Wednesday, February 26, 2014

Sciatic

Sciatica If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disk in your spinal column that is pressing on the nerve roots in the lumbar spine. This condition is known as sciatica. Symptoms Sciatica may feel like a bad leg cramp, with pain that is sharp ("knife-like"), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, "pins and needles" numbness, or a burning or tingling sensation down your leg. Top of page Causes You are most likely to get sciatica between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, plus any sudden pressure on the disks that cushion the bones (vertebrae) of your lower spine. Normal lumbar anatomy/cross-section Herniated disk (side view and cross-section) Sciatica is most commonly caused by a herniated disk. The gel-like center (nucleus) of a disk may protrude into or through the disk's outer lining. This herniated disk may press directly on the nerve roots that become the sciatic nerve. Nerve roots may also get inflamed and irritated by chemicals from the disk's nucleus. Approximately 1 in every 50 people will experience a herniated disk at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks. In rare cases, a herniated disk may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately. Top of page Doctor Examination Diagnosis begins with a complete patient history. Your doctor will ask you to explain how your pain started, where it travels, and exactly what it feels like. A physical examination may help pinpoint the irritated nerve root. Your doctor may ask you to squat and rise, walk on your heels and toes, or perform a straight-leg raising test or other tests. X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan, may confirm your doctor's diagnosis of which nerve roots are affected. Top of page Treatment Nonsurgical Treatment The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks. Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles. It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort. Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks. Sometimes, your doctor may inject your spinal area with a cortisone-like drug. As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy. Surgical Treatment You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disk may be removed to stop it from pressing on your nerve. The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg. Rehabilitation Your doctor may give you exercises to strengthen your back. It is important to walk and move while limiting too much bending or twisting. It is acceptable to perform routine activities around the house, such as cooking and cleaning. Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it is always possible for your disk to rupture again.

Arthritis ( http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/frequently-asked-questions-about-arthritis.html)

This article answers some general questions about arthritis including how arthritis affects the body and some statistics on who gets arthritis.

What is arthritis?
The word arthritis literally means joint inflammation ("arthr-" means joint; "-itis" means inflammation). It refers to more than 100 different diseases. These diseases usually affect the area in or around joints such as muscles and tendons. Some of these diseases can also affect other parts of the body including the skin and internal organs.

There are many types of arthritis. Most forms of arthritis are chronic which means they may last a lifetime.

Who gets arthritis? Nearly 40 million Americans or one in every seven people have arthritis. It affects people of all ages but it most often comes on as a person gets older.

How does arthritis feel? Arthritis usually causes stiffness pain and fatigue. The severity varies from person to person and even from day to day. In some people only a few joints are affected and the impact may be small. In other people the entire body system may be affected. The joints of the body are the site of much of the action in arthritis.
Many types of arthritis show signs of joint inflammation: swelling stiffness tenderness redness or warmth.
These joint symptoms may be accompanied by weight loss fever or weakness. When these symptoms last for more than two weeks inflammatory arthritis such as rheumatoid arthritis may be the cause.
Joint inflammation may also be caused by infection which can lead to septic arthritis. Degenerative joint disease (osteoarthritis) is the most common type of arthritis; joint inflammation is not a prominent feature of this condition. While normal joints can support a vast amount of use mechanical abnormalities of a joint make it susceptible to degeneration. It is healthy for you to keep active and move your joints. If you do not move a joint regularly the muscles around it weaken and/or become tight. The joint can stiffen or even freeze. When you do try to move the joint and muscles hurt because they have been still for so long.
Many things affect how your joints and muscles feel. Pain may be caused by swelling joint damage muscle tightness or spasm. Muscles hurt after doing exercise or activities you aren't used to; sometimes when the joint is damaged simple activities stress the joint. When your joints are inflamed or damaged you need to take certain precautions as you do all your daily activities.
Your doctor or therapist can teach you exercises and the correct use of heat and cold to decrease pain. You can also learn how to use your body with the least stress to your joints for less pain easier movement and even more energy. Arthritis can make it hard to do the movements you rely on every day for work or taking care of your family.

Can arthritis cause numbness? Numbness is often a symptom of nerve involvement. For instance numbness in the arm may be related to nerve irritation in the neck.
In such a situation turning or bending the head to the involved side may increase the symptoms.
For example a pinched nerve in the right side of the neck may cause numbness in the arm and hand when a person attempts to look back over the right shoulder. If nerve irritation becomes more severe the arm and hand may become weak.
A physical examination X-rays and an MRI of the neck and electrodiagnostic tests may be useful in establishing the diagnosis.

Why do joints make popping and cracking noises? Joints can make different noises--some are serious and some are not. Some people learn how to "pop their knuckles." By pushing or pulling a joint in a certain way an air bubble can suddenly appear in the joint with a "pop." Once the bubble is there the joint cannot be popped again until the air has been reabsorbed. Some joints crack as the ligaments and tendons that pass over them slide past bumps on the bones. Individuals who "crack their neck" make noise in this way. Other joints lock up intermittently--often with a loud pop--because something gets caught in between the joint surfaces.
A torn cartilage in the knee or a loose piece of bone or cartilage in the joint can do this. Once a joint is stuck in this way it may need to be wiggled around to unlock it. This may also cause a pop.
Finally joints that are arthritic may crack and grind. These noises usually occur each time the joint is moved. This noise is due to the roughness of the joint surface due to loss of the smooth cartilage. Can cracking knuckles cause arthritis? There is no evidence that cracking one's knuckles can cause arthritis directly. However repeated injury of a joint or repeatedly causing it to swell can injure the cartilage and potentially lead to degenerative joint disease.

What are the warning signs of arthritis? Pain from arthritis can be ongoing or can come and go. It may occur when you're moving or after you have been still for some time. You may feel pain in one spot or in many parts of your body. Your joints may feel stiff and be hard to move. You may find that it's hard to do daily tasks you used to do easily such as climbing stairs or opening a jar.
Pain and stiffness may be more severe during certain times of the day or after you've done certain tasks. Some types of arthritis cause swelling or inflammation. The skin over the joint may appear swollen and red and feel hot to the touch. Some types of arthritis can also cause fatigue.

What causes arthritis? There are more than 100 different types of arthritis. What causes most types is unknown. Because there are so many different types there are likely to be many different causes.
Scientists are currently researching what roles three major factors play in certain types of arthritis. These include the genetic factors you inherit from your parents what happens to you during your life and how you live. The importance of these factors varies for every type of arthritis.

How is arthritis diagnosed?
It's important to find out if you have arthritis and what type it is because treatments vary for each type. Early diagnosis and treatment are important to help slow or prevent joint damage that can occur during the first few years for several types. Only a doctor can tell if you have arthritis and what type it is.
When you see your doctor for the first time about arthritis expect at least three things to happen. Your doctor will ask questions about your symptoms examine you and take some tests or X-rays. You can help your doctor by writing down information about your symptoms before your appointment.
Bring your answers when you see your doctor. Arthritis may limit how far or how easily you can move a joint. Your doctor may move the joint that hurts or ask you to move it. This is to see how far the joint moves through its normal range of motion. Your doctor may also check for swelling tender points skin rashes or problems with other parts of your body.
Finally your doctor may conduct some laboratory tests. These may include tests of your blood muscles urine or joint fluid. They also may include X-rays or scans of your body. The tests will depend on what type of arthritis your doctor suspects. They help confirm what type of arthritis your doctor suspects based on your medical history and physical exam and help rule out other diseases that cause similar symptoms.
The overall results from your medical history physical exam and tests help your doctor match your symptoms to the pattern for a specific type of arthritis. It may take several visits before your doctor can tell what type of arthritis you have. Symptoms for some types of arthritis develop slowly and may appear similar to other types in early stages. Your doctor may suspect a certain type of arthritis but may watch how your symptoms develop over time to confirm it.

What type of doctors treat arthritis? Part of your treatment plan may involve working with different health-care specialists. Some common health-care professionals and their role in your treatment are described below. Most doctors make referrals to one of a group of health professionals with whom they work. But you too can ask your doctor to request medical services you think might help you. Your family doctor may be an excellent source of medical care for your arthritis.
Besides having your medication records your family doctor already has your medical history is familiar with your general physical health and knows of any past illnesses or injuries. All these facts will give your family doctor a head start in prescribing a treatment plan most suited to your needs. If your arthritis affects many joints or other parts of the body or seems resistant to treatment you may benefit from seeing a rheumatologist. This is a doctor with special training and experience in the field of arthritis. Your family doctor the local chapter of the Arthritis Foundation or the county medical society can refer you to a rheumatologist. You can also search for a rheumatologist on the American College of Rheumatology web site. Family physicians and general practitioners provide medical care for adults and for children with different types of arthritis. These doctors also can help you find a specialist if necessary. Internists specialize in internal medicine and in the treatment of adult diseases. They provide general care to adults and often help select specialists. Internists should not be confused with interns who are doctors doing a year's training in a hospital after graduating from medical school.
Rheumatologists and orthopedists specialize in treating people with arthritis or related diseases that affect the joints muscles bones skin and other tissues. Most rheumatologists are internists who have had further training in the care of people with arthritis and related diseases. Some rheumatologists also have training in pediatrics. Orthopedists can offer treatment methods including surgery.
Ophthalmic specialists provide eye care and treatment. Pediatricians treat childhood diseases.
Physiatrists are doctors who specialize in physical medicine and rehabilitation. They may be asked to evaluate your conditions and may direct or prescribe your physical therapy and rehabilitation.
Podiatrists are experts in foot care. If arthritis affects your feet a podiatrist can prescribe special supports and shoes.
Psychiatrists treat mental or emotional problems that need special attention.
Nurses trained in arthritis care assist your doctor with your treatment. They also help teach you about your treatment program and can answer many of your questions. Nurses also provide care during hospitalization. Occupational therapists can teach you how to reduce strain on your joints while doing everyday activities. They can teach you how to manage stress more effectively recommend and show you how to use self-help devices suggest ways to make everyday and work activities easier and teach you how to reduce strain on your joints and conserve energy. They may also provide you with splints and other joint protection devices. Pharmacists fill your prescriptions for medicines and can explain the drugs' actions and side effects. Pharmacists can tell you how different medicines work together when and how to take your medications and can answer questions about over-the-counter medicines. Physical therapists can show you exercises to help keep your muscles strong and your joints from becoming stiff. They can help you learn how to use special equipment to move better.
Some physical therapists also are trained to design personal fitness programs such as prescribed muscle strengthening and range of motion exercises for cardiovascular health maintenance and weight control. They can also show you non-medication ways to control pain. If you've had surgery they can give you pre- and post-surgical care and show you the correct use of devices such as walking aids. Psychologists can help you solve emotional or mental problems. They can offer counseling for individual or family support and help you discover effective ways to cope with the emotional aspects of having arthritis.
Social workers are specially trained to understand situations that may be difficult to deal with or to talk about. People often meet with a social worker to discuss personal family social or financial issues that occur as a result of having arthritis. They often suggest appropriate community resources.
Certified dietitians (nutritionists) can help by teaching you about any special dietary programs or about healthier ways to eat. X-ray and laboratory technologists perform tests which help your doctor make a diagnosis or follow the effects of certain medications. What is the patient's role in treating or managing arthritis? The patient is the most important member of the health care team. The patient plays an important role in his or her medical care.
The patient can contribute to the success of a treatment plan by: learning about arthritis following through with treatment reporting progress and setbacks to health team keeping a positive attitude developing relationships with the rest of the health care team Keeping a positive attitude though sometimes difficult is an important ingredient in overcoming arthritis. Asking questions and finding out as much as you can about of arthritis and its treatment is important.
So talk over your concerns with your doctor. If you still need more information (or if you have difficulty talking to your doctor) ask the nurse physical therapist social worker occupational therapist to help you find answers to your questions.

What are the types of arthritis? Arthritis most often affects areas in or around joints. Joints are parts of the body where bones meet such as your knee. The ends of the bones are covered by cartilage a spongy material that acts as a shock absorber to keep bones from rubbing together. The joint is enclosed in a capsule called the synovium.
The synovium's lining releases a slippery fluid that helps the joint move smoothly and easily. Muscles and tendons support the joint and help you move. Different types of arthritis can affect one or more parts of a joint. This often results in a change of shape and alignment in the joints. Certain types of arthritis can also affect other parts of the body such as the skin and internal organs. There are more than 100 different types of arthritis. It is important to know which type of arthritis you have so you can treat it properly. If you don't know which type you have call your doctor or ask during your next visit. Some common types of arthritis are described below.
Osteoarthritis The most common type of arthritis is osteoarthritis. It affects many of us as we grow older. It is sometimes called degenerative arthritis because it involves the breakdown of cartilage and bones. This causes pain and stiffness. Osteoarthritis usually affects the fingers and weight-bearing joints including the knees feet hips and back. It affects both men and women and usually occurs after age 45. Treatments include pain relievers or anti-inflammatory drugs exercise heat or cold joint protection pacing your efforts self-help skills and sometimes surgery.
Fibromyalgia
Fibromyalgia affects muscles and their attachments to bone. It results in widespread pain and tender points which are certain places on the body that are more sensitive to pain. It also may result in fatigue disturbed sleep stiffness and sometimes psychological distress. Fibromyalgia affects mostly women. It is common and often misdiagnosed. Treatments include exercise relaxation techniques pacing your activities and self-help skills. Rheumatoid arthritis In rheumatoid arthritis a fault in the body's defense or immune system causes inflammation or swelling. Inflammation begins in the joint lining and then damages both cartilage and bone.
Rheumatoid arthritis often affects the same joints on both sides of the body. Hands wrists feet knees ankles shoulders and elbows can be affected. Rheumatoid arthritis is more common in women than in men. Treatments include anti-inflammatory and disease-modifying drugs exercise heat or cold saving energy joint protection self-help skills and sometimes surgery.
Gout
Gout results when the body is unable to get rid of a natural substance called uric acid. The uric acid forms needle-like crystals in the joint that cause severe pain and swelling. Gout usually affects the big toe knees and wrists. More men than women have gout. Treatments include anti-inflammatory and special gout drugs and sometimes a diet low in purines. Foods such as organ meats beer wine and certain types of fish contain high levels of purines.
Low back pain
Low back pain results from a back injury or certain types of arthritis. Back pain is one of the most common health problems in the United States. It can occur at any age in both men and women. Treatments include pain relievers or anti-inflammatory drugs exercise heat or cold joint protection pacing your activities and self-help skills.
Bursitis and tendinitis
Bursitis and tendinitis result from irritation caused by injuring or overusing a joint. Bursitis affects a small sac that helps muscles move easily; tendinitis affects the tendons that attach muscle to bone. Treatments include anti-inflammatory drugs heat or cold and exercise. Other types There are many more types of arthritis and related diseases including ankylosing spondylitis juvenile rheumatoid arthritis polymyalgia rheumatica and lupus erythematosus.

What are bone spurs?
Bone spurs are of two basic types. One is the kind that arises near a joint with osteoarthritis or degenerative joint disease. In this situation the cartilage has been worn through and the bone responds by growing extra bone at the margins of the joint surface. These "spurs" carry the formal name "osteophytes." They are common features of the osteoarthritic shoulder elbow hip knee and ankle. Removing these osteophytes is an important part of joint replacement surgery but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms.
The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. Thus can occur on the bottom of the foot around the Achilles Tendon and in the coroacoacromial ligament of the shoulder. Thus spurs often look impressive on X-rays but because they are in the substance of the ligaments rarely cause sufficient problems to merit excision.

What are common arthritis treatments? There are many things that help reduce pain relieve stiffness and keep you moving. Your care may involve more than one kind of treatment. Your doctor may recommend medications but there are many things you can do on your own to help manage pain and fatigue and move easier. Finding the right treatment takes time. It can involve trial and error until you and your healthcare team or therapist find what works best. Be sure to let your doctor know if a treatment is not working. Your treatment may also change as your arthritis changes. Treatments for arthritis can be divided into several categories: medication exercise heat/cold pacing joint protection surgery and self-help skills. You can do things in each of these areas to help yourself feel better and move easier. Medication Many different drugs are used to treat arthritis. Some are available without a prescription; others must be prescribed by your doctor. You should always check with your doctor before taking any medication even over-the-counter drugs. Your doctor can tell you how much and when to take them for best relief as well as how to avoid any drug-related problems. These are some of the common medications used to treat arthritis. Your doctor may prescribe other medication to treat specific forms of arthritis or in specific situations. Anti-inflammatories reduce both pain and swelling. These medications are called nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs such as aspirin ibuprofen and naproxen sodium are available without a prescription; others are only available by prescription. The most common side effect of these medications is stomach upset. Call your doctor if stomach pain is more than mild and lasts. Aspirin is commonly used to treat many forms of arthritis. Aspirin-free pain relievers may be recommended by your doctor if you just need pain relief are allergic to aspirin or have had an ulcer. Acetaminophen gives temporary relief of common arthritis pain but does not reduce swelling. It is available without a prescription. Corticosteroids are prescribed to reduce severe pain and swelling. They are given by injection or in pill form. Injections can bring quick relief but can only be used several times in one year because they weaken bone and cartilage. Because of potentially serious side effects corticosteroids must be prescribed and monitored by a doctor. Disease modifiers tend to slow down the disease process in rheumatoid arthritis. Researchers do not know how this happens. These drugs are available only by prescription and may take several weeks or months to work. Your doctor will carefully monitor you for side effects. Sleep medications may promote deeper sleep and help relax muscles. These drugs may help people with fibromyalgia sleep better. They are available by prescription and are used in very low doses at bedtime. Questions you should ask about your medications: What is its name? How much do I take? How and when do I take it? How long will it be before it works? What benefits can I expect? When should I contact my doctor if I don't get relief? What side effects should I watch for? What other drugs should I not take with it? Exercise Regular exercise is important to keep you moving and independent. Exercise helps lessen pain increases movement reduces fatigue and helps you look and feel better. Three types of exercises can help people with arthritis. Range-of-motion exercises reduce stiffness. They keep your joints flexible by moving them to their fullest extent. Most people should do these exercises daily. Strengthening exercises increase or maintain muscle strength. Strong muscles help keep your joints stable and make it easier to move. Most people should do these exercises daily or every other day. Endurance exercises build fitness. They help keep your heart healthy and control your weight. You should exercise for a total of 20 to 30 minutes three times a week at a pace that raises or sustains your heart rate. Most people can build your endurance by exercising for shorter periods of time several times a day. Plan your exercises at times of the day when you have less stiffness or pain. Start slowly. Build up the amount of time you exercise and the number of repetitions you do. Exercise at a level that allows you to talk comfortably during the activity. If pain from exercise lasts more than two hours you may have done too much. Reduce your level of activity next time. Stop exercising right away if you have chest pains severe dizziness or shortness of breath or if you feel sick to your stomach. Heat and cold Using heat or cold over joints or muscles may give you short-term relief from pain and stiffness. You can also use heat or cold to help prepare for exercise. Some people feel better using heat; others prefer cold. Heat helps relax aching muscles. Sources of heat include heating pads hot packs hot tubs or heated pools. Cold numbs the area so you don't feel as much pain. You can apply cold with ice cold packs or even bags of frozen vegetables. It's important to use heat and cold safely. Don't use either treatment for more than 20 minutes at a time. Let your skin return to normal temperature between applications. Don't use heat with rubs or creams since this can result in skin burns. For more information on using heat and cold correctly talk to your physical therapist. Pacing yourself Pacing yourself saves energy by switching periods of activity with periods of rest. Pacing helps protect your joints from the stress of repeated tasks and helps reduce fatigue. Alternate heavy or repeated tasks with easy ones. Change tasks often so you don't hold joints in one position for a long time. Plan rest breaks during your daily activities. Joint protection You can protect your joints by using them in ways that avoid excess stress. Protecting your joints makes it easier to do daily tasks. Joint position means using joints in the best way to avoid excess stress. Use larger or stronger joints to carry things. For instance carry your grocery bags using your forearms or palms instead of your fingers. Walking or assistive devices can keep stress off certain joints. Your doctor may suggest using a cane crutches or a walker to reduce stress on your hips and knees. Many assistive devices have special features that help make tasks easier. Special aids with larger handles such as extra-thick pens make it easier to hold and write. Longer handles and reachers give you better leverage. Lightweight items such as plastic dishes are easier to carry. Weight control involves staying close to your recommended weight or losing weight if you are overweight. Weight control helps reduce your risk for developing osteoarthritis in the knees or gout. If you already have knee osteoarthritis losing weight may lessen pain by reducing stress on your joints. Exercise and reducing calories will help you lose weight. If you need to lose a lot of weight work with your doctor and a registered or licensed dietitian to find the best weight-loss program for you. Surgery Most people with arthritis will never need surgery. However surgery can help in some cases when other treatments have failed. It can reduce pain increase movement and improve physical appearance. Two kinds of surgery help people with arthritis. The first kind repairs the existing joint by removing debris fusing or correcting bone deformity. The second replaces the joint with an artificial joint. If your doctor suggests surgery you may want to ask another doctor for a second opinion. Orthopedic surgeons are the doctors who perform most joint replacements. Plastic surgeons may help with hand surgery. What's new in arthritis research? Progress is so fast in some areas of arthritis research today that the media often report new findings before the medical journal with the information reaches your doctor's office. As a result you need to know how to evaluate reports on new arthritis research. Arthritis researchers are looking at four broad areas of research. These include causes treatments education and prevention. Researchers are learning more about certain conditions. For example in osteoarthritis researchers are looking for signs of early destruction of cartilage and ways to rebuild it. For rheumatoid arthritis and other types that involve inflammation researchers are trying to understand the steps that lead to inflammation and how it can be slowed or stopped. An initial study suggests that fibromyalgia affects more older people than originally thought and often may be overlooked in this group. Your doctor can tell you about other new research findings. If you would like to take part in arthritis research ask your doctor for a referral to a study in your area. Many people help make arthritis research possible. The federal government through its National Institutes of Health is the largest supporter of arthritis research. Drug companies do the most research on new medications. Credits Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK contact the National Helpline: (800) 283-7800. Adapted from several pamphlets originally prepared for the Arthritis Foundation one of which is by Beth Ziebell Ph.D. This material is protected by copyright. For up-to-date and comprehensive resources on shoulder arthritis, please visit our new online Shoulder Arthritis Book and Rotator Cuff Tear Book!

Monday, February 17, 2014

Barrett's Esophagus from About.com

Barrett's Esophagus
By Sharon Gillson

Barrett's esophagus is a disorder in which the lining of the esophagus is damaged. This damage occurs when parts of the esophageal lining are repeatedly exposed to stomach acid, and are replaced by tissue that is similar to what is found intestine. This process is called intestinal metaplasia. The cells in the lining of the esophagus and the stomach have different functions, and are different types of cells. Also, their appearance is very different, making it easy for a physician to tell them apart when examining the esophagus and stomach. At the end of the esophagus, there is an area that marks the border between the cells of the esophagus and the cells of the stomach. With Barrett's esophagus, abnormal intestinal-like cells develop above this border. Causes of Barrett's Esophagus Barrett's esophagus is uncommon. The most common risk factor for Barrett's esophagus is long-term gastroesophageal reflux disease (GERD), though only a small percentage of GERD patients will develop Barrett's esophagus.

However, once Barrett's esophagus is present, there is a greater risk of developing esophageal cancer. Statistics show, though, that while the risk is increased, the overall risk is less than 1% per year of Barrett's esophagus patients developing this cancer.
When stomach acid backs up into the esophagus, it can cause injury to the normal lining of the esophagus. Esophageal injury with inflammation is called esophagitis. If this injury to the esophagus continues over many years, the injured normal lining of the esophagus will not grow back. Instead, it is replaced by an abnormal lining called Barrett's esophagus.

Symptoms of Barrett's Esophagus

Barrett's esophagus itself does not produce any symptoms. The acid reflux that causes Barrett's esophagus can have the symptoms of heartburn. If Barrett's esophagus has progressed to cancer of the esophagus, the symptoms can include difficulty swallowing or weight loss. Barrett's esophagus itself, however, does not cause symptoms.
Diagnosing Barrett's Esophagus

Individuals who have experienced acid reflux symptoms for a number of years should undergo an upper endoscopy exam to determine if they have Barrett's esophagus. Tissue samples from abnormal looking areas of the esophagus are taken during this procedure and examined under a microscope for the presence of abnormal cells. Tissue, showing intestinal metaplasia with goblet cells, is necessary to make the diagnosis of Barrett’s esophagus.
Treating Barrett's Esophagus

The best treatment strategy for Barrett's esophagus is prevention. When people are diagnosed with GERD, their doctor will work with them on lifestyle and diet modifications, and possible medications (such as antacids, proton pump inhibitors, and H2 blockers) to control the acid reflux.
Currently, there are no medications that will reverse Barrett's esophagus. Treating the underlying GERD, however, may slow the progress of the disease and help prevent complications. This includes:

Eating smaller, more frequent meals
Limiting intake of acid-stimulating foods and beverages
Not laying down for about two hours after you eat
Elevating the head a few inches while you sleep
Maintaining a reasonable weight
Quit smoking
Avoiding drink alcohol
Not wearing belts or clothes that are tight fitting around the waist
Taking any doctor-prescribed medications for acid reflux symptoms
Prognosis

An increased risk of esophageal cancer is present. A follow-up endoscopy to look for dysplasia or cancer is important.

Other ref: http://www.sts.org/patient-information/esophageal-surgery/barretts-esophagus

Sunday, February 9, 2014

National Organization of Rare Diseases

http://books.google.com/books?id=99YPDvFWBB0C&pg=PA303&lpg=PA303&dq=adiposis+dolorosa+heart&source=bl&ots=BjpOyDwIGB&sig=ODgYk93e-Yo0rmgAD-CdRFT7_PE&hl=en&sa=X&ei=81b3Uu-GOJKCyAHmkoHICA&ved=0CDIQ6AEwBTgK

Dercums Heart

adiposis car·di·a·ca (kär′dē-ā′kə) n. See fatty heart.

fatty heart
1. one that has undergone fatty degeneration.
2. a condition in which fat has accumulated around and in the heart muscle.

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company.

Feb 09, 2014 |  Cherokee Nation citizen diagnosed with rare disease 7/23/2012 9:16:36 AM

  Cherokee Nation citizen Leigh Beyard, of Claremore, Okla., points to an area on her leg where there are several lipomas or painful fatty tissue growths. Those with the rare condition, Dercum’s Disease, have several lipomas mostly on their arms, abdomen and legs. TESINA JACKSON/CHEROKEE PHOENIX BY TESINA JACKSON Reporter CLAREMORE, Okla. –

When Cherokee Nation citizen Leigh Beyard first felt pain throughout her body, the doctors at Claremore Indian Hospital could not find what caused it. It wasn’t until after sharing a newspaper column with the doctors that they were able to diagnose her with Dercum’s Disease, a rare condition characterized by painful fatty tissue growths called lipomas. “I want them to be able to help me find out what causes this,” Beyard said. “Some people have had this for 15 years. Other people have died within three years of being diagnosed.” Dercum’s Disease, or adiposis dolorosa, was discovered in 1888 by neurologist Francis Xavier Dercum. Although it’s more common in women, 16 percent of reported cases are male. Symptoms include lipomas, usually around the legs, arms and abdomen; generalized obesity; weakness and tiredness; depression; irritability; confusion; and possible dementia. “People with Dercum’s Disease have problems in every system,” said Dr. Karen Herbst, one of few doctors in the country who researches the disease. “They have trouble sleeping. They have depression and anxiety. They have shortness of breath. They have palpitations. They have gastro-intestinal problems like constipation and diarrhea, irritable bowel, and they have pain.” Beyard, 47, said when she first went to Claremore Indian Hospital she waited eight hours for a doctor to say, “I can tell you what your problem is right now. You’re fat.” “It’s not due to being obese. It’s actually that the underlying Dercum’s Disease is causing people to become more obese,” Herbst said. “I think obesity contributes to it. I think it kind of sets it off and then when it sets it off then the people become even more obese.” The disease’s cause is unknown because of the little research that has been conducted. Also, there is no cure. Dercum’s Disease is often controlled with pain medication. In some cases, surgery or liposuction can be performed to remove the lipomas, but results often come back inconclusive. Beyard first felt pain five years ago and was diagnosed three years ago. She now sees a doctor at OMNI Medical Group in Claremore who is helping her research the disease. “We’re just wanting to find out more to see life expectancy and everything like that because they told me that if these tumors are on my lungs then I may not live two years and that was eight months ago,” Beyard said. When a friend of hers, CN citizen Aubrey Skaggs, started having similar symptoms, Beyard suggested that Skaggs mention the disease to her doctors. After feeling pain for six years, the doctors diagnosed Skaggs with Dercum’s in 2011. “I had no idea what it was and I go to the Indian hospital here in Claremore. And the first time I went in they didn’t have any idea what it was,” Skaggs said. “The doctor I talked to that day had never even heard of it.” Skaggs tried to get a referral for another doctor but was denied based of funding. She continues to work and takes anti-inflammatory for the pain. “It’s pretty painful, but it’s something I try to deal with everyday,” she said. When Herbst started researching the disease, she found that out of 110 people she surveyed, 20 percent of them had Native American blood. Her research also shows that Caucasian and Native American are the dominant races with the disease, but she can’t explain why. In most cases, Dercum’s Disease has been sporadic and thought to be hereditary. Beyard and Skaggs both had family members who had similar symptoms but was never diagnosed. “In some cases, nobody else in the family is affected,” Herbst said. “So it could develop spontaneously like a new mutation in that person. But in other cases, it’s clearly in the family.” To lessen the pain, Beyard and Skaggs have dieted to lose weight. They also find exercise painful. Herbst said she tries to help those with Dercum’s by changing their diet and exercise regimen. “I do a multipronged approach to help people,” she said. “Even though it’s really hard to lose the fat by diet and exercise, I still have them change their diet to one that’s as healthy as possible. So lots of fruits and vegetables.” Herbst said exercise causes inflammation in the body. People with Dercum’s can’t handle the inflammation as well as healthy people, so she advocates swimming. “We encourage swimming as the most important thing to do because the water kind of acts as compression outside of their body. And as they move in the water, the water squeezes the fat in between the muscle and it tends to help mobilize fluid,” she said. When Dercum’s Disease was first discovered, doctors didn’t have the tools they have today to research it. For many people who have the disease, it leaves unanswered questions. “I want to find out so that maybe other people won’t have to go through the same thing that I had to go through,” Beyard said. tesina-jackson@cherokee.org 918-453-5000, ext. 6139 Latest headlines... 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Monday, February 3, 2014