that some form of hemolytic anemia is occurring Blood transfusions can be used in dogs with IMHA if necessary but they can make the condition worse so most vets reserve this approach for dogs that appear to be in imminent danger of dying due to severe anemia. It is necessary to treat most dogs for a fairly long time to prevent recurrence of the disease and some dogs seem to require lifelong use of corticosteroids or other immunosuppressants. Splenectomy is done in resistant cases since it is a major site of red blood cell destruction.
Idiopathic autoimmune hemolytic anemia results from an abnormality of the immune system that destroys red blood cells prematurely. It has numerous possible causes, ranging from relatively harmless to life-threatening. The immune system wishes to attack the offending agent, but manages to injure the red blood cells as well. When the spleen and the rest of the immune system is working to rid the body of the old, diseased or damaged red blood cells, it is doing its job properly. Whenever hemolytic anemia is present it is wise to carefully rule out initiating causes that might be treatable. Examples of problems that can lead to hemolytic anemia include ehrlichiosis (a blood parasite), reactions to sulfa antiseptics or penicillin antibiotics, zinc toxicosis - which can occur due to the ingestion of pennies. In some people, the destruction may stop after a period of time; whereas in other people, it persists and becomes chronic. There are two main types of autoimmune hemolytic anemia: warm antibody hemolytic anemia and cold antibody hemolytic anemia. In acquired hemolytic anemia, the person develops the condition from some other cause. Hemolytic anemia can begin rapidly or come on gradually and can range from mild to severe.

Causes of Hemolytic Anemia

The common Causes of Hemolytic Anemia :

• Autoimmune disorders, such as systemic lupus erythematous (SLE, or lupus), rheumatoid arthritis, Wiskott-Aldrich syndrome, or ulcerative colitis
• Drugs such as penicillin, antimalaria medications, sulfa medications or acetaminophen
• surgery, radiotherapy, chemotherapy and/or immunotherapy...
• Blood loss excessive bleeding such as hemorrhages or abnormal menstrual bleeding.
• Penicillin and its derivatives .
• Cephalosporins.
• Levodopa.
• Tumors.
• AIHA and hereditary spherocytosis are classified as examples of extravascular hemolysis because the RBCs are destroyed in the spleen and other reticuloendothelial organs.
• Hereditary spherocytosis.

Symptoms of Hemolytic Anemia

Some are common Symptoms of Hemolytic Anemia :

• Abnormal paleness or lack of color of the skin.
• Jaundice, or yellowing of the skin, eyes, and mouth.
• weakness.
• Dizziness.
• Pale color.
• Dark urine.
• Rapid heartbeat.
• Enlarged spleen.
• Confusion.
• Heart murmur.

Treatment of Hemolytic Anemia

• your age, overall health, and medical history
• vitamin and mineral supplements
• extent of the disease
• Surgical removal of the spleen generally is reserved for children who do not respond to other therapies.
• Administer packed RBC slowly to avoid cardiac stress.
• Corticosteroid medications, which are synthetic versions of natural hormones produced by the body's adrenal glands
• Blood transfusions are given with caution, if indicated for severe anemia , because of the potential that blood may not be compatible and may bring on a reaction.
• corticosteroid medications
• splenectomy - surgery to remove the spleen.
• Administer folic acid because active hemolysis may consume folate and cause megaloblastosis.

Rhinitis

 

Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterised by a runny nose and stuffiness and usually caused by the common cold or and an allergy.

The nose is the most commonly infected part of the upper airways. Rhinitis may be acute or chronic. Acute rhinitis commonly results from viral infections but may also be a result of allergies or other causes. Chronic rhinitis usually occurs with chronic sinusitis (chronic rhinosinusitis).

Viral Rhinitis

• Acute viral rhinitis (the common cold) can be caused by a variety of viruses
• Symptoms consists of runny nose, congestion, post nasal drip, cough, and a  low-grade fever.
• Stuffiness can be relieved by taking phenylephrine as a nasal spray or pseudphedrine by mouth. These drugs, available by over the counter, cause the blood vessels of the nasal mucous membrane to constrict. Nasal spray should only be used for only 3 or 4 days because  after that period of time, when the effects of the drugs wear off, the mucous membrane often swells even more that before. This phenomena is called as rebound congestion.
• Antihistamines help  control runny nose but cause drowsiness and other problems, especially in older people.
• Antibiotics are not effective for acute viral rhinitis.

Allergic Rhinitis

• Allergic rhinitis is caused by a reaction of the body's immune system to an enviromental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals.
• Symptoms include sneezing, runny nose, stuffiness, and itchy, watery eyes.
• A doctor may diagnose  allergic rhinitis based on a person's history of symptoms. Often, the person has a family history of allergies.More detailed information may be obtained using blood tests or skin testing.
• Avoiding the substance that triggers the allergy prevents symptoms but is often not possible.
• Nasal corticosteroid sprays decrease nasal inflammation caused by many sources and are relatively safe for long-term use.
• Antihistamine help prevent the allergy reaction and thus symptoms.
• Antihistamines dry the mucous membrane of the nose but many of them also cause sleepiness and other problems, especially in older  people.
• Never ones require a prescription but do not have these side effects.
• Allergy shots (desensitization) help to build long therm tolerance to specific  environmental triggers, but they may take months  or years to become fully effective.
• Antibiotic do not relieve the symptoms of allergic rhinitis.

Atrophic Rhinitis

• Atrophic rhinitis is a form of chronic rhinitis in which  the mucous membrane thins (atropies) and hardens, causing the nasal passages to widen and dry out.
• The cells normally found in the mucous membrane of the nose - cells that secrete mucus and have hairlike projections to move dirt particles out - are replaced by cells like those normally found in the skin.
• The disorder can develop in someone who had sinus surgery in which a significant amount of intranasal structures and mucous membranes were removed. 
• A prolong bacterial infection of the lining of the nose is also a factor.
• Crust form inside  the nose, and an offensive odour develops.
• A person may have recurring severe nosebleeds and can lose his sense of smell (anosmia).
• Treatment is aimed at reducing the crusting, elimination the odour, and reducing infections. 
• Topical antibiotics, such as bacitracin applied  inside the nose, kill bacteria.
• Estrogens and vitamins A and D sprayed into the nose or taken by mouth may reduce crusting by promoting mucosal secretions.
• Other antibiotics, given by mouth or intravenously, may also be helpful.
• Surgery to narrow the nasal passages may reduce crusting became the decreased airflow prevents drying if the thinned mucous membrane

Vasomotor Rhinitis

• Vasomotor rhinitis is a form of chronic rhinitis.
• Nasal stuffiness, sneezing, and a runny nose - common allergic symptoms - occur when allergies do not appear to be present.
• In some people, the nose reacts strongly to irritants, perfumes, and pollution.
• The disorder comes and goes but is worsened by dry air.
• The swollen mucous membrane varies fro bright red to purple.
• Sometimes, people also have slight inflammation of the sinuses.
• When persistent, endoscopy of the nose or CT scan of the sinus is not significant.
• Treatment is aimed at relieving symptoms.
• Avoiding smoke and irritants and using a humidified central heating system or vaporizer to increase humidity may be beneficial.

Heart Diseases

Introduction - Heart disease is the name given to a whole collection of heart conditions that affect people on a daily basis and a term that people across the world are most certainly familiar with. To really understand what heart disease is all about, you need to know what each of the conditions are, and what they do to your body if you are unlucky enough to suffer from one of them.
It’s a killer disease that affects a vast portion of the world population, but few people know the facts related to heart disease. Heart disease is actually an umbrella term for many different types of afflictions affecting the heart and below we have listed a few conditions that affect the heart; however, this does not represent the full scope of the many specific medical conditions that make up heart disease.

What is Heart Disease? - Coronary Heart Disease

Coronary heart disease is the build up of atheromatous plaque (inflamed tissue) within the arteries that pump blood into the heart; this can build up over time and restrict the flow of blood to the heart causing heart failure. If this does not happen then there is also the possibility that the plaques can rupture causing blood to clot and restrict blood flowing to the heart. The disease progresses over time, and symptoms are often non-existent until the condition manifests itself in the form of a heart attack.
When the plaque builds up to a point where the blood flow to the heart is reduced or cut off, serious consequences can result. Those with an advanced case of coronary heart disease may experience frequent and painful chest pains, due to a symptom known as ‘angina’. The best way of preventing a case of coronary heart disease involves engaging in an active lifestyle, watching what you eat and avoid smoking.
What is Heart Disease?- Ischemic (or ischaemic) heart disease
Those who suffer from Ischemic heart disease experience a decreased flow of blood to the heart. Angina may also occur when a case of Ischemic heart disease is present. Just like Coronary Heart Disease this type of heart disease is very serious and can be prevented by maintaining a healthy lifestyle.
‘Ischaemia’   means an "inadequate blood supply". The only supply of blood to the heart muscle is through the coronary arteries, so any obstruction in the coronary arteries will reduce the supply of blood to the heart muscle.
Atherosclerosis is one of the most common cause of ischemic heart disease and may even exist when the artery lumens appear normal by angiography.
Possible consequences of Ischemic heart disease can be:
v Temporary damage and pain (ischemia)
v Permanent heart muscle damage, heart muscle does not grow back (acute myocardial infarction /infarct)
v Loss of muscle activity (acute heart failure)
v Long term loss of heart muscle activity (chronic heart failure)
v Cardiac arrhythmias: irregular heartbeat which can be fatal. Most death is due to arrhythmias, usually tachyarrhythmias.
v Other structural damage to the heart including damaged heart valves, actual perforation of the heart and a thin walled fibrous floppy heart.

What is Heart Disease? - Cardiovascular Heart Disease

Cardiovascular disease - is a term that represents a number of different types of heart disease. These types of heart disease often affect the blood vessels of the heart. With over 71.3 million citizens of the United States alone affected by a form of cardiovascular disease, it is a common type of illness that can also be avoided by staying healthy.
Pulmonary heart disease - is a very serious form of heart disease. If there is a change in the structure of the right ventricle located in the heart, due to respiratory problems. The affect this has on the right ventricle is great; it can cause increased pressure in the right ventricle, which will eventually lead to the right ventricle stretching through dilation or additional muscle growth in the ventricle to help add strength to the contractions needed for the increase in pressure.
This will add a lot of strain to the heart and will eventually lead to heart failure, and in some cases swelling in the legs.

What is Heart Disease? - Hypertensive Heart Disease

Hypertensive heart disease is related to hypertension, which is commonly known as high blood pressure and affects a large group of people worldwide.
High blood pressure means the heart has produced an elevated amount of pressure to pump the blood around the body, this can, overtime cause a strain on the heart leading to heart failure or an aortic arterial aneurysm.
An aortic arterial aneurysm is the bulging of a blood vessel in the artery, which will increase to the point that it bursts causing severe pain, and without immediate medical assistance, death.
If found early then surgical intervention can take place and an artificial tube sewn into the aorta and the aneurysm closed so it wont rupture causing a massive internal hemorrhage. This surgery is very invasive so the medical profession will not carry out the surgery unless it is deemed necessary. When arterial hypertension is occurring within the heart, the disease takes over, causing fatigue, an irregular pulse, and a swelling of the feet. The condition can lead to cases of congestive heart failure, and it is a leading cause of death in western society. 

What is Heart Disease? - V alvular Heart Disease
There are valves in the heart which assist the bloods journey through the labyrinth of channels that keep the heart functioning. Sometimes there are problems with these valves thus impeding the flow of blood.
The valves in the heart are the tricuspid valve and pulmonic valve, which are both found in the right side of the heart and the mitral valve and aortic valve, which are found in the left side of the heart.
There are a great number of medical conditions that affect the valves in different ways but they all generally involve one or more of the valves being too narrow, wide or loose causing regurgitation of the blood.

What is Heart Disease? - Summary

Now that you know more about the different types of heart disease, you’ll be better able to draw parallels when it comes to acting in a preventative matter and keeping a healthy heart.
By knowing all that you can about:
v coronary heart disease,
v ischaemic heart disease,
v cardiovascular disease,
v pulmonary heart disease
v valvular heart disease
v hypertensive heart disease,
you’ll be better suited than most when it comes to staying healthy, recognizing symptoms and avoiding a visit to the  A & E of your nearest hospital .
As you can see the causes and affects vary greatly, and it is due to this that we need to be diligent and understand heart disease better, after all it is one of the biggest killers of the present day.

Valvular heart disease

Valvular heart disease occurs when any of your heart’s four valves are damaged.


In the vast majority of cases it is a type of chronic heart disease (i.e. it has progressed over a number of years) although in a small number of people it may be classed as acute(i.e. sudden – over a short period of time)if it result from infection or complications following a heart attack.
The valves of the heart open and close in sequence in order to pump your blood around your body. If one is damaged then the heart has to work harder to compensate.
The two normal problems with the vales are that they either become narrow (stenosis), reducing blood flow or they do not close properly allowing some blood to be pumped in the wrong direction (insufficiency, incompetency, or regurgitation)
Both types of defects reduce blood flow and therefore oxygen supply resulting in you feeling weak and tired.

Depending which valve(s) are affected you will also either notice swelling of your feet and ankles or problems breathing due to congestion of your lungs.
Treatment depends on the severity of the problem.
Many people continue to lead normal live without any treatment, however if the damage is severe then the valves, can be replaced.

Ecology of Infectious Disease

Human diseases
Many disease organisms that threaten humans worldwide have complex life histories that are affected by both human and non-human attributes of the ecosystems in which they occur. For example,

• Lyme disease is carried by ticks that move about on mammal hosts such as deer and mice - environmental parameters that affect these non-human hosts have implications for human exposure to Lyme disease
• Rabies is a disease that is contracted by wildlife and can be passed on to humans. NCEAS researchers have assembled and analyzed an extensive database documenting rabid raccoons, refining predictions of rabies dynamics
• The bacterium causing the gastrointestinal disease cholera is waterborne and associated with microscopic crustaceans - climatic and environmental factors that affect hydrodynamics and the ecology of aquatic food webs can influence the dynamics of cholera
• The brain parasite that causes toxoplasmosis is passed among rats, cats, and humans; in humans, infection is associated with lifelong personality changes that may influence human culture
• NCEAS ecologists have formulated and applied cutting edge approaches in analysis and synthesis of human disease scenarios in recent years, improving our understanding of human disease risk

Disease and ecosystems
Ecologists have a growing awareness of the importance of pathogens and parasites in the evolution and ecology of natural systems.  Researchers at NCEAS have examined the evolutionary relationships between disease organisms and their hosts, as well as more modern alterations of pathogen and parasite dynamics by humans . For example:

• Introduced species have escaped many of the parasites of their native ranges ;
• The removal of predators that normally select sick individuals from prey groups may increase pathogen transmission among their populations, when diseased individuals continue living within groups ;
• Primate researchers have examined the role of social and feeding behavior in moderating infection by sexually transmitted diseases and parasites in non-human primates ;
• Disease is considered to be among the most significant causes of the modern coral reef decline, and warmer temperatures encourage some of the most common diseases on coral reefs ;
• Environmental warming and human activities, such as fishing, may have complex disease effects as warm temperatures seem to favor some pathogens and parasites, while decreasing the prevalence or severity of others , and human activities alter host abundance, behavior and environment

Respiratory Failure

Respiratory failure is nearly any condition that affects breathing function or the lungs themselves and can result in failure of the lungs to function properly. The main tasks of the lungs and chest are to get oxygen from the air that is inhaled into the bloodstream, and, at the same to time, to eliminate carbon dioxide (C02) from the blood through air that is breathed out. In respiratory failure, the level of oxygen in the blood becomes dangerously low, and/or the level of C02 becomes dangerously high. There are two ways in which this can happen. Either the process by which oxygen and C02 are exchanged between the blood and the air spaces of the lungs (a process called "gas exchange") breaks down, or the movement of air in and out of the lungs (ventilation) does not take place properly.
Respiratory failure often is divided into two main types. One of them, called hypoxemic respiratory failure, occurs when something interferes with normal gas exchange. Too little oxygen gets into the blood (hypoxemia), and all organs and tissues in the body suffer as a result. One common type of hypoxemic failure, occurring in both adults and prematurely born infants, is respiratory distress syndrome, a condition in which fluid or tissue changes prevent oxygen from passing out of the air sacs of the lungs into the circulating blood. Hypoxemia also may result from spending time at high altitudes (where there is less oxygen in the air); various forms of lung disease that separate oxygen from blood in the lungs; severe anemia ("low blood"); and blood vessel disorders that shunt blood away from the lungs, thus precluding the lungs from picking up oxygen.

The other main type of respiratory failure is ventilatory failure, occurring when, for any reason, breathing is not strong enough to rid the body of C02. Then CO2 builds up in the blood (hypercapnia). Ventilatory failure can result when the respiratory center in the brainstem fails to drive breathing; when muscle disease keeps the chest wall from expanding when breathing in; or when a patient has chronic obstructive lung disease that makes it very difficult to exhale air with its C02. Many of the specific diseases and conditions that cause respiratory failure cause both too little oxygen in the blood (hypoxemia) and abnormal ventilation.
Several different abnormalities of breathing function can cause respiratory failure. The major categories, with specific examples of each, are:

Obstruction of the airways. Examples are chronic bronchitis with heavy secretions; emphysema; cystic fibrosis; asthma (a condition in which it is very hard to get air in and out through narrowed breathing tubes).

Weak breathing. This can be caused by drugs or alcohol, which depress the respiratory center; extreme obesity; or sleep apnea, where patients stop breathing for long periods while sleeping.

Muscle weakness. This can be caused by a muscle disease called myasthenia; muscular dystrophy; polio; a stroke that paralyzes the respiratory muscles; injury of the spinal cord; or Lou Gehrig's disease.

Lung diseases, including severe pneumonia. Pulmonary edema, or fluid in the lungs, can be the source of respiratory failure. Also, it can often be a result of heart disease; respiratory distress syndrome; pulmonary fibrosis and other scarring diseases of the lung; radiation exposure; burn injury when smoke is inhaled; and widespread lung cancer.

An abnormal chest wall (a condition that can be caused by scoliosis or severe injury of the chest wall).

A majority of patients with respiratory failure are short of breath. Both low oxygen and high carbon dioxide can impair mental functions. Patients may become confused and disoriented and find it impossible to carry out their normal activities or do their work. Marked C02 excess can cause headaches and, in time, a semi-conscious state, or even coma. Low blood oxygen causes the skin to take on a bluish tinge. It also can cause an abnormal heart rhythm (arrhythmia). Physical examination may show a patient who is breathing rapidly, is restless, and has a rapid pulse. Lung disease may cause abnormal sounds heard when listening to the chest with a stethoscope: wheezing in asthma, "crackles" in obstructive lung disease. A patient with ventilatory failure is prone to gasp for breath, and may use the neck muscles to help expand the chest.
The symptoms and signs of respiratory failure are not specific. Rather, they depend on what is causing the failure and on the patient's condition before it developed. Good general health and some degree of "reserve" lung function will help see a patient through an episode of respiratory failure. The key diagnostic determination is to measure the amount of oxygen, carbon dioxide, and acid in the blood at regular intervals. A sudden low oxygen level in the lung tissue may cause the arteries of the lungs to narrow. This, in turn, causes the resistance in these vessels to increase, which can be measured using a special catheter. A high blood level of C02 may cause increased pressure in the fluid surrounding the brain and spinal cord; this, too, can be measured.
Nearly all patients are given oxygen as the first treatment. Then the underlying cause of respiratory failure must be treated. For example, antibiotics are used to fight a lung infection, or, for an asthmatic patient, a drug to open up the airways is commonly prescribed.

A patient whose breathing remains very poor will require a ventilator to aid breathing. A plastic tube is placed through the nose or mouth into the windpipe and is attached to a machine that forces air into the lungs. This can be a lifesaving treatment and should be continued until the patient's own lungs can take over the work of breathing. It is very important to use no more pressure than is necessary to provide sufficient oxygen; otherwise ventilation may cause further lung damage. Drugs are given to keep the patient calm, and the amount of fluid in the body is carefully adjusted so that the heart and lungs can function as normally as possible. Steroids, which combat inflammation, may sometimes be helpful but they can cause complications, including weakening the breathing muscles.

The respiratory therapist has a number of methods available to help patients overcome respiratory failure. They include:

Suctioning the lungs through a small plastic tube passed through the nose, in order to remove secretions from the airways that the patient cannot cough up.

Postural drainage, in which the patient is propped up at an angle or tilted to help secretions drain out of the lungs. The therapist may clap the patient on the chest or back to loosen the secretions, or a vibrator may be used for the same purpose.

Breathing exercises often are prescribed after the patient recovers. They make the patient feel better and help to strengthen the muscles that aid breathing. One useful method is for the patient to suck on a tube attached to a clear plastic hosing containing a ball so as to keep the ball lifted. Regular deep breathing exercises are simpler and often just as helpful. Another technique is to have the patient breathe out against pursed lips to increase pressure in the airways and keep them from collapsing.
The outlook for patients with respiratory failure depends chiefly on its cause. If the underlying disease can be effectively treated, with the patient's breathing supported in the meantime, the outlook is usually good.

Care is needed not to expose the patient to polluting substances in the atmosphere while recovering from respiratory failure; this could tip the balance against recovery. When respiratory failure develops slowly, pressure may build up in the lung's blood vessels, a condition called pulmonary hypertension. This condition may damage the vessels, worsen hypoxemia, and cause the heart to fail. If it is not possible to provide enough oxygen to the body, complications involving either the brain or the heart may prove fatal.

If the kidneys fail or the diseased lungs become infected, the prognosis is worse. In some cases, the primary disease causing the lungs to fail is irreversible. The patient, family, and physician together then must decide whether to prolong life by ventilator support. Occasionally, lung transplantation is a possibility, but it is a highly complex procedure and is not widely available

Because respiratory failure is not a disease itself, but the end result of many lung disorders, the best prevention is to treat any lung disease promptly and effectively. It is also important to make sure that any patient who has had lung disease is promptly treated for any respiratory infection (even of the upper respiratory tract). Patients with lung problems should also avoid exposure to pollutants, as much as is possible. Once respiratory failure is present, it is best for a patient to receive treatment in an intensive care unit, where specialized personnel and all the needed equipment are available. Close supervision of treatment, especially mechanical ventilation, will help minimize complications that would compound the problem.
A common form of lung disease in which breathing, and therefore gas exchange, is labored and increasingly difficult.

Gas exchange
The process by which oxygen is extracted from inhaled air into the bloodstream, and, at the same time, carbon dioxide is eliminated from the blood and exhaled.

Hypoxemia
An abnormally low amount of oxygen in the blood, the major consequence of respiratory failure, when the lungs no longer are able to perform their chief function of gas exchange.

Pulmonary fibrosis
An end result of many forms of lung disease (especially chronic inflammatory conditions). Normal lung tissue is converted to scarred, "fibrotic" tissue that cannot carry out gas exchange.

Lung Cancer

Lung Cancer is the leading cause of cancer deaths in both women and men in the United States and throughout the world. Lung cancer is the number one cause of cancer deaths in men and has surpassed breast cancer as the leading cause of cancer deaths in women. In the United States in 2004, 160,440 people were projected to die from lung cancer compared with a projected 127,210 deaths from colorectal, breast, and prostate cancer combined. Only about 14% of all people who develop lung cancer survive for 5 years.
Cancer occurs when normal cells undergo a transformation that causes them to grow and multiply without the normal controls. The cells form a mass or tumor that differs from the surrounding tissues from which it arises. Tumors are dangerous because they take oxygen, nutrients, and space from healthy cells.

Most lung tumors are malignant. This means that they invade and destroy the healthy tissues around them.

The tumors can also spread to nearby lymph nodes or through the bloodstream to other organs. This process is called metastasis.

When lung cancer metastasizes, the tumor in the lung is considered the primary tumor, and the tumors in other parts of the body are called secondary tumors or metastatic tumors.

Some lung tumors are metastatic from cancers elsewhere in the body. The lungs are a common site for metastasis. Lung cancers are usually divided into 2 groups that account for about 95% of all cases.

The division is based on the type of cells that make up the cancer.

The 2 types of lung cancer are classified based on the cell size of the tumor. They are called small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC). NSCLC includes several more types of tumors.

SCLCs are less common, but they grow more quickly and are more likely to metastasize than NSCLCs. Often, SCLCs have already spread to other parts of the body when the disease is diagnosed.

About 5% of lung cancers are of rare cell types, such as carcinoid tumor, lymphoma, or metastatic (cancers from other parts of the body that spread to the lungs). The specific types of primary lung cancers are as follows:

Adenocarcinoma (an NSCLC) is the most common type of lung cancer, making up 30-40% of all cases. A subtype of adenocarcinoma is called bronchoalveolar cell carcinoma, which creates a pneumonialike appearance on chest x-ray films.

Squamous cell carcinoma (an NSCLC) is the second most common type of lung cancer, making up about 30% of all lung cancers.

Large cell cancer makes up 10% of all cases.

SCLC makes up 20% of all cases.

Carcinoid Lung Cancer accounts for 1% of all cases.

Laryngitis

Laryngitis is caused by inflammation of the larynx, resulting in hoarseness of the voice.

When air is breathed in (inspired), it passes through the nose and the nasopharynx or through the mouth and the oropharynx. These are both connected to the larynx, a tube made of cartilage. The vocal cords, responsible for setting up the vibrations necessary for speech, are located within the larynx. The air continues down the larynx to the trachea. The trachea then splits into two branches, the left and right bronchi (bronchial tubes). These bronchi branch into smaller air tubes which run within the lungs, leading to the small air sacs of the lungs (alveoli).

Either food, liquid, or air may be taken in through the mouth. While air goes into the larynx and the respiratory system, food and liquid are directed into the tube leading to the stomach, the esophagus. Because food or liquid in the bronchial tubes or lungs could cause a blockage or lead to an infection, the airway must be protected. The epiglottis is a leaf-like piece of cartilage extending upwards from the larynx. The epiglottis can close down over the larynx when someone is eating or drinking, preventing these substances from entering the airway.

In laryngitis, the tissues below the level of the epiglottis are swollen and inflamed. This causes swelling around the area of the vocal cords, so that they cannot vibrate normally. A hoarse sound to the voice is very characteristic of laryngitis. Laryngitis is a very common problem, and often occurs during the course of an upper respiratory tract infection (cold).

Laryngitis - Causes and Symptoms

Laryngitis is caused almost 100% of the time by a virus. The same viruses which cause the majority of simple upper respiratory infections (colds, etc.) are responsible for laryngitis. These include parainfluenzae virus, influenza virus, respiratory syncytial virus, rhinovirus, coronavirus, and echovirus. Extremely rarely, bacteria such as Group A streptococcus, M. catarrhalis, or that which causes tuberculosis may cause laryngitis. In people with faulty immune systems (particular due to acquired immunodeficiency syndrome, or AIDS), infections with fungi may be responsible for laryngitis.

Symptoms usually begin along with, or following, symptoms of a cold. A sore, scratchy throat, fever, runny nose, achiness, and fatigue may all occur. Difficulty swallowing sometimes occurs with streptococcal infections. The patient may cough and wheeze. Most characteristically, the patient's voice will sound strained, hoarse, and raspy.

In extremely rare cases, the swelling of the larynx may cause symptoms of airway obstruction. This is more common in infants, because the diameter of their airways is so small. In that case, the baby may have a greatly increased respiratory rate, and exhibit loud high-pitched sounds with breathing (called stridor).

Laryngitis - Diagnosis

Diagnosis is usually made by learning the history of a cold followed by hoarseness. The throat usually appears red and somewhat swollen. Listening to the chest and back with a stethoscope may reveal some harsh wheezing sounds with inspiration (breathing in).

In long-standing (chronic laryngitis), tuberculosis may be suspected. Using a scope called a laryngoscope, examination of the airway will show redness, swelling, small bumps of tissue called nodules, and irritated pits in the tissue called ulcerations. Special skin testing (TB testing) will reveal that the individual has been exposed to the bacteria causing TB.

Laryngitis - Treatment

Treatment of a simple, viral laryngitis simply addresses the symptoms. Gargling with warm salt water, pain relievers such as acetaminophen, the use of vaporizers to create moist air, and rest will help the illness resolve within a week.

In an infant who is clearly struggling for air, it may be necessary to put in an artificial airway for a short period of time. This is very rarely needed.

An individual with tubercular laryngitis is treated with a combination of medications used to treat classic TB. In people with fungal laryngitis, a variety of anti-fungal medications are available.

Laryngitis - Alternative treatment

Alternative treatments include aromatherapy inhalations made with benzoin, lavender, frankincense, thyme, and sandalwood. Decoctions (extracts made by boiling an herb in water) or infusions (extracts made by steeping an herb in boiling water) can be made with red sage (Salvia officinalis var. rubra) and yarrow (Achillea millefolium) or with licorice (Glycyrrhiza glabra). These are used for gargling, and are said to reduce pain. Echinacea ( Echinacea spp.) tincture taken in water every hour for 48 hours is recommended to boost the immune system. Antiviral herbs, including usnea (Usnea spp.), lomatium (Lomatium dissectum), and ligusticum (Ligusticum porteri), may help hasten recovery from laryngitis. Homeopathic remedies are recommended based on the patient's symptoms. Some people may get relief from placing cold compresses on the throat.

Laryngitis - Prognosis

Prognosis for laryngitis is excellent. Recovery is complete, and usually occurs within a week's time.

Laryngitis - Prevention

Prevention of laryngitis is the same as for any upper respiratory infections. The only way to even attempt to prevent such illnesses is by good handwashing, and by avoiding situations where one might come in contact with people who might be sick. However, even with relatively good hygiene practices, most people will get about five to six colds per year. It is unpredictable which of these may lead to laryngitis.

Key Terms

Epiglottis
A leaf-like piece of cartilage extending upwards from the larynx, which can close like a lid over the trachea to prevent the airway from receiving any food or liquid being swallowed.

Larynx
The part of the airway lying between the pharynx and the trachea.

Nasopharynx
The part of the airway into which the nose leads.

Oropharynx
The part of the airway into which the mouth leads.

Trachea
The part of the airway which leads into the bronchial tubes.

Laryngeal Cancer

Laryngeal cancer is cancer of the larynx or voice box.

The larynx is located where the throat divides into the esophagus and the trachea. The esophagus is the tube that takes food to the stomach. The trachea, or windpipe, takes air to the lungs. The area where the larynx is located is sometimes called the Adam's apple.

The larynx has two main functions. It contains the vocal cords, cartilage, and small muscles that make up the voice box. When a person speaks, small muscles tighten the vocal cords, narrowing the distance between them. As air is exhaled past the tightened vocal cords, it creates sounds that are formed into speech by the mouth, lips, and tongue.

The second function of the larynx is to allow air to enter the trachea and to keep food, saliva, and foreign material from entering the lungs. A flap of tissue called the epiglottis covers the trachea each time a person swallows. This blocks foreign material from entering the lungs. When not swallowing, the epiglottis retracts, and air flows into the trachea. During treatment for cancer of the larynx, both of these functions may be lost.

Cancers of the larynx develop slowly. About 95% of these cancers develop from thin, flat cells similar to skin cells called squamous epithelial cells. These cells line the larynx. Gradually, the squamous epithelial cells begin to change and are replaced with abnormal cells. These abnormal cells are not cancerous but are pre-malignant cells that have the potential to develop into cancer. This condition is called dysplasia. Most people with dysplasia never develop cancer. The condition simply goes away without any treatment, especially if the person with dysplasia stops smoking or drinking alcohol.

The larynx is made up of three parts, the glottis, the supraglottis, and the subglottis. Cancer can start in any of these regions. Treatment and survival rates depend on which parts of the larynx are affected and whether the cancer has spread to neighboring areas of the neck or distant parts of the body.

The glottis is the middle part of the larynx. It contains the vocal cords. Cancers that develop on the vocal cords are often diagnosed very early because even small vocal cord tumors cause hoarseness. In addition, the vocal cords have no connection to the lymphatic system. This means that cancers on the vocal cord do not spread easily. When confined to the vocal cords without any involvement of other parts of the larynx, the cure rate for this cancer is 75% to 95%.

The supraglottis is the area above the vocal cords. It contains the epiglottis, which protects the trachea from foreign materials. Cancers that develop in this region are usually not found as early as cancers of the glottis because the symptoms are less distinct. The supraglottis region has many connections to the lymphatic system, so cancers in this region tend to spread easily to the lymph nodes and may spread to other parts of the body (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells). In 25% to 50% of people with cancer in the supraglottal region, the cancer has already spread to the lymph nodes by the time they are diagnosed. Because of this, survival rates are lower than for cancers that involve only the glottis.

The subglottis is the region below the vocal cords. Cancer starting in the subglottis region is rare. When it does, it is usually detected only after it has spread to the vocal cords, where it causes obvious symptoms such as hoarseness. Because the cancer has already begun to spread by the time it is detected, survival rates are generally lower than for cancers in other parts of the larynx.

About 12,000 new cases of cancer of the larynx develop in the United States each year. Each year, about 3,900 die of the disease. Laryngeal cancer is between four and five times more common in men than in women. Almost all men who develop laryngeal cancer are over age 55. Laryngeal cancer is about 50% more common among African-American men than among other Americans.

Hantaviruses

Hantaviruses, any of several members of the virus family Bunyaviridae that infect vertebrates (animals with backbones, including humans). Unlike most members of this family, which are carried by mosquitoes, ticks, or flies, hantaviruses are carried by specific rodent hosts and are transmitted directly from host to host by virus-laden saliva, urine, and feces. Humans are infected through exposure to the dried excretions from infected rodents. Hantaviruses cause two different human diseases: hemorrhagic fever with renal syndrome, in which damage to the kidneys is common, and acute respiratory distress syndrome, in which damage to the lungs is common.

Hantaviruses are spherical and are 90 to 100 nanometers (1 nanometer equals 1 billionth of a meter, or 4 x 10-8 inches) in diameter. They are composed of an envelope covered with spikes surrounding three protein-wrapped, circular pieces of ribonucleic acid (RNA). Although many hantaviruses have been identified recently, their true number and potential for causing disease is probably far greater than is presently thought.

Acute respiratory distress syndrome is one of two human diseases caused by hantavirus. Dust containing virus-infected rodent feces becomes airborne and is inhaled. The virus embeds in the lungs where the infection begins. Flulike symptoms appear in about a week, followed by the collection of fluid and white blood cells in the lungs, causing respiratory failure, then death.

HANTAAN VIRUS

The first human disease known to be due to a hantavirus infection was hemorrhagic fever with renal syndrome, identified in the early 1950s during the Korean War. Thousands of United Nations troops developed a mysterious disease marked by fever, headache, hemorrhage, and acute kidney failure. Despite much research, the cause remained unknown for 26 years until a new virus, named Hantaan virus, was isolated in Korea from field mice in 1976.

Hemorrhagic fever with renal syndrome is widespread in the Far East, particularly in China and Korea. There are two seasonal disease peaks, associated with the harvesting of wheat in summer and of rice in late fall. During these times the host rodent populations peak and the fields are full of dust containing dried, virus-laden excrement. The disease is fatal in about 5 to 10 percent of cases. A milder form of the disease, caused by Seoul virus and transmitted by rats, occurs in Japan, Korea, China, and the United States, especially in seaports, where rats are common. Symptoms are less severe and include nephritis (inflammation of the kidneys).

SIN NOMBRE VIRUS

In 1993 a new hantavirus disease was recognized in the southwestern United States. The illness was at first referred to as Four Corners Disease, named for the area where the disease was first observed, where Arizona, New Mexico, Colorado, and Utah meet. The agent responsible was called the Sin Nombre (an area in New Mexico which in Spanish means “no name”) virus. The victims of the virus developed influenza-like symptoms—including fever, muscle aches, cough, and headache—which rapidly worsened. Fluid and white blood cells accumulated in the lungs, causing hypoxia (low blood-oxygen levels), shock, and, in many cases, death from a type of lung failure called acute respiratory distress syndrome, also known as hantavirus pulmonary syndrome. Within a short time, cases were found in other states. By the end of 1995, 123 cases, with a fatality rate of 51 percent, had been confirmed from 23 states. The disease was also identified in Canada, Brazil, Venezuela, and Argentina.

The search for the cause of this mysterious disease began with typical epidemiological studies that involved interviewing survivors and people who came in contact with the victims. Blood samples from victims shared evidence of antibodies against hantaviruses, an indication that they had been exposed to hantavirus in the past, and that this earlier exposure had initiated an immune response. To prove which hantavirus was indeed the cause of the victims' death, scientists used the polymerase chain reaction (PCR). This technique is used to rapidly amplify DNA strands. Once amplified, specific methods are used to identify the specific virus. Scientists determined with certainty that hantavirus was present in the tissues of the victims and determined that the disease was caused by a previously unknown hantavirus. Hantavirus specimens from different areas were compared, revealing that several previously unknown viruses were active in the United States. The entire genetic structure of the Sin Nombre virus was determined, and diagnostic tests were created. The same methods are being used in attempts to develop a vaccine. (For a description of vaccines, See Immunization.)

The primary host of Sin Nombre virus in the southwestern United States is the deer mouse, Peromyscus maniculatus. In large sections of this part of the country, 10 to 35 percent of deer mice are infected, and in certain areas about 80 percent of deer mice carry the virus.

Sin Nombre virus, like other hantaviruses, does not cause disease in its rodent hosts. The virus is shed in the saliva, urine, and feces of these animals for many weeks and perhaps for the lifetime of the animal. Human infection occurs when dust containing infected dried rodent excretions is inhaled. Sin Nombre and the other newly discovered hantaviruses probably have long been present in the region of the western United States inhabited by deer mice. The virus was recognized in 1993 only because of the number and clustering of human cases, after two particularly wet winters and an abundant supply of rodent food caused an increase in rodent populations, which then led to a rise in the incidence of the disease.

PREVENTION

The risk of infection by hantaviruses can be reduced by preventing rodents from living in or near human dwellings. Rodent nests and droppings should be wetted down with a disinfectant before they are removed.

Cough

A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions.

Cough - Description

While people can generally cough voluntarily, a cough is usually a reflex triggered when an irritant stimulates one or more of the cough receptors found at different points in the respiratory system. These receptors then send a message to the cough center in the brain, which in turn tells the body to cough. A cough begins with a deep breath in, at which point the opening between the vocal cords at the upper part of the larynx (glottis) shuts, trapping the air in the lungs. As the diaphragm and other muscles involved in breathing press against the lungs, the glottis suddenly opens, producing an explosive outflow of air at speeds greater than 100 mi (160 km) per hour.

In normal situations, most people cough once or twice an hour during the day to clear the airway of irritants. However, when the level of irritants in the air is high or when the respiratory system becomes infected, coughing may become frequent and prolonged. It may interfere with exercise or sleep, and it may also cause distress if accompanied by dizziness, chest pain, or breathlessness. In the majority cases, frequent coughing lasts one to two weeks and tapers off as the irritant or infection subsides. If a cough lasts more than three weeks it is considered a chronic cough, and physicians will try to determine a cause beyond an acute infection or irritant.

Coughs are generally described as either dry or productive. A dry cough does not bring up a mixture of mucus, irritants, and other substances from the lungs (sputum), while a productive cough does. In the case of a bacterial infection, the sputum brought up in a productive cough may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

Cough - Causes and Symptoms

In the majority of cases, coughs are caused by respiratory infections, including:

colds or influenza, the most common causes of coughs

bronchitis, an inflammation of the mucous membranes of the bronchial tubes

croup, a viral inflammation of the larynx, windpipe, and bronchial passages that produces a bark-like cough in children

whooping cough, a bacterial infection accompanied by the high-pitched cough for which it is named

pneumonia, a potentially serious bacterial infection that produces discolored or bloody mucus

tuberculosis, another serious bacterial infection that produces bloody sputum

fungal infections, such as aspergillosis, histoplasmosis, and cryptococcoses.

Environmental pollutants, such as cigarette smoke, dust, or smog, can also cause a cough. In the case of cigarette smokers, the nicotine present in the smoke paralyzes the hairs (cilia) that regularly flush mucus from the respiratory system. The mucus then builds up, forcing the body to removed it by coughing. Post-nasal drip, the irritating trickle of mucus from the nasal passages into the throat caused by allergies or sinusitis, can also result in a cough. Some chronic conditions, such as asthma, chronic bronchitis, emphysema, and cystic fibrosis, are characterized in part by a cough. A condition in which stomach acid backs up into the esophagus (gastroesophageal reflux) can cause coughing, especially when a person is lying down. A cough can also be a side-effect of medications that are administered via an inhaler. It can also be a side-effect of beta-blockers and ACE inhibitors, which are drugs used for treating high blood pressure.

Cough - Diagnosis

To determine the cause of a cough, a physician should take an exact medical history and perform an exam. Information regarding the duration of the cough, what other symptoms may accompany it, and what environmental factors may influence it aid the doctor in his or her diagnosis. The appearance of the sputum will also help determine what type of infection, if any, may be involved. The doctor may even observe the sputum microscopically for the presence of bacteria and white blood cells. Chest x rays may help indicate the presence and extent of such infections as pneumonia or tuberculosis. If these actions are not enough to determine the cause of the cough, a bronchoscopy or laryngoscopy may be ordered. These tests use slender tubular instruments to inspect the interior of the bronchi and larynx.

Cough - Treatment

Treatment of a cough generally involves addressing the condition causing it. An acute infection such as pneumonia may require antibiotics, an asthma-induced cough may be treated with the use of bronchodialators, or an antihistamine may be administered in the case of an allergy. Physicians prefer not to suppress a productive cough, since it aids the body in clearing respiratory system of infective agents and irritants. However, cough medicines may be given if the patient cannot rest because of the cough or if the cough is not productive, as is the case with most coughs associated with colds or flu. The two types of drugs used to treat coughs are antitussives and expectorants.

Antitussives

Antitussives are drugs that suppress a cough. Narcotics--primarily codeine--are used as antitussives and work by depressing the cough center in the brain. However, they can cause such side effects as drowsiness, nausea, and constipation. Dextromethorphan, the primary ingredient in many over-the-counter cough remedies, also depresses the brain's cough center, but without the side effects associated with narcotics. Demulcents relieve coughing by coating irritated passageways.

Expectorants

Expectorants are drugs that make mucus easier to cough up by thinning it. Guaifenesin and terpin hydrate are the primary ingredients in most over-the-counter expectorants. However, some studies have shown that in acute infections, simply increasing fluid intake has the same thinning effect as taking expectorants.

Cough - Alternative treatment

Coughs due to bacterial or viral upper respiratory infections may be effectively treated with botanical and homeopathic therapies. The choice of remedy will vary and be specific to the type of cough the patient has. Some combination over-the-counter herbal and homeopathic cough formulas can be very effective for cough relief. Lingering coughs or coughing up blood should be treated by a trained practitioner.

Many health practitioners advise increasing fluids and breathing in warm, humidified air as ways of loosening chest congestion. Others recommend hot tea flavored with honey as a temporary home remedy for coughs caused by colds or flu. Various vitamins, such as vitamin C, may be helpful in preventing or treating conditions (including colds and flu) that lead to coughs. Avoiding of mucous-producing foods can be effective in healing a cough condition. These mucous-producing foods can vary, based on individual intolerance, but dairy products are a major mucous-producing food for most people.

Cough - Prognosis

Because the majority of coughs are related to the common cold or influenza, most will end in seven to 21 days. The outcome of coughs due to a more serious underlying disease depends on the pathology of that disease.

Cough - Prevention

It is important to identify and treat the underlying disease and origin of the cough. Avoid smoking and coming in direct contact with people experiencing cold or flu symptoms. Wash hands frequently during episodes of upper-respiratory illnesses.

Key Terms

Antitussives
Drugs used to suppress coughing.

Expectorant
Drug used to thin mucus.

Gastroesophageal reflux
Condition in which stomach acid backs up into the esophagus.

Glottis
The opening between the vocal cords at the upper part of the larynx.

Larynx
A part of the respiratory tract between the pharynx and the trachea, having walls of cartilage and muscle and containing the vocal cords.

Sputum
The mixture of mucus, irritants, and other substances expelled from the lungs by coughing.

Byssinosis

  Byssinosis is a chronic, asthma-like narrowing of the airways. Also called brown lung disease, byssinosis results from inhaling particles of cotton, flax, hemp, or jute.

Byssinosis - Description

Although inhaling cotton dust was identified as a source of respiratory disease more than 300 years ago, byssinosis has been recognized as an occupational hazard for textile workers for less than 50 years. More than 800,000 workers in the cotton, flax, and rope-making industries are exposed in the workplace to airborne particles that can cause byssinosis. Only workers in mills that manufacture yarn, thread, or fabric have a significant risk of dying of this disease.

In the United States, byssinosis is almost completely limited to workers who handle unprocessed cotton. More than 35,000 textile workers have been disabled by byssinosis and 183 died between 1979 and 1992. Most of the people whose deaths were due to byssinosis lived in the textile-producing regions of North and South Carolina.

Byssinosis - Causes and Symptoms

Wheezing, shortness of breath, and a feeling of tightness in the chest occur occasionally during the early stages of the disease. Symptoms are usually more pronounced when returning to work after a weekend, holiday, or vacation and subside as the worker becomes reaccustomed to the environment.

As many as 25% of workers with byssinosis have symptoms that continue or recur throughout the workweek. More severe breathing problems seem to result both from exposure to high levels of dust and from longer dust exposure. Workers who also smoke cigarettes suffer the most severe impairment.

Byssinosis - Diagnosis

Tests that detect decreasing lung capacity during the workday are used to diagnose byssinosis. Obstructive patterns are likely in patients who have had recurrent symptoms for more than 10 years.

Byssinosis - Treatment

Therapy for early-stage byssinosis focuses on reversing airway narrowing. Antihistamines may be prescribed to reduce tightness in the chest. Bronchodilators (drugs used to relax breathing passages and improve air flow) may be used with an inhaler or taken in tablet form. Reducing exposure is essential. Any worker who has symptoms of byssinosis or who has trouble breathing should transfer to a less-contaminated area.

Byssinosis - Prognosis

Smoking, impaired lung function, and a history of respiratory allergy increase a textile worker's risk of developing byssinosis. Prolonged exposure makes patients wheeze more often and can cause chronic bronchitis. It does not lead to permanently disabling lung disease.

Byssinosis - Prevention

Eliminating exposure to textile dust is the surest way to prevent byssinosis. Using exhaust hoods, improving ventilation, and employing wetting procedures are very successful methods of controlling dust levels to prevent byssinosis. Protective equipment required during certain procedures also prevents exposure to levels of contamination that exceed the current United States standard for cotton dust exposure.

Weight loss

Weight loss is typically recommended for people who are 20 or more pounds overweight. Being overweight can lead to diabetes, heart attack, stroke, early death, and complicate pregnancy. Those who are significantly overweight complain of joint and foot pain, foot disfigurement from an inability to find proper shoes, and chronic fatigue.

Weight problems can have various contributing factors, most of which has to do with lifestyle and the ability to make healthy choices. Snack foods, preprocessed foods, and candy are all contributors of weight problems. While it is true that thyroid problems can contribute to obesity, thyroid problems can be medicated. Some prescription medications cause significant weight gain such as prednisone, and other medications such as antidepressants.

The majority of obese people are victims of diet. Eating too much, having little to no education on what the food groups are and how they impact weight, and making chronically poor choices are often issues that are handed down from one generation to another. Children who come from obese households run a very high risk of becoming obese themselves. Often doctors will encourage overweight patients to lose weight. Weight indicator charts allow both physicians and patients see exactly where a patient’s body weight should be by figuring in their age and height. Overweight people are at risk for complications regarding their overall health. Heart attacks and strokes lead the list, but other complications exist such as kidney problems, joint problems, breathing problems, and breast problems in women. Underweight people are at risk for serious health issues as well, including osteoporosis, the inability to fight infection, the inability to regulate body temperature, and even death. Obese treatments vary, and most doctors still insist that the absolute best way to fight obesity is to reduce caloric intake and increase caloric output. Burning more calories than a person puts in invariably leads to weight loss. While the media has barraged television and magazine viewers with magic diet pills that will peel the pounds off for you, the Mayo Clinic studies have found no conclusive evidence that these pills do anything. Weight loss supplements, drinks, prepackaged foods, workout DVDs, surgically reducing the size of the stomach, and weight loss programs are all weight loss ideas that have become part of Americana. Some work reasonably well while others have not been proven to enhance permanent weight loss. Anything that promotes the burning of energy such as exercise DVDs has potential. Prepackaged weight loss meals teach people how to make better choices, and group programs help people stay in the program. Unintentional weight loss may be the result of an illness or depression. Diagnosing the problem is the key to stopping the weight loss and encouraging healthy body weight. Unintentional weight loss that can be attributed to lack of appetite may be caused by medication. Many people who have lost weight unintentionally do not wish to gain the weight back. Losing weight is a struggle, and patients need to be motivated in order to be successful. They need to stop believing the media hype that promises weight loss of unreasonable weight in very short amounts of time. Dropping too much weight in a short time is not healthy. Real weight loss comes from a dedicated effort to chronically make healthy food choices and exercising regularly. Patients need to set reasonable goals for themselves and ask for their physician’s assistance in the best weight loss program for them. Underweight individuals need to recognize that they are unhealthy and learn to manage their weight issues with more care, without just eating high calorie, high fat foods. Coping with weight issues can be a chronic lifetime struggle. Every time the patient exercises and makes good choices, they are winning the battle. Every time they can see the results on a scale or when they put their clothes on, they receive positive feedback. Positive feedback reinforces the positive behavior.

Asthma

Asthma is a chronic disorder of the lungs in which inflamed airways are prone to constrict, causing episodes of breathlessness, wheezing, coughing, and chest tightness that range in severity from mild to life-threatening. Inflamed airways become hypersensitive to a variety of stimuli, including dust mites, animal dander, pollen, air pollution, cigarette smoke, medications, weather conditions, and exercise. Stress can exacerbate symptoms.

Asthmatic episodes may begin suddenly or may take days to develop. Although an initial episode can occur at any age, about half of all cases occur in persons younger than 10 years of age, with boys being affected more often than girls. Among adults, however, the incidence of asthma is approximately equal in men and women. When asthma develops in childhood, it is often associated with an inherited susceptibility to allergens, substances such as pollen, dust mites, or animal dander that may induce an allergic reaction. In adults, asthma also may develop in response to allergens, but viral infections, aspirin, and exercise may cause the disease as well. Adults who develop asthma may have nasal polyps or sinusitis.

Lupus Erythematosus

Also often referred to simply as lupus, this is an autoimmune disorder that causes chronic inflammation in various parts of the body. Three main types of lupus are recognized—discoid, systemic, and drug-induced.

Discoid lupus affects only the skin and does not usually involve internal organs. The term discoid refers to a rash of distinct reddened patches covered with grayish brown scales that may appear on the face, neck, and scalp. In about 10 percent of people with discoid lupus, the disease will evolve into the more severe systemic form of the disorder.

Systemic lupus erythematosus is the most common form of the disease. It may affect virtually any organ or structure of the body, especially the skin, kidneys, joints, heart, gastrointestinal tract, brain, and serous membranes (membranous linings of organs, joints, and cavities of the body.) While systemic lupus can affect any area of the body, most people experience symptoms in only a few organs. The skin rash, if present, resembles that of discoid lupus. In general, no two people will have identical symptoms. The course of the disease is also variable and is marked by periods when the disease is active and by other periods when symptoms are not evident (remission).