Facial Nerve Palsy or Bell's palsy

Facial Nerve Palsy

Jean Chrétien He was the twentieth Prime Minister of Canada, serving for over ten years, from November 4, 1993 to December 12, 2003;.suffered from facial palsy.

Bell's palsy or facial nerve palsy.

Bell's palsy is a weakness of the facial muscles. It develops suddenly, usually on one side of the face. The cause is not clear but most cases are probably due to a virus infection. Most people make a full recovery within 2-3 months. A course of steroid tablets started within 72 hours of the onset improves the chance of full recovery even further. You should protect your eye if you cannot close your eyelids fully.

What is Bell's palsy?

Bell's palsy is a weakness (paralysis) that affects the muscles of the face. It is due to a problem with the facial nerve. The weakness usually affects one side of the face. Rarely, both sides are affected. Many people who have a Bell's palsy at first think that they have had a stroke. This is not so. Bell's palsy is very different to a stroke and full recovery occurs in most cases. Bell's palsy is named after the doctor who first described it. Originally described by Sir Charles Bell in 1821. Incidence 20/100,000 between 10-40 years, but 59/100,000 over 65 years.Recent work suggests that a large number of these cases may be due to herpetic viral infection - particularly Herpes Simplex type 1, or Varicella (herpes) Zoster which clearly may have implications for

management.

What is the facial nerve?

Neuroanatomy

The VII th cranial (facial) nerve is largely motor in function (some sensory fibres from external acoustic meatus, fibres controlling salivation and taste fibres from the anterior tongue in the chorda tympani branch). It also supplies the stapedius (so a complete nerve lesion will alter auditory acuity on the affected side). From the facial nerve nucleus in the brain stem, fibres loop around the VI nucleus before leaving the pons medial to VIII and passing through the internal acoustic meatus. It passes through the petrous temporal in the facial canal, widens to form the geniculate ganglion (taste and salivation) on the medial side of the middle ear whence it turns sharply (and the chorda tympani leaves), to emerge through the stylomastoid foramen to supply all the muscles of facial expression including platysma.

You have a facial nerve (also called the seventh cranial nerve) on each side of your face. Each facial nerve comes out from your brain, through a small tunnel in your skull just under your ear.The nerve splits into many branches that supply the small muscles of the face that you use to smile, frown, etc. It also supplies the muscles that you use to close your eyelids.Branches of the facial nerve also take taste sensations from your tongue to your brain.

Who gets Bell's palsy?
Anyone can get Bell's palsy, and it affects both men and women equally. It most commonly occurs between the ages of 10 and 40. Bell's palsy is the most common cause of a sudden facial weakness. About 1 in 70 people has a Bell's palsy at some stage in their life.

What causes Bell's palsy?
It is thought that inflammation develops around the facial nerve as it passes through the skull from the brain. The inflammation may compress (squash) the nerve as it passes through the skull. The nerve then partly, or fully, stops working until the inflammation goes. If the nerve stops working, the muscles that the nerve supplies also stop working.

The cause of the inflammation is not known; but, in most cases, it is probably due to a viral infection. There is some evidence that the cold sore virus (herpes simplex virus) or the chickenpox virus (varicella zoster virus) cause most cases of Bell's palsy. Most people have chickenpox at some stage (usually as a child) and many people have cold sores. The virus does not completely go after you have chickenpox or a cold sore. Some virus particles remain dormant (inactive) in the nerve roots. They do no harm there, and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (re-activate). This is often many months or years later. In some cases, the re-activated' virus is thought to cause inflammation around the facial nerve to cause Bell's palsy.

What are the symptoms of Bell's palsy?
Weakness of the face which is usually one-sided. The weakness normally develops quickly, over a few hours or so. You may first notice the weakness after getting up in the morning, and so it may appear quite dramatic. It may gradually become worse over several days. The effects of the weakness vary, depending on whether the nerve is partially or fully affected. These include the following:

Your face may droop to one side. When you smile, only half of your face may move.
Chewing food on the affected side may be a problem. Food may get trapped between your gum and cheek. Drinks and saliva may escape from the side of your mouth.

. You may not be able to close an eye. This may cause a watery or dry eye.
. You may not be able to wrinkle your forehead, whistle or blow out your cheek.
. You may have some difficulty with speech, as the muscles in the side of the face help in forming some words. For example, words beginning with a P.

. Most cases are painless or cause just a mild ache. However, some people develop some pain near the ear which can last for a few days.
. Loud sounds may be uncomfortable and normal noises may sound louder than usual. This is because a tiny muscle in the ear may stop working.
. You may lose the sense of taste on the side of the tongue that is affected.

Does Bell's palsy affect the brain or other parts of the body?
No. Bells palsy is a local problem confined to the facial nerve and facial muscles. If you have other symptoms, such as weakness or numbness in other parts of your body, there will be another cause and you should tell your doctor.

Other conditions that may be confused with Bell's palsy
Bell's palsy is a common cause of a facial palsy. Less commonly, facial palsy is caused by other things that can damage or affect the facial nerve. For example: a head injury, sarcoidosis, Lyme disease, growths in the ear, tumours in the parotid gland and tumours in the brain. Also, some people who have a stroke develop facial weakness. With these conditions you are likely to have other symptoms too. This helps doctors to tell the difference between a Bell's palsy and other causes of a facial palsy.

For example:

With a stroke, the forehead muscles are not affected. Also, you are likely to have other nerves that are affected in addition to the facial nerve.

With tumours, the symptoms usually develop slowly - over weeks or months. This is unlike a Bell's palsy when symptoms develop quickly - often 'overnight'.

Conditions such as sarcoidosis and Lyme disease tend to cause various other symptoms in addition to nerve palsies.

In particular, Bell's palsy is uncommon in children under 10 years old. Other conditions should be carefully ruled out in children who develop facial weakness.

How does Bell's palsy progress?

Without treatment, full recovery is still likely and occurs in about 15 in 20 cases. With treatment, the chance of full recovery is improved (see below). In most people the function of the nerve gradually returns to normal. Symptoms usually start to improve after about 2-3 weeks, and have usually gone within two months. In some cases, it can take up to twelve months to recover fully.In some cases, symptoms do not completely go. Some weakness may remain for good. However, it is often a slight weakness of part of the face and hardly noticeable. It is uncommon to have no improvement at all; however, some people are left with some degree of permanent facial weakness.

Do I need any tests?
When a doctor sees a patient with a sudden facial muscle weakness, he or she will aim to rule out other causes of the problem before diagnosing Bell's palsy. Most other causes can be ruled out by the absence of other symptoms, and a by doctor's examination. No tests may be needed.

However, some tests are done in some situations. For example, in areas where Lyme disease is common (due to tick bites), then tests to rule out Lyme disease may be done. This is because a facial weakness is, rarely, the first indication of Lyme disease. Other tests may be advised if the diagnosis is not clear-cut.

What is the treatment for Bell's palsy?
As mentioned, there is a good chance of full recovery without any treatment. However, drug treatment is usually advised to improve the chance of full recovery even more. Also, you need to protect your eye if your eyelids cannot close (see below).

Drug treatment is still controversial and intradepartmental variation exists.
· Steroids - Most now give 7-10 days of prednisolone (1mg/kg/day - adult 60-80 mg/day) as early as possible (ideally within 72 hours), either alone or with antivirals because this study showed steroids result in more complete recovery rates at 3 and 9 months.
· Antivirals - There is less evidence for the use of antivirals in the absence of any viral vesicles.

The general conclusion of an earlier Cochrane analysis was that the use of steroids and aciclovir was neither safe nor evidence based, although a recent multicentre, randomised, placebo-controlled trial of valacyclovir and prednisolone treatment showed that the rate of patient recovery among those treated with valacyclovir was significantly better than the rate among those treated with prednisolone alone.

In the meantime, a reasonable course of action is to use steroids in early cases, always use aciclovir for Ramsay-Hunt syndrome and consider referral or discuss all non-straightforward cases with neurology or ENT department, who can offer appropriate follow up.

· Surgery - Surgical transmastoid decompression of the facial nerve in severe cases is being investigated but cannot currently be recommended. Where nerve fails to regenerate, cosmetic surgery to elevate mouth or anastomosis of hypoglossal nerve to the facial nerve may help.

Prognosis
71% of untreated patients with idiopathic non progressive Bell's palsy recover completely (84% have near-normal function) usually within a few weeks.

Poor prognostic features:
· Complete palsy or severe degeneration (electrophysiology)
· No signs of recovery by three weeks
· Age >60
· Severe pain
· Ramsay Hunt syndrome (herpes zoster virus)
· Associated with either hypertension, diabetes, or pregnancy

Eye protection
If you cannot close your eyelids fully, the front of your eye is at risk of becoming damaged. Also, your tear glands may not work properly for a while and your eye may become dry. Dryness could cause damage, so treatment is needed to keep the eye moist.

Therefore, you doctor may advise one or more of the following until the eyelids and tear production recover:

. An eye pad or goggles to protect the eye.
. Eye drops to lubricate the eye during the day.
. Eye ointment to lubricate the eye overnight.

An option is to tape the upper and lower lid together when you are asleep. Other procedures are sometimes done to keep the eye shut until the eyelids recover.

If the facial weakness does not recover
For the small number of cases where the facial weakness does not recover fully, and remains unsightly, some techniques may be considered. For example:
A treatment called, 'facial retraining' with facial exercises may help.

Injections of botulism toxin ('Botox®') may help if spasm develops in the facial muscles.
Various surgical techniques can help with the cosmetic appearance.

Will it happen again?
In most cases, a Bell's palsy is a 'one-off'. About 1 in 10 people who have a Bell's palsy can have a further episode sometime in the future, often several years afterwards.

Presentation
. Weakness of the muscles of facial expression and eye closure.

. Face sags and is drawn across to opposite side on smiling.

. Voluntary eye closure may not be possible and can produce damage to conjunctiva and cornea.
· In partial paralysis, lower face is generally more affected.
· In severe cases, there is often demonstrable loss of taste over front of tongue and intolerance to high pitched or loud noises. May cause mild dysarthria and difficulty with eating.

The most common system used for describing the degree of paralysis is the House-Brackmann scale, where 1 is normal power and 6 is total paralysis. It is important to identify whether the patient has an upper motor neurone (UMN) or lower motor neurone (LMN) lesion to assist in identifying cause.

· In a LMN lesion the patient can't wrinkle their forehead - the final common pathway to the muscles is destroyed. Lesion must be either in the pons, or outside the brainstem (posterior fossa, bony canal, middle ear or outside skull).
· In an UMN lesion, the upper facial muscles are partially spared because of alternative pathways in the brainstem i.e. the patient can wrinkle their forehead (unless bilateral lesion) and the sagging of the face seen with lower motor neurone palsies is not as prominent. There appear to be different pathways for voluntary and emotional movement.

CVA's (cerebro vascular accident) usually weaken voluntary movement often sparing involuntary movements (e.g. spontaneous smiling). The much rarer selective loss of emotional movement is called mimic paralysis and is usually due to a frontal or thalamic lesion.

Characteristic features

Acute LMN palsy

Acute LMN palsy can present at any age but most frequently seen at 20-50 years affecting both sexes equally. Incidence is around 30 cases per 100,000 per year, slightly higher in pregnant women (45 per 100,000). There is usually a rapid onset of unilateral facial paralysis.

Aching pain below ear or in mastoid area is also common and may suggests middle ear or herpetic cause if severe. There may be hyperacusis, and patients with lesions proximal to the geniculate ganglion may be

Investigations

· Serology - lyme, herpes and zoster (paired samples 4-6 weeks apart). It may not influence management, but may reveal aetiology.
· Check blood pressure in children with Bell's palsy (2 case reports of aortic coarctation presenting with facial nerve palsy and hypertension).
· The following tests are rarely done but combined with a good understanding of the neuroanatomy can determine the level of the palsy:
· Schirmer tear test (reveals reduced flow of tears on the side of a palsy affecting the greater palatine nerve).
· Stapedial reflex (an audiological test absent if stapedius muscle is affected).
· Electrodiagnostic studies (generally a research tool) reveal no changes in involved facial muscles for the first three days, but a steady decline of electrical activity often occurs over the next week, and will identify the 15% with axonal degeneration.

Bell's palsy management
Those with axonal degeneration may not show any re-innervation for three months, and recovery may be partial or not at all.Following this synkinesis is often seen e.g. blinking causes angle of mouth to contract. Also aberrant parasympathetic re-innervation may cause symptoms such as gustatory lacrimation ('crocodile tears'). Symptoms can be helped by subcutaneous or intramuscular injections of botulinum toxin.

Treatment of facial palsy by Chinese herbs.
A specific cause of Bell's palsy is unknown, however, it has been suggested that the disorder may be inherited. It also may be associated with:

. diabetes
. high blood pressure
. trauma
. toxins
. Lyme disease
. Guillain-BarrÉ syndrome
. sarcoidosis
. myasthenia gravis
. infection

SYMPTOMS The following are the most common symptoms of Bell's palsy.

However, each individual may experience symptoms differently. Symptoms may include:
. loss of feeling in the face
. headache
. tearing
. drooling
. loss of the sense of taste on the front two-thirds of the tongue
. hypersensitivity to sound in the affected ear
. inability to close the eye on the affected side of the face
. affects the muscles that control facial expressions such as smiling, squinting, blinking, or closing the eyelid

The symptoms of Bell's palsy may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

DESCRIPTION Bell's palsy describes an unexplained weakness or paralysis of the muscles on one side of the face. Afflicted individuals may be unable to close the eye on the affected side of the face, and may also experience tearing, drooling, and hypersensitive hearing.

CLINICAL SUCCESS IN CHINA Chinese herbal doctors have reported some successful applications of these herbal combinations. During observation on 132 patients receiving treatment with herbal remedy, 118 cases were judged as healing (full recovery and symptom free), 11 cases others significant improvement. Physicians judged the clinical efficacy to be good or excellent in 97.7%.

HERBAL REMEDY BEST FOR YOU The most powerful feature of Traditional Chinese Medicine is that it allows you to easily combine multiple ingredients to form a recipe to suit the specific need of individual.

Authoritative Oriented Recipes: All these well chosen herbal combinations source from experienced and authoritative experts, and have been most commonly recognized by the practitioners in this field. When you choose a herbal remedy there are two important things among your concerns: a good recipe and a correct way to cook it. A good recipe is half the good results.

HERBS OF CHOICE Herbs are often used in combinations when combating an illness. Some of the most frequently used herbs are listed below. These nine herbs were picked up from different herbal combinations and are not meant to form a recipe.

1 - Radix Angelicae Pubescentis
2 - Radix Gentianae Macrophyllae
3 - Concha Haliotidis
4 - Ramulus Uncariae cum Uncis
5 - Rhizoma Ligustici Chuanxiong
6 - Radix Bupleuri
7 - Radix Angelicae Sinensis
8 - Fructus Tribuli
9 - Radix Angelicae Dahuricae

Safe and Side Effect Free: All these herbs have been being used in China for thousands of years, and have been proven to be safe. In fact most Chinese herbs are tonics without side effects. What important is that experienced practitioners should know how to use herbs to avoid possible side effects.

Acupuncture would help peoples suffered from facial palsy
We have the herbs and willing to help any one suffering from Facial Nerve Palsy
Just ask for it.

Multiple Sclerosis .. MS

What Is MS?

Comedian Richard Pryor dies at 65; had been ill with multiple sclerosis

Ms, or multiple sclerosis as it is more commonly know, is a disease of the nerveous system. With people who suffer from multiple sclerosis, the body's immune system eats away at the protective sheath around the nerves, causing signal disorder between the nerve and the brain. Depending on the severity of the case, the results of multiple sclerosis can vary greatly.

Multiple sclerosis (MS) is a disease in which the nerves of the central nervous system (brain and spinal cord) degenerate. Myelin, which provides a covering or insulation for nerves, improves the conduction of impulses along the nerves and also is important for maintaining the health of the nerves. In multiple sclerosis, inflammation causes the myelin to eventually disappear. Consequently, the electrical impulses that travel along the nerves decelerate, that is, become slower. In addition, the nerves themselves are damaged. As more and more nerves are affected, a patient experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.

About 350,000 people in the U.S. have multiple sclerosis. Usually, a patient is diagnosed with multiple sclerosis between 20 and 50 years of age, but multiple sclerosis has been diagnosed in children and in the elderly. Multiple sclerosis is twice as likely to occur in Caucasians as in any other group. Women are twice as likely as men to be affected by multiple sclerosis earlier in life.

What causes multiple sclerosis?
The cause of multiple sclerosis is still unknown. In the last 20 years, researchers have focused on disorders of the immune system and genetics for explanations. The immune system is the body's defender and is highly organized and regulated. If triggered by an aggressor or foreign object, the immune system mounts a defensive action which identifies and attacks the invader and then withdraws. This process depends upon rapid communication among the immune cells and the production of cells that can destroy the intruder.

In multiple sclerosis, researchers suspect that a foreign agent such as a virus alters the immune system so that the immune system perceives myelin as an intruder and attacks it. The attack by the immune system on the tissues that it is supposed to protect is called autoimmunity, and multiple sclerosis is believed to be a disease of autoimmunity. While some of the myelin may be repaired after the assault, some of the myelin disappears and nerves are stripped of this covering (become demyelinated). Scarring also occurs, and material is deposited into the scars and forms plaques.

Is multiple sclerosis inherited?
Although its role is unclear, genetics may play a role in multiple sclerosis. European gypsies, Eskimos and African Bantu essentially do not develop multiple sclerosis, while Native Indians of North and South America, Japanese and other Asian groups have a low incidence. The general population has less than a one-percent chance of ever contracting multiple sclerosis. The chance increases in families where a first-degree relative has the disease.

Thus, a brother, sister, parent, or child of a person with multiple sclerosis stands a one-percent to three percent chance of developing multiple sclerosis. Similarly, an identical twin runs a nearly 30% chance of acquiring multiple sclerosis whereas a non-identical twin has only a 4% chance if the other twin has the disease. These statistics suggest that genetic factors play a major role in multiple sclerosis. However, other data suggest that environmental factors also play an important role.

What are the types of multiple sclerosis?
1 - exacerbation of multiple sclerosis
There are different clinical manifestations of multiple sclerosis. During an attack, a patient experiences a sudden deterioration in normal physical abilities that may range from mild to severe. This attack, sometimes referred to as an exacerbation of multiple sclerosis, typically lasts more than 24 hours and generally more than a few weeks (rarely more than four weeks).

2 - Relapsing-Remitting (RR) MS
About 65-80% of patients begin with Relapsing-Remitting (RR) MS, the most common type. In this type, patients experience a series of attacks followed by complete or partial disappearance of the symptoms (remission) until another attack occurs (relapse). It may be weeks to decades between relapses.

3 - Primary-Progressive (PP) MS
In Primary-Progressive (PP) MS, there is a continuous, gradual decline in a patient's physical abilities from the outset rather than relapses. About 10%-20% of patients begin with PP-MS.

Patients beginning with RR-MS can then enter a phase where relapses are rare but more disability accumulates, and are said to have the Secondary-Progressive (SP) type of multiple sclerosis. About 50% of RR-MS patients will develop SP-MS within 10 years. Progressive-Relapsing (PR) MS is a type of multiple sclerosis characterized by a steady decline in abilities accompanied by sporadic attacks.

There are cases of of multiple sclerosis that are mild and can be recognized only retrospectively after many years and also rare cases of extremely rapid progression of multiple sclerosis symptoms (sometimes fatal) known as malignant or fulminant (Marburg variant) multiple sclerosis.

What are the symptoms of multiple sclerosis?
Symptoms of multiple sclerosis may be single or multiple and may range from mild to severe in intensity and short to long in duration. Complete or partial remission from symptoms occurs early in about 70% of multiple sclerosis patients.

Visual disturbances may be the first symptoms of multiple sclerosis, but they usually subside. A patient may notice blurred vision, red-green distortion (color desaturation), or sudden monocular blindness (blindness in one eye).
Muscle weakness with or without difficulties with coordination and balance may occur early.

Muscle spasms, fatigue, numbness, and prickling pain are common symptoms.
There may be a loss of sensation, speech impediment (typically a problem articulating words), tremors, or dizziness.

Fifty-percent of patients experience mental changes such as:
. decreased concentration,
. attention deficits,
. some degree of memory loss,
. inability to perform sequential tasks, or
. impairment in judgment.

Other symptoms may include
. depression,
. manic depression,
. paranoia, or
. an uncontrollable urge to laugh and weep.

As the disease worsens, patients may experience sexual dysfunction or reduced bowel and bladder control. Heat appears to intensify multiple sclerosis symptoms for about 60% of patients. Pregnancy seems to reduce the number of attacks.

The most common early symptoms of MS include:
· Tingling
· Numbness
· Loss of balance
· Weakness in one or more limbs
· Blurred or double vision

Less common symptoms of MS may include
· Slurred speech
· Sudden onset of paralysis
· Lack of coordination
· Cognitive difficulties

As the disease progresses, other symptoms may include muscle spasms, sensitivity to heat, fatigue, changes in thinking or perception, and sexual disturbances.

· Fatigue

This is the most common symptom of MS. It is typically present in the mid afternoon and may consist of increased muscle weakness, mental fatigue, sleepiness, or drowsiness.

Heat sensitivity .

Heat sensitivity (the appearance or worsening of symptoms when exposed to heat, like a hot shower) occurs in most people with MS.

· Spasticity .

Muscle spasms are a common and often debilitating symptom of MS. Spasticity usually affects the muscles of the legs and arms, and may interfere with a persons ability to move those muscles freely.
·
· Dizziness.

Many people with MS complain of feeling "off balance" or lightheaded. Occasionally they may experience the feeling that they or their surroundings are spinning; this is called vertigo. These symptoms are caused by damage in the complex nerve pathways that coordinate vision and other inputs into the brain that are needed to maintain balance.

· Impaired thinking . Problems with thinking occur in about half of people with MS. For most, this means slowed thinking, decreased concentration, or decreased memory. Approximately 10% of people with the disease have severe impairment that significantly impairs their ability to carry out tasks of daily living.

· Vision problems . Vision problems are relatively common in people with MS. In fact, one vision problem, optic neuritis, occurs in 55% of people with the condition. Most vision problems do not lead to blindness.

· Abnormal sensations. Many people with MS experience abnormal sensations such as "pins and needles," numbness, itching, burning, stabbing, or tearing pains. Fortunately, most of these symptoms, while aggravating, are not life-threatening or debilitating and can be managed or treated.

· Speech and swallowing problems .

People with MS often have swallowing difficulties. In many cases, they are associated with speech problems as well. They are caused by damaged nerves that normally aid in performing these tasks.

· Tremors .

Fairly common in people with MS, tremors can be debilitating and difficult to treat.
· Difficulty walking. Gait disturbances are amongst the most common symptoms of MS. Mostly this problem is related to muscle weakness and/or spasticity, but having balance problems or numbness in your feet can also make walking difficult.

Other rare symptoms include breathing problems and seizures.

How is multiple sclerosis diagnosed?
Due to the broad range and subtleties of symptoms, multiple sclerosis may not be diagnosed for months to years after the onset of symptoms. Physicians, particularly neurologists, take detailed histories and perform complete physical and neurological examinations.

. MRI (magnetic resonance imaging) scans with intravenous gadolinium helps to identify, describe, and in some instances date lesions in the brain (plaques).

. An electro-physiological test, evoked potentials, examines the impulses traveling through the nerves to determine if the impulses are moving normally or too slowly.

. Finally, examining the cerebro-spinal fluid that surrounds the brain and spinal cord may identify abnormal chemicals (antibodies) or cells that suggest the presence of multiple sclerosis.

Collectively, these three tests help the physician in confirming the diagnosis of multiple sclerosis. For a definite diagnosis of multiple sclerosis, spreading in time (at least two separate symptomatic events or changes on MRI) and in anatomical space (for example, within the central nervous system) must be demonstrated.

How is multiple sclerosis treated?

There are many issues for the patient and physician to consider in treating multiple sclerosis. Goals may include:
· Reducing the number of attacks,
· Improving recovery from attacks,
· Slow further progression of the disease (treatment with disease-modifying drugs).

An additional goal is relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms). Most neurologists will consider treatment with disease-modifying drugs once the diagnosis of multiple sclerosis is established. Many will begin treatment at the time of the first multiple sclerosis attack, since clinical trials have suggested that patients in whom treatment is delayed may not benefit as much as patients who are treated early.

Finally, utilizing support groups or counseling may be helpful for patients and their families whose lives may directly be affected by multiple sclerosis.
Once goals have been set, initial therapy may include medications to manage attacks, symptoms, or both. An understanding of the potential side effects of drugs is critical for the patient because sometimes side effects alone deter patients from drug therapy. Patients may choose to avoid drugs altogether or choose an alternative drug that may offer relief with fewer side effects. A continuous dialogue between the patient and physician about the medications is important in determining the needs for treatment.

Cheryl Miller, severely disabled by multiple sclerosis, is given marijuana to chew by her husband Jim as they participate in a protest against anti-medicinal marijuana legislation in Washington, D.C.

Drugs known to affect the immune system have become the primary focus for managing multiple sclerosis. Initially, corticosteroids, such as prednisone (Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is non-specific and their use may cause numerous side effects, corticosteroids now tend to be used to manage only sudden, severe multiple sclerosis attacks.

Interferon
Since 1993, medications that alter the immune system, particularly interferons, have been used to manage multiple sclerosis. Interferons are protein messengers that cells of the immune system manufacture and use to communicate with one another. There are different types of interferons, such as alpha, beta, and gamma. All interferons have the ability to regulate the immune system and play an important role in protecting against viral infections. Each interferon functions differently, but the functions overlap.

The beta interferons have been found useful in managing multiple sclerosis. Interferon beta-1b (Betaseron®) was the first interferon approved to manage RR-MS in 1993. In 1996, interferon beta-1a (Avonex®) gained FDA approval for RR-MS.

Overall, patients treated with interferons experience fewer relapses or a longer interval between relapses. Clinical trials have also shown effects on slowing the accumulation of disability. The most common side effect is a flu-like syndrome that includes fever, tiredness, weakness, chills, and muscle aches. This syndrome tends to occur less frequently as therapy continues.

Other common side effects are injection site reactions, changes in blood cell counts, and abnormalities of liver tests. Regular liver tests and blood counts are recommended for patients receiving interferon beta-1b. With the concomitant use of analgesics and local skin measures, the tolerability to interferons has increased.

Clinical trials of interferon beta drugs in patients with the first attack of multiple sclerosis showed that in this early patient population, these drugs delay the onset of the second attack. Avonex® is administered intramuscularly once a week, Betaseron® is administered subcutaneously every other day, and Rebif® is administered subcutaneously three times per week.

Available interferon betas include:
IFN beta-1b (Betaseron®) that is used for the treatment of relapsing forms of multiple sclerosis, to reduce the frequency of clinical relapses. Patients with multiple sclerosis in whom efficacy has been demonstrated include patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis.

IFN beta-1a (Rebif®) that is used for the treatment of patients with relapsing forms of multiple sclerosis to decrease the frequency of clinical relapses and delay the accumulation of physical disability. Efficacy of Rebif® in chronic progressive multiple sclerosis has not been established.

IFN beta-1a (Avonex®) that is used for the treatment of patients with relapsing forms of multiple sclerosis to slow the accumulation of physical disability and decrease the frequency of clinical relapses. Patients with multiple sclerosis in whom efficacy has been demonstrated include patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis. Safety and efficacy in patients with chronic progressive multiple sclerosis has not been established.

Other medications:

Glatiramer acetate

Glatiramer acetate (Copaxone) is another disease-modifying drug that is approved for reducing the frequency of relapses in RR-MS. Glatiramer acetate is a synthetic (man-made) amino acid mixture that may resemble a protein component of myelin. It is thought that the immune system reaction against myelin in multiple sclerosis may be blocked by glatiramer acetate. A reaction occurring immediately after the injection of glatiramer acetate is common, affecting one out of 10 patients. The reaction may involve flushing, chest pain or tightness, palpitations, anxiety, shortness of breath, tightness in the throat, or hives. The reaction usually resolves within 30 minutes and requires no treatment. Some patients may be at risk of developing lipoatrophy, inflammation and destruction of tissue beneath the skin at the site of injection. Glatiramer acetate is used for reducing the frequency of relapses in patients with relapsing-remitting multiple sclerosis.

Natalizumab

Natalizumab (Tysabri®)

Is a drug approved by the FDA to treat multiple sclerosis. Natalizumab is a monoclonal antibody against VLA-4, a molecule required for immune cells to adhere to other cells, penetrate the blood brain barrier and enter the brain. It is administered via monthly intravenous infusions. It carries a warning for a potentially fatal disease, progressive multifocal leukoencephalopathy (PML), a viral infection of the brain that usually leads to death or severe disability. For this reason only patients who have signed up for treatment under a controlled drug distribution program can get this treatment.

Natalizumab is used as monotherapy for the treatment of patients with relapsing forms of multiple sclerosis to delay the progression of physical disability and reduce the frequency of clinical relapses. The safety and efficacy of natalizumab beyond two years are unknown. Because natalizumab increases the risk of PML, it is generally recommended only for patients who have had an inadequate response to, or are unable to tolerate alternate multiple sclerosis therapies.

Mitoxantrone

Mitoxantrone (Novantrone®) is also approved by the FDA for the treatment of multiple sclerosis.

Mitoxantrone is a chemotherapy drug that carries the risk of serious cardiac side effects or cancer. Because of these serious side effects, physicians tend to reserve its use for more advanced or worsening cases of multiple sclerosis.

Mitoxantrone is used for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (for example, patients whose neurologic status is significantly abnormal between relapses). Mitoxantrone is not used in the treatment of patients with primary progressive multiple sclerosis.

How are the manifestations of multiple sclerosis treated?
There are numerous medications that are used to manage complications associated with multiple sclerosis. The following lists of common complications, examples of drug and non-drug therapy, and comments about complications and/or management.

Multiple sclerosis complications with examples of drug and non-drug management (this list is not exhaustive; some of the drugs listed below are used to treat multiple sclerosis symptoms even though they have not been FDA-approved for this particular purpose)

Muscle spasticity

baclofen (Lioresal) tizanidine (Zanaflex) diazepam (Valium) clonazepam (Klonopin) dantrolene (Dantrium)

Physical therapy may also provide benefit. Most drugs are given by mouth. Some drugs are given via spinal pumps.

Weakness .. None

Physical therapy and exercise mostly are used. Foot braces, canes or walkers are of benefit.

Eye problems (acute) optic neuritis .. methylprednisolone (Solu-Medrol)
Solu-Medrol is given during the acute attack intravenously, sometimes followed by a corticosteroid by mouth.

Fatigue, emotional outbursts
Anti-depressants amantadine (Symmetrel) for fatigue;

modafinil (Provigil) for fatigue .. Decrease or avoid physical activity and heat exposure.

Amitriptyline is used for sudden laughing/weeping.

Pain
aspirin Ibuprofen acetaminophen Aspirin, NSAIDs, acetaminophen, or physical therapy are used for muscle and back pain

anti-convulsants anti-depressants
Anti-convulsants, like carbamazepine (Tegretol) or gabapentin

(Neurontin) are used for face or limb pain. Anti-depressants or electrical stimulation are used for prickling pain, intense tingling, and burning.

Referral to pain specialist is recommended with severe pain.

Bladder dysfunction
Antibiotics .. Vitamin C oxybutynin (Ditropan)
Antibiotics are used to manage infections.Vitamin C and cranberry juice are used to prevent infections. Catheters are used to relieve urine retention. Oxybutynin (Ditropan, Ditropan LX, Oxytrol) or tolterodine (Detrol, Detrol LA) is used for bladder spasms.
Constipation

Increase fluids and fiber.

Sexual dysfunction
sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), papaverine (Pavabid, Vasal) Vaginal gels

For males, erectile dysfunction drugs, papaverine, penile implant, or electrostimulation are used.

For females, vaginal gels or a vibrating device are used.
Tremors

Often resistant to treatment. Sometimes drugs, or surgery are used if extreme.

What are the future directions for managing multiple sclerosis?
There is a great deal of ongoing research in multiple sclerosis, and there continues to be a focus on the immune system in investigational therapies. In addition, scientists are trying to develop techniques that allow brain cells to generate new myelin or that prevent neuronal death. Other promising approaches include the use of precursor (neuronal stem or progenitor) cells that could be implanted into the brain or spinal cord to repopulate areas of missing cells. Future therapy may involve methods designed to improve impulses traveling over the damaged nerves. Scientists also are exploring the effects of diet on multiple sclerosis.

Multiple Sclerosis At A Glance
Multiple sclerosis (MS) is a disease which progressively injures the nerves of the brain and spinal cord.

Injury to the nerves in multiple sclerosis may be reflected by alterations of virtually any sensory or motor (muscular) function in the body.
The cause of multiple sclerosis is unknown, but it has become widely accepted that genetic, immunological, and environmental factors play a role.
Current FDA-approved multiple sclerosis treatments include the beta-interferons (Betaseron®, Rebif® and Avonex®), glatiramer acetate (Copaxone®), mitoxantrone (Novantrone®) and natalizumab (Tysabri®). The selection of therapy should be made after the multiple sclerosis patient has been properly informed of drug efficacy, administration routes, risks of adverse events, and methods to enhance tolerability and compliance.

Herbal Medicine to control Multiple Sclerosis

The question of whether marijuana (Cannabis sativa) should be used for symptom management in MS is a complex one. It is generally agreed that better therapies are needed for distressing symptoms — including pain, tremor, and spasticity — that may not be sufficiently relieved by available treatments. Yet there are serious uncertainties about the benefits of marijuana relative to its side effects.

Early Studies Showed Mixed Results and Some Side Effects
Well known for its mind-altering properties, marijuana is produced from the flowering top of the hemp plant, Cannabis sativa.

Early studies explored the role of THC (tetrahydrocannabinol — an active ingredient in marijuana) or smoked marijuana in treating spasticity, tremor, and balance control in small numbers of people with MS. Most of these studies were done with THC. Because THC can be given by mouth, it is easier to control the dose. The results of these studies were mixed, and participants reported a variety of uncomfortable side effects. In addition, smoked marijuana poses health risks that are at least as significant as those associated with tobacco.
For spasticity (unusual muscle tension or stiffness) Studies of THC for spasticity have had mixed results. While some people reported feeling "looseness" and less spasticity, this could not always be confirmed by objective testing done by physicians. Even at its best, effects lasted less than three hours. Side effects, especially at higher doses, included weakness, dry mouth, dizziness, mental clouding, short-term memory impairment, space-time distortions and lack of coordination.

For tremor (uncontrolled movements) In a small study of THC involving eight seriously disabled individuals with significant tremor and ataxia (lack of muscle coordination), two people reported improvement in tremor that could be confirmed by an examination by a physician and another three reported improvement in tremor that could not be confirmed. All eight patients taking THC experienced a "high," and two reported feelings of discomfort and unease.
For balance Smoked marijuana was shown to worsen control of posture and balance in 10 people with MS and 10 who did not have MS. All 20 study participants reported feeling "high."

Chinese medicine prevails on marijuana for treatment and control MS

Congestive Heart Failure (CHF)

What is congestive heart failure?

Congestive heart failure (CHF) is a condition in which the heart's function as a pump to deliver oxygen rich blood to the body is inadequate to meet the body's needs. Congestive heart failure can be caused by:
. diseases that weaken the heart muscle,
. diseases that cause stiffening of the heart muscles, or
. diseases that increase oxygen demand by the body tissue beyond the capability of the heart to deliver.

The heart has two atria (right atrium and left atrium) that make up the upper chambers of the heart, and two ventricles (left ventricle and right ventricle) that make up the lower chambers of the heart. The ventricles are muscular chambers that pump blood when the muscles contract (the contraction of the ventricle muscles is called systole).

Many diseases can impair the pumping action of the ventricles. For example, the muscles of the ventricles can be weakened by heart attacks or infections (myocarditis). The diminished pumping ability of the ventricles due to muscle weakening is called systolic dysfunction. After each ventricular contraction (systole) the ventricle muscles need to relax to allow blood from the atria to fill the ventricles. This relaxation of the ventricles is called diastole.

Diseases such as hemochromatosis or amyloidosis can cause stiffening of the heart muscle and impair the ventricles' capacity to relax and fill; this is referred to as diastolic dysfunction. The most common cause of this is longstanding high blood pressure resulting in a thickened (hypertrophied) heart. Additionally, in some patients, although the pumping action and filling capacity of the heart may be normal, abnormally high oxygen demand by the body's tissues (for example, with hyperthyroidism) may make it difficult for the heart to supply an adequate blood flow (called high output heart failure).

In some patients one or more of these factors can be present to cause congestive heart failure. The remainder of this article will focus primarily on congestive heart failure that is due to heart muscle weakness, systolic dysfunction.

Congestive heart failure can affect many organs of the body. For example, the weakened heart muscles may not be able to supply enough blood to the kidneys, which then begin to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can cause to body to retain more fluid. The lungs may become congested with fluid (pulmonary edema) and the person's ability to exercise is decreased. Fluid may likewise accumulate in the liver, thereby impairing its ability to rid the body of toxins and produce essential proteins. The intestines may become less efficient in absorbing nutrients and medicines. Over time, untreated, worsening congestive heart failure will affect virtually every organ in the body.

Basic Facts
· In the United States, 5.7 million people have HF and it afflicts 10 in every 1,000 people over the age of 65.
· The three major contributors to HF are coronary artery disease, hypertension, and dilated cardiomyopathy. HF can also result from heart defects, arrhythmias, unhealthy lifestyles, and more.
· The most common signs of HF are shortness of breath, fatigue, and swelling in the feet, ankles, legs, and abdomen.
· Medication can help stem progression of HF and most patients take a combination of a diuretic, ACE inhibitor, and beta-blocker. Lifestyle changes are critical to slowing heart failure.
· Some patients may need cardiac resynchronization therapy, ICDs, pacemakers, or heart assist devices.
· Patients with end-stage heart failure require heart transplantation to survive.

What causes congestive heart failure?
Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure. In the United States, the most common causes of congestive heart failure are:
1. coronary artery disease,
2. high blood pressure (hypertension),
3. longstanding alcohol abuse, and
4. disorders of the heart valves.

Less common causes include viral infections of the stiffening of the heart muscle, thyroid disorders, disorders of the heart rhythm, and many others.
It should also be noted that in patients with underlying heart disease, taking certain medications can lead to the development or worsening of congestive heart failure. This is especially true for those drugs that can cause sodium retention or affect the power of the heart muscle. Examples of such medications are the commonly used nonsteroidal antiinflammatory drugs (NSAIDs), which include ibuprofen (Motrin and others) and naproxen (Aleve and others) as well as certain steroids, some diabetic medication, and some calcium channel blockers.

What are the symptoms of congestive heart failure?
The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness.

1. An early symptom of congestive heart failure is fatigue. While fatigue is a sensitive indicator of possible underlying congestive heart failure, it is obviously a nonspecific symptom that may be caused by many other conditions. The person's ability to exercise may also diminish. Patients may not even sense this decrease and they may subconsciously reduce their activities to accommodate this limitation.
2. As the body becomes overloaded with fluid from congestive heart failure, swelling (edema) of the ankles and legs or abdomen may be noticed.

1. In addition, fluid may accumulate in the lungs, thereby causing shortness of breath, particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air.
2. Some may be unable to sleep unless sitting upright.
3. The extra fluid in the body may cause increased urination, particularly at night.
4. Accumulation of fluid in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.
5. Symptoms of congestive heart failure depend upon the side of the heart that is affected. Left-side congestive heart failure causes fatigue and shortness of breath during even mild exertion.
6. Other symptoms include a wheezing or hacking cough and shortness of breath during sleep, called orthopnea.
7. One particularly serious symptom is pulmonary edema, a condition in which fluids accumulate in the lungs.
8. Right-side congestive heart failure reduces the amount of blood returning to the heart. The main symptom is swelling, usually of the feet, ankles, legs, and abdomen, as the veins and tissues throughout the body fill up with the excess fluid.
9. Patients with right-heart failure often feel tired, have little appetite, and experience weight gain because they retain so much salt and water. With treatment, patients may live with right-heart failure for many years.
10. Because of the risk of pulmonary edema, left-heart failure is more life threatening.

How is congestive heart failure diagnosed?
The diagnosis of congestive heart failure is most often a clinical one that is based on knowledge of the patient's pertinent medical history, a careful physical examination, and selected laboratory tests.

A thorough patient history may disclose the presence of one or more of the symptoms of congestive heart failure described above. In addition, a history of significant coronary artery disease, prior heart attack, hypertension, diabetes, or significant alcohol use can be clues.
The physical examination is focused on detecting the presence of extra fluid in the body (breath sounds, leg swelling, or neck veins) as well as carefully characterizing the condition of the heart (pulse, heart size, heart sounds, and murmurs).

Useful diagnostic tests include the electrocardiogram (ECG) and chest x-ray to explore the possibility of previous heart attacks, arrhythmia, heart enlargement, and fluid in and around the lungs. Perhaps the single most useful diagnostic test is the echocardiogram, in which ultrasound is used to image the heart muscle, valve structures, and blood flow patterns. The echocardiogram is very helpful in diagnosing heart muscle weakness. In addition, the test can suggest possible causes for the heart muscle weakness (for example, prior ultrasound, and severe valve abnormalities). Virtually all patients in whom the diagnosis of congestive heart failure is suspected should ideally undergo echocardiography early in their assessment.

Nuclear medicine studies assess the overall pumping capability of the heart and examine the possibility of inadequate blood flow to the heart muscle. Heart catheterization allows the arteries to the heart to be visualized with angiography (using dye inside of the blood vessels that can be seen using x-ray methods). During catheterization the pressures in and around the heart can be measured and the heart's performance assessed.

In rare cases, a biopsy of the heart tissue may be recommended to diagnose specific diseases. This biopsy can often be accomplished through the use of a special catheter device that is inserted into a vein and maneuvered into the right side of the heart.

Another helpful diagnostic test is a blood test called a BNP or brain natriuretic peptide level. This level can vary with age and gender but is typically elevated from heart failure and can aid in the diagnosis, and can be useful in following the response to treatment of congestive heart failure.
The choice of tests depends on each patient's case and is based on the suspected diagnoses.

What is the treatment of congestive heart failure?

Lifestyle modifications
After congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day. In patients with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total sodium intake is very important.

Likewise, the total amount of fluid consumed must be regulated. Although many patients with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given patient and should be discussed with the patient's physician.

An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight. An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe.

Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each patient's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, patients may display widely varying degrees of limitation of function. Regular exercise, when tailored to the patient's tolerance level, appears to provide significant benefits and should be used only when the patient is compensated and stable.

Addressing potentially reversible factorsDepending on the underlying cause of congestive heart failure, potentially reversible factors should be explored. For example, in certain patients whose congestive heart failure is caused by inadequate blood flow to the heart muscle, restoration of the blood flow through coronary artery surgery or catheter procedures (angioplasty, intracoronary stenting) may be considered. Congestive heart failure that is due to severe disease of the valves may be alleviated in appropriate patients by valve surgery. When congestive heart failure is caused by chronic, uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve the condition.

Likewise, heart muscle weakness that is due to longstanding, severe alcohol abuse can improve significantly with abstinence from drinking. Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible by appropriate measures.

Medications
Until recently, the selection of medications available for the treatment of congestive heart failure was frustratingly limited and focused mainly on controlling the symptoms. Medications have now been developed that both improve symptoms, and, importantly, prolong survival.

Angiotensin Converting Enzyme (ACE) InhibitorsACE inhibitors have been used for the treatment of hypertension for more than 20 years. This class of drugs has also been extensively studied in the treatment of congestive heart failure. These medications block the formation of angiotensin II, a hormone with many potentially adverse effects on the heart and circulation in patients with heart failure. In multiple studies of thousands of patients, these drugs have demonstrated a remarkable improvement of symptoms in patients, prevention of clinical deterioration, and prolongation of survival. In addition, they have been recently been shown to prevent the development of heart failure and heart attacks.

The wealth of the evidence supporting the use of these agents in heart failure is so strong that ACE inhibitors should be considered in all patients with heart failure, especially those with heart muscle weakness.

Possible side effects of these drugs include a:
· nagging, dry cough, low blood pressure,
· worsening kidney function and electrolyte imbalances, and
· rarely, true allergic reactions.

When used carefully with proper monitoring, however, the majority of congestive heart failure patients tolerate these medications without significant problems. Examples of ACE inhibitors include:
1. captopril (Capoten),
2. enalapril (Vasotec),
3. lisinopril (Zestril, Prinivil),
4. benazepril (Lotensin),
5. ramipril (Altace).

For those patients who are unable to tolerate the ACE inhibitors, an alternative group of drugs, called the angiotensin receptor blockers (ARBs), may be used. These drugs act on the same hormonal pathway as the ACE inhibitors, but instead block the action of angiotensin II at its receptor site directly. A small, early study of one of these agents suggested a greater survival benefit in elderly congestive heart failure patients as compared to an ACE inhibitor. However, a larger, follow-up study failed to demonstrate the superiority of the ARBs over the ACE inhibitors.

Further studies are underway to explore the use of these agents in congestive heart failure both alone and in combination with the ACE inhibitors.
Possible side effects of these drugs are similar to those associated with the ACE inhibitors, although the dry cough is much less common. Examples of this class of medications include:

1. losartan (Cozaar),
2. candesartan (Atacand),
3. telmisartan (Micardis),
4. valsartan (Diovan), and
5. irbesartan (Avapro).

Beta-blockersCertain hormones, such as epinephrine (adrenaline), norepinephrine, and other similar hormones, act on the beta receptor's of various body tissues and produce a stimulative effect. The effect of these hormones on the beta receptors of the heart is a more forceful contraction of the heart muscle. Beta-blockers are agents that block the action of these stimulating hormones on the beta receptors of the body's tissues.

Since it was assumed that blocking the beta receptors further depressed the function of the heart, beta-blockers have traditionally not been used in patients with congestive heart failure. In congestive heart failure, however, the stimulating effect of these hormones, while initially useful in maintaining heart function, appears to have detrimental effects on the heart muscle over time.
However, studies have demonstrated an impressive clinical benefit of beta-blockers in improving heart function and survival in congestive heart failure patients who are already taking ACE inhibitors. It appears that the key to success in using beta-blockers in congestive heart failure is to start with a low dose and increase the dose very slowly. At first, patients may even feel a little worse and other medications may need to be adjusted.

Possible side effects include:
· fluid retention,
· low blood pressure,
· low pulse, and
· general fatigue and lightheadedness.

Beta-blockers should generally not be used in people with certain significant diseases of the airways (for example, asthma, emphysema) or very low resting heart rates. While carvedilol (Coreg) has been the most thoroughly studied drug in the setting of congestive heart failure, studies of other beta-blockers have also been promising. Research comparing carvedilol directly with other beta-blockers in the treatment of congestive heart failure is ongoing. Long acting metoprolol (Toprol XL) is also very effective in patients with congestive heart failure.

Digoxin

Digoxin (Lanoxin) has been used in the treatment of congestive heart failure for hundreds of years. It is naturally produced by the foxglove flowering plant. Digoxin stimulates the heart muscle to contract more forcefully. It also has other actions, which are incompletely understood, that improve congestive heart failure symptoms and can prevent further heart failure. However, a large-scale randomized study failed to demonstrate any effect of digoxin on mortality.

Digoxin is useful for many patients with significant congestive heart failure symptoms, even though long-term survival may not be affected. Potential side effects include:

· nausea,
· vomiting,
· heart rhythm disturbances,
· kidney dysfunction, and
· electrolyte abnormalities.

These side effects, however, are generally a result of toxic levels in the blood and can be monitored by blood tests. The dose of digoxin may also need to be adjusted in patients with significant kidney impairment.

DiureticsDiuretics are often an important component of the treatment of congestive heart failure to prevent or alleviate the symptoms of fluid retention. These drugs help keep fluid from building up in the lungs and other tissues by promoting the flow of fluid through the kidneys.

Although they are effective in relieving symptoms such as shortness of breath and leg swelling, they have not been demonstrated to positively impact long term survival.
Nevertheless, diuretics remain key in preventing deterioration of the patient's condition thereby requiring hospitalization. When hospitalization is required, diuretics are often administered intravenously because the ability to absorb oral diuretics may be impaired, when congestive heart failure is severe. Potential side effects of diuretics include:

· dehydration,
· electrolyte abnormalities,
· particularly low potassium levels,
· hearing disturbances, and
· low blood pressure.

It is important to prevent low potassium levels by taking supplements, when appropriate. Such electrolyte disturbances may make patients susceptible to serious heart rhythm disturbances. Examples of various classes of diuretics include:

· furosemide (Lasix),
· hydrochlorothiazide (Hydrodiuril),
· bumetanide (Bumex),
· torsemide (Demadex),
· spironolactone (Aldactone), and
· metolazone (Zaroxolyn).

One particular diuretic has been demonstrated to have surprisingly favorable effects on survival in congestive heart failure patients with relatively advanced symptoms. Spironolactone (Aldactone) has been used for many years as a relatively weak diuretic in the treatment of various diseases. Among other things, this drug blocks the action of the hormone aldosterone.

Aldosterone has many theoretical detrimental effects on the heart and circulation in congestive heart failure. Its release is stimulated in part by angiotensin II (see ACE inhibitors, above). In patients taking ACE inhibitors, however, there is an "escape" phenomenon in which aldosterone levels can increase despite low levels of angiotensin II. Medical researchers have found that spironolactone can improve the survival rate of patients with congestive heart failure. In that the doses used in the study were relatively small, it has been theorized that the benefit of the drug was in its ability to block the effects of aldosterone rather than its relatively weak action as a diuretic (water pill). Possible side effects of this drug include elevated potassium levels and, in males, breast tissue growth (gynecomastia). Another aldosterone inhibitor is eplerenone (Inspra).

Heart transplant
In some cases, despite the use of optimal therapies as described above, the patient's condition continues to deteriorate due to progressive heart failure. In selected patients, heart transplantation is a viable treatment option. Candidates for heart transplantation are generally under age 70 and do not have severe or irreversible diseases affecting the other organs.

Additionally, a transplant is done only when it is clear that the patient's prognosis is poor with continued medical treatment of the heart condition. Transplant patients require close medical follow-up while taking the necessary drugs that suppress the immune system, and because of the risk of rejection of the transplanted heart. They must even be monitored for possible development of coronary artery disease in the transplanted heart.

Although there are thousands of patients on waiting lists for a heart transplant at any given time, the number of operations performed each year is limited by the number of available donor organs. For these reasons, heart transplantation is a realistic option in only a small subset of the large numbers of patients with congestive heart failure.

Other mechanical therapies
Given the limitations associated with heart transplantation, much attention has recently been directed towards the development of mechanical assist devices that are designed to assume part or all of the pumping function of the heart. There are several devices available for clinical use and many more are actively being developed. For instance, there are currently left ventricular assist devices that are approved for use as a temporary mode of circulatory support in very ill patients until a transplant can be performed. Studies examining the possible role of these mechanical assist devices on a long term basis as permanent self-contained implants are ongoing.

The current major limitation of these devices is the risk of infection, especially at the site where the device exits the body through the skin to communicate with its external power source.

A less invasive modality, which can be placed without surgery, is the biventricular pacemaker. This device has proved valuable in appropriate types of patients with heart failure and impaired ventricles by improving the synchrony of contraction.

What are stem cells, and how can they be used to treat heart damge?
Stem cells are unspecialized cells within the body that have the potential to develop into one or many kinds of cells. Stem cells potentially could treat or cure many diseases and conditions, including Parkinson's disease, Alzheimer's disease, diabetes, certain heart diseases, stroke, arthritis, certain birth defects, osteoporosis, spinal cord injury and burns.

There are essentially two types of human stem cells – embryonic and adult. In order for a stem cell to differentiate into a specialized cell type, such as a cardiac or brain cell, the stem cell must achieve a “pluripotent” state. Pluripotent stem cells can potentially develop into any kind of cell in the body and come from three sources:

. fetal tissue from miscarriages and abortions
. embryos created for in vitro fertility treatments but not selected for implantation
. adult cells that have been reprogrammed to embryonic stem cell-like state

The American Heart Association funds commendable research involving human adult stem cells.

What is the importance of stem cell research to cardiovascular disease and stroke?
Stem cell research offers great promise to treat or cure many diseases and conditions. It could be used to develop dramatic new procedures and techniques to reverse degenerative heart disease. For example, it may help generate new, healthy heart tissue, valves and other vital tissues and structures. About 128 million people suffer from diseases that might be cured or treated through stem cell research. About 58 million of these people suffer from cardiovascular disease.

New discoveries in the field also show potential for being able to study the origins of disease, which could lead to new knowledge related to CVD and stroke prevention. Also, the development of cardiac cells from stem cells provides the unique opportunity for researchers to test new drugs on actual human tissue rather than in animals.

What is the long term outlook for patients with congestive heart failure?
Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given patient, however, is extremely variable.

Factors involved in determining the long term outlook (prognosis) for a given patient include:
. the nature of the underlying heart disease,
. the response to medications,
. the degree to which other organ systems are involved and the severity of other accompanying conditions,
the patient's symptoms and degree of impairment, and other factors that remain poorly understood.

With the availability of newer drugs to potentially favorably affect the progression of disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.

An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). Of those deaths that occur in patients with congestive heart failure, approximately 50% are related to progressive heart failure.

Importantly, the other half are thought to be related to serious arrhythmias. A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in patients with severe congestive heart failure (defined by an ejection fraction below 30%-35%) can significantly improve survival, and has become the standard of care in most such patients.

What are the areas of new research in congestive heart failure?
Despite the significant advances in drug therapy for congestive heart failure over the past 20 years, many exciting developments are under active study. New classes of medications are being tested in clinical trials, including the calcium sensitizing agents, vasopeptidase inhibitors, and natriuretic peptides. As was the case with the ACE inhibitors and beta-blockers, the potential use of these drugs is based on theoretical considerations that have resulted from an increased understanding of the processes both underlying and resulting from heart failure. Additionally, gene therapy that is targeted toward certain genes thought to contribute to heart failure is being tested.

These developments have justified an unprecedented optimism in the treatment of congestive heart failure. The majority of patients, with appropriate lifestyle measures and medical regimens, can maintain active, fulfilling lifestyles. The range of treatment options has been significantly strengthened by drugs such as the ACE inhibitors and beta-blockers. In the future, we will surely see the addition of many more and equally potent interventions.

Congestive Heart Failure At A Glance
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs.
Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure.

The symptoms of congestive heart failure vary, but can include fatigue, diminished exercise capacity, shortness of breath, and swelling.
The diagnosis of congestive heart failure is based on knowledge of the patient's medical history, a careful physical examination, and selected laboratory tests.

The treatment of congestive heart failure can include lifestyle modifications, addressing potentially reversible factors, medications, heart transplant, and mechanical therapies.
The course of congestive heart failure in any given patient is extremely variable.

Chinese herbal medicine for congestive heart failure
1. Astragali Membranacei
2. Stephaniae Tetrandrae
3. Tinctorii
4. Salviae Miltiorrhizae
5. Lepidii Seu Descurianiae

We sell the above herbs in wholesale price in certain proportion to be used by patients suffering from congestive heart failure.
Just ask for it; we deliver those herbs all over the world.

Cancer .. Causes; prevention; and treatment.

What Is Cancer?

Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.

How a normal cell becomes cancer
Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.
Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, cancer cells outlive normal cells and keep forming new abnormal cells. Another difference between cancer cells and normal cells is that cancer cells can invade (grow into) other tissues. Being able to grow out of control and to invade other tissues makes a cell a cancer cell.

Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its actions. Most of the time, when DNA gets damaged the cell can fix it. If the cell can’t repair the damage, the cell dies. In cancer cells the damaged DNA is not repaired, but the cell doesn’t die like it should. Instead, this cell goes on making new cells even though the body does not need them. These new cells will all have the same DNA damage as the first cell does.
People can inherit damaged DNA, but most of the time DNA damage is caused by something we are exposed to in our environment. Sometimes the cause of the DNA damage is something obvious, like cigarette smoking. But many times no clear cause is found.
A cancer cell has many mistakes in its DNA -- having damage in just one spot does not cause cancer. Even when someone inherits damaged DNA, more mistakes in their DNA are needed before a cancer will develop. Staying away from things that are known to damage DNA (like smoking) as a part of a healthy life style lowers the chance that more DNA damage will take place. This can reduce the risk of cancer -- even in people who have an inherited tendency to get cancer.

How cancers grow and spread
In most cases the cancer cells form a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. But sometimes the extra cells in these blood cancers may also form a mass of tissue called a tumor.
Cancer cells often travel to other parts of the body, where they begin to grow and replace normal tissue. This process is called metastasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body.
But no matter where a cancer may spread, it is always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer.

Not all tumors are cancerous. Tumors that aren't cancer are called benign. Benign tumors can cause problems -- they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.
How cancers differ
Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

How common is cancer
Cancer is the second leading cause of death in the United States. Nearly half of all men and a little over one third of all women in the United States will develop cancer during their lifetimes.
Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. Often, the sooner a cancer is found and treatment begins, the better are the chances for living for many years.

Who Gets Cancer?
Over one million people get cancer each year. About 1 out of every 2 American men and 1 out of every 3 American women will have some type of cancer at some point during their lifetime. Anyone can get cancer at any age; but about 77% of all cancers are diagnosed in people age of 55 and older. Cancer can be found in Americans of all racial and ethnic groups, but the rate of cancer occurrence (called the incidence rate) varies from group to group.
Today, millions of people are living with cancer or have been cured of the disease. The sooner a cancer is found and the sooner treatment begins, the better a patient's chances are of a cure. That's why early detection of cancer is such an important weapon in the fight against cancer.

What Are the Risk Factors for Cancer?
Smoking and drinking alcohol cause some people to get certaintypes of cancer. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The best thing is to never use tobacco at all. Cigarettes, cigars, pipes and smokeless tobacco all cause cancer and should not be used. People who already smoke should try to quit -- we know that former smokers have less risk of cancer than do people who continue to smoke.

Many of the more than 1 million skin cancers that are diagnosed every year could have been prevented by protecting the skin from the sun's rays and avoiding indoor tanning. The chances of getting skin cancer can be lowered by staying in the shade as much as you can, wearing a hat and shirt when you are in the sun, and using sunscreen.
About one third of the cancer deaths expected every year are related to nutrition, overweight or obesity, and physical inactivity, and thus could also be prevented. We know that our diet, (what we eat) is linked to some types of cancer, but the exact reasons are not yet clear. The best advice is to eat a lot of fresh fruits and vegetables, whole grains like pasta and bread, and limit foods high in saturated fat, like high-fat dairy products, processed meats (like bacon, hot dogs, and luncheon meats), and red meats. It is also important to get to and stay at a healthy weight and get at least 30 to 45 minutes of physical activity on at least 5 days per week. You can get more information on this in our document.

Certain cancers are related to infectious diseases, such as hepatitis B virus (HBV), human papilloma virus (HPV), human immunodeficiency virus (HIV), Helicobacter pylori (H. pylori), and others. Many of these could be prevented through behavioral changes, vaccines, or antibiotics.
There is no way to prevent most cancers, but the best plan is to avoid risk factors you can control and make healthy lifestyle choices.

Can Cancer Be Prevented?

Smoking and drinking alcohol cause some people to get certain types of cancer. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The best thing is to never use tobacco at all. Cigarettes, cigars, pipes and smokeless tobacco all cause cancer and should not be used. People who already smoke should try to quit -- we know that former smokers have less risk of cancer than do people who continue to smoke.
Many of the more than 1 million skin cancers that are diagnosed every year could have been prevented by protecting the skin from the sun’s rays and avoiding indoor tanning. The chances of getting skin cancer can be lowered by staying in the shade as much as you can, wearing a hat and shirt when you are in the sun, and using sunscreen.

About one third of the cancer deaths expected every year are related to nutrition, overweight or obesity, and physical inactivity, and thus could also be prevented. We know that our diet, (what we eat) is linked to some types of cancer, but the exact reasons are not yet clear. The best advice is to eat a lot of fresh fruits and vegetables, whole grains like pasta and bread, and limit foods high in saturated fat, like high-fat dairy products, processed meats (like bacon, hot dogs, and luncheon meats), and red meats. It is also important to get to and stay at a healthy weight and get at least 30 to 45 minutes of physical activity on at least 5 days per week. You can get more information on this in our document.

Certain cancers are related to infectious diseases, such as hepatitis B virus (HBV), human papilloma virus (HPV), human immunodeficiency virus (HIV), Helicobacter pylori (H. pylori), and others. Many of these could be prevented through behavioral changes, vaccines, or antibiotics.

There is no way to prevent most cancers, but the best plan is to avoid risk factors you can control and make healthy lifestyle choices.
What Causes Cancer?

Some kinds of cancer are caused by things people do. For example, smoking causes cancers of the lungs, mouth, throat, bladder, kidneys and some other organs, as well as heart disease and stroke. While not everyone who smokes will get cancer, smoking increases a person's chance of getting the disease. Drinking a lot of alcohol has also been shown to increase a person's chance of getting cancer of the mouth, throat, and some other organs. This is especially true if the person drinks and smokes.

Radiation (x-rays) can cause cancer. But the x-rays used by the doctor or dentist are safe. Too much exposure to sunlight without any protection can cause skin cancer.
Certain inherited DNA changes can increase the risk for developing some cancers and are responsible for the cancers that run in some families. For example, the BRCA genes (BRCA1 and BRCA2) are tumor suppressor genes -- they keep tumors from growing. Changes (mutations) in these genes can be passed on (inherited) from parents. When they are mutated, they no longer suppress abnormal growth, and cancer is more likely to develop.

But in most cases, the exact cause of cancer remains a mystery. We know that certain changes in our cells can cause cancer to start, but we don't yet know exactly how this happens. Many scientists are studying this problem.
Cancer Screening and Early Detection

There are tests, called screening tests, which adults should have in order to find cancers at an early stage when they are most treatable. Screening can prevent cancers of the cervix, colon, and rectum by allowing doctors to take out pre-cancerous tissue before it becomes cancer. Screening can also detect cancers of the breast, colon, rectum, cervix, prostate, oral cavity, and skin at early stages. For most of these cancers, early detection has been shown to reduce the number of deaths caused by cancer.
Cancers that can be prevented or detected earlier by screening account for at least half of all new cancer cases. For complete information on cancer screening and early detection.

Signs and Symptoms of Cancer

What are signs and symptoms?
A symptom is a signal of disease, illness, injury, or that something is not right in the body. Symptoms are felt or noticed by the person who has them, but may not be easily seen by anyone else. For example, chills, weakness, aches, and feeling short of breath may be symptoms of pneumonia.

A sign is also a signal that something is not right in the body. But signs are signals that can be seen by a doctor, nurse, or other health care professional. Fever, fast breathing, and abnormal breathing sounds heard through a stethoscope may be signs of pneumonia.
Having one symptom or sign may not be enough to figure out what's causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, an infectious disease like measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. In many cases, a patient's signs and symptoms alone do not give the doctor enough clues to figure out the cause of an illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

How does cancer cause signs and symptoms?
Cancer is a group of diseases that may cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects nearby organs or tissues. If a cancer has spread (metastasized), symptoms may appear in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure creates some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause early symptoms.

But sometimes cancer starts in places where it will not cause any symptoms until it has grown quite large. Pancreas cancers, for example, do not usually grow large enough to be felt from the outside of the body. Some pancreatic cancers do not cause symptoms until they begin to grow around nearby nerves (this causes a backache). Others grow around the bile duct and block the flow of bile. This causes a yellowing of the eyes and skin called jaundice. By the time a pancreatic cancer causes these signs or symptoms, it is usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

Patrick Swayze dies from pancreatic cancer

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Or the cancer may cause the immune system to react in ways that produce these symptoms.

Sometimes, cancer cells release substances into the bloodstream that cause symptoms which are not usually linked to cancer. For example, some cancers of the pancreas can release substances which cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

How are signs and symptoms helpful?
Treatment is most successful when cancer is found as early as possible. Finding cancer early usually means it can be treated; while it is still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. Skin cancer can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people living at least 5 years after diagnosis) at this stage is nearly 100%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops below 20%.

Sometimes people ignore symptoms. They may not know that symptoms could mean something is wrong. Or they may be frightened by what the symptoms might mean and don't want to get medical help. Some symptoms, such as tiredness, are more likely to have a cause other than cancer and can seem unimportant, especially if there is an obvious cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has been there for a long time or is getting worse.

Most likely, any symptoms you may have will not be caused by cancer, but it’s important to have them checked out by a doctor, just in case. If cancer is not the cause, a doctor can help figure out what is and treat it, if needed.
Sometimes, it is possible to find cancer before you have symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms occur.

General cancer signs and symptoms
You should know some of the general (non-specific) signs and symptoms of cancer. But remember , having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too.

Unexplained weight loss
Most people with cancer will lose weight at some point. An unexplained weight loss of 10 pounds or more (when you're not trying to lose weight) may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus, or lung.

Fever
Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. This can make it harder for the body to fight infection. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue
Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in cancers like leukemia, or if the cancer is causing blood loss, which can happen with some colon or stomach cancers.

Pain
Pain may be an early symptom with some cancers such as bone cancers or testicular cancer. A headache that does not go away or respond to treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain that is linked to cancer is a symptom of cancer that has already metastasized (spread from where it started).

Skin changes
Along with cancers of the skin (see the next section), some other cancers can cause skin symptoms or signs that can be seen. These signs and symptoms include:
darker looking skin (hyperpigmentation)
yellowish skin and eyes (jaundice)
reddened skin (erythema)
itching

Excessive hair growth

Signs and symptoms of certain cancers
Along with the general symptoms, you should watch for certain other common symptoms and signs which could suggest cancer. Again, there may be other causes for each of these, but it is important to see a doctor about them as soon as possible.

Change in bowel habits or bladder function
Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Any changes in bladder or bowel function should be reported to a doctor.

Sores that do not heal
Skin cancers may bleed and look like sores that do not heal. A long-lasting sore in the mouth could be an oral cancer and should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should not be ignored.

White patches inside the mouth or white spots on the tongue
White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that is caused by ongoing irritation. It is often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for developing leukoplakia. If it is not treated, leukoplakia can become oral cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge
Unusual bleeding can happen in early or advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause unusual vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body
Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size.

Indigestion or trouble swallowing
While they most often are caused by other things, indigestion or swallowing problems may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat).

Recent change in a wart or mole or any new skin change
Any wart, mole, or freckle that changes color, size, or shape, or loses its definite borders should be reported to a doctor right away. Any new skin changes should be reported as well. A skin change may be a melanoma which, if found early, can be treated successfully.

Nagging cough or hoarseness
A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid.

Although the signs and symptoms listed are the ones more commonly seen with cancer, there are many others that are less common and are not listed here. If you notice any major changes in the way your body works or the way you feel, especially if it lasts for a long time or gets worse, let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what's going on and treat it, if needed. If it is cancer, you'll give yourself the best chance to have it treated early, when treatment is most likely to be effective.

How Is Cancer Diagnosed?

A patient's signs and symptoms are not enough to know whether or not cancer is present. If your doctor suspects cancer you will probably need to have more tests done, such as x-rays, blood tests, or a biopsy. In most cases a biopsy is the only way to tell for sure whether or not cancer is present.

To do a biopsy a piece of the lump or abnormal area is taken out and sent to the lab. There a pathologist (a doctor who specializes in diagnosing diseases) looks at the tissue under a microscope to see if it contains cancer cells. If there are cancer cells the doctor tries to figure out exactly what type of cancer it is and whether it is likely to grow slowly or more quickly.
Scans can measure the size of the cancer and whether it has spread to nearby tissues. Blood tests can tell doctors about your overall health and can show how well your organs are working.

What Are Imaging Tests?
Imaging tests are studies that make pictures of what's going on inside your body. These tests use different forms of energy (x-rays, sound waves, radioactive particles, or magnetic fields) that are passed through the body. The changes in energy patterns caused by different body tissues can be detected by special devices, which change them into pictures. These pictures can show normal body structure and function as well as abnormalities caused by diseases such as cancer.

Imaging tests are different from endoscopic tests (for example, colonoscopy or bronchoscopy), which use a flexible, lighted tube connected to a viewing lens or a video camera. Endoscopic tests allow doctors to look inside parts of the body as if they were looking with the "naked eye."

What Are Imaging Tests Used For?

Imaging tests are used for cancer in many ways:
They are sometimes used in screening – looking for cancer in its early stages, even though a person has no symptoms. A mammogram is an example of an imaging test used for cancer screening.

They sometimes help predict whether a tumor is likely to be cancer and help doctors decide if you need to have a biopsy (taking a tissue sample to be looked at under the microscope) . A biopsy is almost always needed to know for sure that a tumor is cancer.

. They sometimes help predict whether a tumor is likely to be cancer and help doctors decide if a biopsy (removal of a tissue sample for viewing under the microscope) is needed. However, a biopsy is almost always needed to say for sure that a tumor is cancer.
. They show exactly where the tumor is, even deep within the body, so that a sample of it can be taken for further study.
. They help stage cancer (determining how far the cancer has spread).
. They can be used to plan treatment, such as when determining where the beams should be focused in radiation therapy.
. They can give a doctor an idea of how well treatment is working (that is, if a tumor has shrunken, stayed the same, or grown after treatment).
. They can help find out if a cancer has recurred (come back) after treatment.

Imaging tests are only part of the process of cancer diagnosis and management. A complete initial workup for your cancer also includes a careful medical history (interview about symptoms and risk factors) and physical exam, and possibly blood or other lab tests.

Imaging tests may give important evidence that a lump or mass is present, but they usually cannot tell for sure if the lump is a cancer. For the doctor to make a diagnosis, a biopsy is almost always needed. In many cases, imaging tests make it possible to get a biopsy without the need for major surgery.

Many doctors request x-rays or other images before treatment begins so that a record is available showing how things change over time. These studies are called baseline studies because they provide a basis of information that helps doctors evaluate the results of treatment or progression of the disease.

Who Performs and Interprets Imaging Tests?

A doctor, a certified technologist, or other health professional may perform an imaging test. Depending on the technology involved, the test may be done in a hospital, a special clinic or imaging center, or a doctor's office. In larger medical centers, imaging tests are usually done in the radiology department (even though some types of tests do not involve high-energy radiation).

A radiologist, a doctor who specializes in imaging techniques, usually reads (interprets) the imaging test. The radiologist writes a report on the findings and sends the report to your doctor. A copy of the report will become part of your patient records. Your other doctors (oncologists, surgeons, etc.) may look at the images as well.

Types of Imaging Tests
The rest of this document explains some of the more common types of imaging tests, how they are done, and when they may be needed.

Computed Tomography (CT) Scan

Other Names

CT scan, CAT scan, spiral CT, helical CT

What Does It Show?
Computed tomography or CT (also called CAT) scans show a slice, or cross-section, of the body. The image shows your organs and soft tissues more clearly than standard x-rays. Because the image is created by a computer, it can be enlarged to make it easier to read and interpret.
Since the late 1970s, CT scans have been a very valuable technology in detecting cancer. CT scans can show a tumor's shape, size, volume, and location and can reveal the blood vessels that feed the tumor.

Doctors often use CT scans to help them guide a needle to remove a tissue sample (called a CT-guided biopsy). They can also be used to guide needles into tumors for some types of cancer treatments, such as radiofrequency ablation (destroying a tumor using heat and ionic agitation).

CT scans are especially effective in detecting and evaluating cancer in the liver, pancreas, adrenal glands, lungs, and bones. They are also used to provide information about cancer in the large and small intestines, esophagus, stomach, brain, prostate, or other organs.

By comparing CT scans done over time, doctors can see how a tumor is responding to therapy or detect a possible recurrence after treatment.

Magnetic Resonance Imaging (MRI)

Other Names

magnetic resonance (MR), nuclear magnetic resonance (NMR) imaging

What Does It Show?

Like computed tomography (CT) scans, MRI displays a cross-section of your body. However, MRI uses powerful magnetic fields instead of radiation to create the images. An MRI scan can present cross-sectional slices (views) from several angles, as if someone were looking at a slice of your body from the front (frontal view), from the side (sagittal view), or from above your head (axial view). The procedure creates images of soft tissue parts of the body that would sometimes be hard to see using other imaging tests.

MRI is especially valuable in detecting and localizing cancer in the brain and spinal cord, head, neck, and bones and muscles. Used with contrast agents, it is the best way to see brain tumors. Using MRI, doctors can sometimes tell a benign tumor from a malignant (cancerous) tumor.

In recent years, MRI has become the main way to thoroughly evaluate the female reproductive system, and it is helpful in determining the stage of endometrial cancer before surgery. Another important use for MRI is looking for signs that cancer may have metastasized (spread) to the liver from another site in the body.

MRI images can also help doctors plan treatment such as surgery or radiation therapy.
Unlike x-rays or CT scans, MRI cannot detect calcifications (tiny mineral deposits that may suggest the presence of cancer) in tissues such as the breast. However, special MRI machines, now available in a few hospitals, are designed specifically for examining the breast. MRI is sometimes used along with mammograms or breast ultrasound to look for breast cancer, particularly in younger women or those with very dense breasts. At this time MRI is not recommended by itself for the early detection of breast cancer.

Radiographic Studies (Regular X-rays and Contrast Studies)

Other Names

Radiographs, roentgenograms.

What Do They Show?
Radiographs, commonly known as x-rays, produce shadow-like images of certain organs or tissues. An abdominal x-ray may reveal tumors or other diseases in organs of the abdomen, including the intestines, stomach, liver, spleen, and kidneys. A chest x-ray is used to detect lung diseases, including cancer. These tests, which produce a single image or series of still images, are sometimes referred to as standard radiographic studies. Mammography (a breast x-ray) is another form of radiographic study (for more information, see the section Mammography).

Special types of x-ray tests may use dyes called contrast materials. For example, a lower gastrointestinal (GI) series, often called a barium enema exam, takes x-ray images after the bowel is filled with barium sulfate (a contrast material). Another contrast study, intravenous pyelography (IVP), examines the structure and function of the kidneys.
With advances in technology, many contrast studies once commonly used for diagnosis are being replaced by other methods, such as CT or MRI scans

Mammography

Other Names

mammogram, digital mammography

What Does It Show?
A mammogram is an x-ray exam of the breast. It can detect and diagnose many cases of breast cancer.
A mammogram is an effective screening tool. A screening mammogram is used to look for signs of breast disease when you do not have any breast symptoms. Many breast cancers take years to develop. A mammogram can detect cancer in its early stages, when treatment is most likely to be successful.

A diagnostic mammogram is the imaging test used when you have breast symptoms or when abnormalities appear on a screening mammogram. Diagnostic mammograms may include additional views (images) of the breast that are not usually done on screening mammograms.
Mammograms can't prove that an abnormal area is (or is not) cancer, but it can give information that shows whether further testing is needed. The 2 main types of breast abnormalities that can be found with a mammogram are calcifications and masses.

Calcifications are tiny mineral deposits within the breast tissue, which look like small white spots on the films. They may or may not be caused by cancer. There are 2 types of calcifications:
Macrocalcifications are coarse (larger) calcium deposits that are most likely changes in the breasts caused by aging of the breast arteries, old injuries, or inflammation. These deposits are related to non-cancerous conditions and do not require a biopsy (removing a sample of tissue for viewing under a microscope). Macrocalcifications are found in about half the women over 50, and in 1 of 10 women under 50.

Microcalcifications are tiny specks of calcium in the breast. They may appear alone or in clusters. Microcalcifications seen on a mammogram are of more concern, but still usually do not mean that cancer is present. The shape and layout of microcalcifications help the radiologist judge how likely it is that cancer is present. In most instances, the presence of microcalcifications does not mean a biopsy is needed. In other cases, the microcalcifications look more suspicious and a biopsy is needed.

A mass, which may occur with or without calcifications, is another important change seen on mammograms. Masses can be caused by many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors, but they could be cancer and usually should be biopsied if they are not cysts.

A cyst cannot be diagnosed by physical exam alone, nor can it be diagnosed by a mammogram alone. To confirm that a mass is really a cyst, either breast ultrasound or removal of fluid with a thin, hollow needle (aspiration) is needed.

If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to have more imaging tests. Some masses can be watched with periodic mammograms, while others may need a biopsy. The size, shape, and margins (edges) of the mass help the radiologist to determine whether cancer may be present.

Your prior mammograms may help show that a mass has not changed for many years, which would mean that the mass is likely a benign condition and a biopsy would not be needed. Having your prior mammograms available to the radiologist is very important.
A mammogram may show something suspicious, but by itself it cannot prove that an abnormal area is cancer. If a mammogram raises a suspicion of cancer, tissue must be removed and looked at under the microscope to tell if it is cancer. This can be done with a needle biopsy or an open surgical biopsy.

To get an accurate breast biopsy, enough cells or fluid must be removed from the suspicious area for the pathologist to study. It can be hard for a doctor to insert the needle precisely where the abnormality exists, especially if the lump cannot be felt. To improve accuracy, your doctor may use different imaging studies to guide the placement of the needle:
Stereotactic mammography uses mammograms taken from 2 angles (a "stereo" view). A computer calculates the precise location of the mass or calcification and then guides the placement of the biopsy needle.

Breast ultrasound can also be used to guide biopsy needles (see the section on Ultrasound).
A ductogram (galactogram) is a type of mammogram that is done after a contrast agent is inserted into a nipple duct with a thin tube. It is used to evaluate nipple discharge.

What Else Should I Know About This Test?
The American Cancer Society has developed guidelines for the early detection of breast cancer in women who are not having breast symptoms:

Women 40 years of age and older should have a mammogram every year and a clinical breast exam (CBE) performed by a health care professional every year. They also have the option of performing a breast self-exam (BSE) every month. The CBE should be conducted close to and preferably before the scheduled mammogram.

Women aged 20 to 39 should have a clinical breast exam by a health care professional every 3 years and have the option of performing breast self-exam every month.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.

Mammography alone cannot detect all cases of breast cancer. For this reason, mammograms should be used in addition to a clinical breast exam by a health care professional. Knowing how your breasts normally look and feel, and reporting any changes to your doctor, is also very important.

To reduce the chance of discomfort during a mammogram, schedule the procedure for a week or so after your menstrual period, when your breasts are less likely to be tender.

A negative mammogram (no sign of calcifications or masses) does not necessarily mean that cancer is not present or that cancer will not develop later.
The need for a biopsy does not mean that you have cancer. About 70% to 80% of biopsies turn out to be benign (not cancer).

If you have breast implants, find a radiologist who is experienced in performing mammograms on augmented breasts and let the facility know this ahead of time. Additional views may be necessary, so it may take longer.

Nuclear Scans

Other Names

nuclear imaging, radionuclide imaging, nuclear medicine scans

What Do They Show?
Nuclear scans provide images based on the body’s chemistry rather than on anatomy (as is the case with other imaging tests). They use substances called radionuclides (also known as tracers or radiopharmaceuticals) that release low levels of radiation. The small amount of radioactivity used is harmless.

Inside the body, tissues affected by certain diseases such as cancer may absorb more or less of the tracer than normal tissues. Special cameras pick up the pattern of radioactivity to create images that show where the material has traveled and where it has accumulated. The scans show certain disorders of internal organs and tissues more accurately than standard x-ray images.

If cancer is present, the tumor may show up on the image as a "hot spot" – an area of increased uptake. Depending on the type of scan performed, the tumor may instead be a "cold spot" – a site of decreased uptake.
Nuclear scans are used to locate tumors, especially in the bones and thyroid gland. They are also used to study a cancer's stage (extent of its spread) and to decide if treatment is working. In the past, nuclear scans were often used to detect liver and brain tumors. Because of improvements in technology, a CT or MRI scan can now be done instead of a nuclear scan in many of these cases.

Nuclear scans may not detect very small tumors, nor do they always distinguish between benign and malignant (cancerous) tumors. They are often used along with other imaging tests to give a more complete picture of what is going on. For example, bone scans that show "hot spots" on the skeleton are usually followed by x-rays of the affected bones, which are better at showing details of the bone structure.

Nuclear scans have different names, depending on the organ involved. Some of the more commonly used nuclear scans (described in more detail below) include:
. bone scans
. gallium scans
. FDG PET scans

Ultrasound (US)

Other Names

ultrasonography, sonography, sonogram

What Does It Show?
An ultrasound machine produces images called sonograms by generating high-frequency sound waves that go through your body. As the sound waves bounce off your internal organs and tissues, they create echoes. Cysts (fluid-filled sacs) and solid tumors have different echo patterns than normal body tissues.

Ultrasound is especially good at giving pictures of some diseases of soft tissues that do not show up as well on x-rays. Ultrasound is an excellent way to tell fluid-filled cysts from solid tumors because the echo patterns produced by these disorders look very different. In diagnosing breast masses, for example, ultrasound is often used to tell cysts from solid tumors. Ultrasound can also be used to determine how deeply a tumor of the esophagus, rectum, or uterus has gone through the wall of the organ.

However, ultrasound images are not as detailed as those from CT or MRI scans. Ultrasound alone cannot distinguish a benign tumor from a cancerous one. Its use is also limited in some areas of the body because the sound waves cannot go through air (such as in the lungs) or through bone.

Doctors often use ultrasound to determine where to place a needle to obtain a biopsy (withdrawing fluid or tiny tissue fragments for viewing under a microscope). This procedure occurs in "real time" -- that is, the doctor can look at the ultrasound monitor while moving the needle and actually see the needle moving toward and into the tumor.

For some types of ultrasound exams, the transducer (the wand that produces the sound waves and detects echoes) is placed on the skin surface. The sound waves pass through the skin and reach the internal organs. In other cases, to get the best images, the doctor must use a transducer that is inserted into a body opening, such as the esophagus, rectum, or vagina.

Special ultrasound machines, known as Doppler flow machines, are able to show how blood is flowing through the vessels. This is important because blood flows differently through tumors than it does through normal tissue. Some of these machines make color images to increase the amount of information it contains. Unlike other forms of blood vessel imaging, color Doppler studies do not require contrast agents. Color Doppler has made it easier for doctors to determine if cancer

Screening tests refer to procedures used to find a disease, such as cancer, in people who do not have symptoms of that disease.
Detection refers to diagnostic procedures used if you have some indication (such as symptoms, abnormal physical exam results, or abnormal results from screening tests) that a disease such as cancer may be present. Imaging tests for detection can help find a mass or other abnormality of tissue and can often predict whether it is likely to be a cancer or some other type of disease. However, in almost all cases, a tissue sample (biopsy) must be viewed under the microscope to be sure if a cancer is present.

Image-guided biopsy refers to use of imaging tests to help guide a biopsy needle into the area of abnormal tissue. An image-guided biopsy can often provide tissue for study without the need for surgery.

Staging is the process of determining how far a cancer has grown and spread. Imaging tests are often used to estimate the size of a cancer; to find out how far it has spread in the organ in which it started; and to see whether it has spread to nearby tissues and organs, nearby lymph nodes, or distant organs. Most of the tests listed in this section are used to look for metastases in distant organs or tissues. For instance, men with prostate cancer often have bone scans to see if the cancer has spread to bones.

What Is Staging?

Staging is the process of finding out how much cancer there is in the body and where it is located. Staging the cancer is a key step in deciding on your best treatment choices. It also gives your health care team an idea of your outlook (prognosis).

Staging can take time, and people are usually anxious to begin treatment right away. Do not worry that the staging process is taking up treatment time. In most cases it is OK because by staging the cancer, you and your health care team will know which treatments are likely to work best.

Why is staging needed?
Doctors need to know the amount of cancer and where it is in the body to make sure a person gets the best possible treatment. For example, the treatment for early stage breast cancer may be surgery and radiation, while a more advanced stage of breast cancer may need to be treated with chemotherapy, too. Doctors also use the stage to help predict the course a cancer is likely to take.

What is the doctor looking for when staging cancer?
For most cancers, the stage is based on 3 main factors:
the original (primary) tumor's size and whether or not the tumor has grown into nearby areas
whether or not the cancer has spread to the nearby lymph nodes
whether or not the cancer has spread to distant areas of the body

Some cancers of the blood, such as leukemias, are not staged in this way because they are assumed to be in all parts of the body. Cancers in or around the brain are also not staged using the TNM system, since these cancers can disrupt vital brain and body functions before they even begin to spread.

What does staging involve?
Doctors gather different types of information about a cancer to figure out its stage. Depending on where the cancer is located, the physical exam may give some clue as to the extent of the cancer. Pictures taken during tests like x-rays, CT scans, and MRIs may also provide information about how much and where cancer is in the body. Taking out tumors or pieces of tumors and looking at them under the microscope (biopsy) is needed to confirm the diagnosis of cancer, but it can also help stage the cancer. Samples can be removed either during surgery or during less invasive biopsy procedures.

Types of staging
There are different types of staging.

Clinical staging is done at the time of diagnosis, before any treatment is given. It is an estimate how much cancer there is based on the physical exam, imaging tests (x-rays, CT scans, etc.), and sometimes biopsies of affected areas. For some cancers the results of other tests, such as blood tests, are also used in staging. The clinical stage is a key part of deciding the best treatment to use. It is also the baseline used for comparison when looking at the cancer's response to treatment.

Pathologic staging can only be done on patients who have had surgery to remove the cancer or to look at how much cancer is in the body. It combines the results of clinical staging with the results from the surgery. In some cases, the pathologic stage may be different from the clinical stage (for example, if the surgery shows the cancer has spread more than it was thought to have spread before surgery).

The pathological stage gives the health care team more precise information that can be used to predict treatment response and outcomes (prognosis).
Restaging is not common, but it may be done to find the extent of the cancer if it comes back (recurs) after treatment. This is done to help decide what the best treatment option would be at this time. Restaging is discussed further in the section "A cancer's stage does not change."

How Is Cancer Treated?

The number of treatment choices you have will depend on the type of cancer, the stage of the cancer, and other factors such as your age, health status, and personal preferences. You are a key part of your cancer care team -- you should talk to them about which treatment choices are best for you. Don't be afraid to ask questions. Make sure you understand your options. A cancer diagnosis often makes people feel like they have to hurry to make choices about treatment and services. But take time to look at all the options available to you so you will be as well informed as possible.

The 3 major types of treatment for cancer are surgery, radiation, and chemotherapy. Depending on the type and stage of the cancer, 2 or more of these types of treatment may be combined at the same time or used after one another.

After the cancer is found and staged, your cancer care team will discuss your treatment options with you. It is important to take time and think about your possible choices. In choosing a treatment plan, one of the most important factors is the stage of the cancer. Other factors to consider include your overall health, the likely side effects of the treatment, and the probability of curing the disease, extending life, or relieving symptoms.

In considering your treatment options it is often a good idea to seek a second opinion, if possible. This may give you more information and help you feel more confident about the treatment plan you have chosen. It is also important to know that your chances for having the best possible outcome are highest in the hands of a medical team that is experienced in treating the type of cancer you have.

What treatment will be best for me?
Your cancer treatment will be based on your unique situation. Certain types of cancer respond very differently to different types of treatment, so figuring out the type of cancer is a key step toward knowing which treatments will work best. The cancer's stage (how widespread it is) will also determine the best course of treatment. This is because early-stage cancers respond better to different treatments than later-stage ones. Your overall health, your lifestyle, and your personal preferences will also play a part in deciding which treatment options are best for you.

Not all types of treatment will work well in your situation, so be sure that you understand your options. Don't be afraid to ask questions; it is your right to know what treatments are most likely to help you and what their side effects may be.
Before making treatment decisions, ask about and be sure you understand the goal of treatment in your situation. Is the purpose of the treatment to cure the cancer, keep it under control, or treat the problems it is causing? Know that the goal of treatment can change over time, so you may need to ask about this again at some point.

Complementary and Alternative Therapies

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet groups and Web sites offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

What exactly are complementary and alternative therapies?
Not everyone uses these terms the same way, and they are used to refer to many different methods, so it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor's medical treatment.

Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not be helpful, and a few have even been found harmful.

Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

Finding out more
It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.

Cancer Treatment Side Effects

Cancer treatment can cause many different side effects. The kinds of side effects depend mostly on the type of treatment used. Side effects vary from patient to patient. Some people have no side effects at all, while others have quite a few. This is because every person responds to treatment differently. There is no way to predict who might or might not have side effects.
Many side effects of treatment can be managed or treated. And most side effects go away over time. In the meantime, there are ways to reduce the discomfort they may cause. Tell your doctor or nurse about any side effects you notice so they can help you manage them.

What Is Remission?

Some people think that remission means the cancer has been cured, but this is not always the case. Remission is a period of time when the cancer is responding to treatment or is under control. In a complete remission, all the signs and symptoms of the disease go away and cancer cells cannot be detected by any of the tests available for that cancer. It is also possible for a patient to have a partial remission. This is when the cancer shrinks but does not completely disappear. Remissions can last anywhere from several weeks to many years. Complete remissions may go on for years and over time be considered cures. If the disease returns (recurs), another remission may be possible with further treatment.

Want to Help Prevent Cancer? Drink green Tea, and specific herbs.
Looking for advice on foods and herbs that help prevent cancer, one recommendation crops up over and over. Tea, especially green, and Strobilanthes crispus herb, is revered as being at the top of most lists of cancer prevention. Both are packed with antioxidants, flavonoids and other anti-cancer compounds.

"Clinical studies indicate that regular tea or herbal tea drinking is safe and may contribute to the prevention of . . . several kinds of cancer including cancer of the mouth, breast, bladder, skin, stomach, pancreas, lungs, prostate, and esophagus," among many other potential problems.

Other Foods and Herbs That Lower Cancer Risk
For preventing cancer before it even begins, in what is known as the initiation stage, recommends "Foods rich in carotenoids, such as dark-green leafy vegetables an yellow and orange fruits and vegetables; foods rich in sulphoraphanes, such as broccoli, cabbage, and Brussels sprouts; and food and herbs rich in flavonoids such as berries, green tea, and grapes."

Also mentioned specifically in several sources are:
· Evening Primrose
· Peppermint - high antioxidant content
· Purslane - highly packed with an amazing amount of nutrients, many of them potent cancer fighters
· Garlic - contains antioxidants and sulfides
· Tomatoes - contains lycopene
· Cat's Claw - helps prevent the formation of tumors
· Shiitake, Maitake, Reishi
· Milk Thistle - protects and helps to recover damage to the liver, and has shown some activity against breast and prostate cancer cells
· Grapeseed and Pinebark Extracts - studies have shown they help inhibit abnormal cell growth
· Red Clover - studies show it helps control the spread of cancerous cells
· Turmeric - prevents angiogenesis (formation of new blood supply to tumors, required to grow over 2 cm in size) and may have other anti-cancer properties as well

There are a variety of herbal programs that will assist the immune system and which are considered worthy in nutrition for cancer. However, the one particular formula that has stood the test of time is known to many as "Essiac". This is a formula which many use in the hope that they are preventing cancer and more especially, the impediment of cancer cells from metastasizing.

In the early 1920's a young Canadian nurse by the name of Rene Caisse was given this herbal formula by a patient. The patient said she had cured herself of breast cancer by using this combination prepared by a medicine man from the Ojibwa tribe. Caisse used the same formula on patients who were terminally ill. She claimed many cures and a staggering success rate. She obtained permission from the Canadian government to use this to treat people who were hopeless cases. Many attempts were made to legalize Essiac as a "cure for cancer", including the submission of a bill to parliament, which was defeated by only a few votes. The affect was quite detrimental and Essiac was outlawed, to be used only as an underground remedy.

The formula is quite simple and consists of four basic herbs: Sheep Sorrel (Rumex acetosella), the primary herb, Burdock (Arcticum lappa), Slippery Elm Bark (Ulmus fulva), and Turkey Rhubarb Root (Rheum palmarum). Other herbs can be added such as Pau de Arco and Red Clover Blossom.

Sheep Sorrel is the most important herb in the formula. It is known to be effective in breaking down and reducing (in some cases eradicating) tumors. It contains large amounts of vitamins A, B complex, C, D, E, K, P, and U. It has a high mineral content, including sodium, calcium, sulphur, iron, magnesium, chlorine, silicon, and trace amounts of copper, iodine, manganese and zinc. It also contains malic, oxalic, tannic, tartaric acids as well as a high amount of chlorophyll and carotenoids. Chlorophyll raises the amount of oxygen in the body. Some believe that cancer cannot live or thrive when oxygen levels are increased in the body.

Caretenoids include beta carotene which converts to vitamin A in the liver. This is a known antioxidant and is very high in oxalic acid which is a contributing factor to the anti-tumor and anti-cancer aspects of the herb. It has been said that this herb work, in formula, to stop cancer cells from metastasizing.

Burdock Root has been used for centuries for its amazing healing properties. It is an extremely powerful blood purifier. It is also rich in vitamins and has similar minerals to Sheep Sorrel. Burdock contains phosphorous, potassium, selenium.

The principle ingredient in Burdock is a polysaccharide called inulin. Inulin strengthens vital organs. It is a powerful immune modulator that can enhance white blood cell activity.

Turkey Rhubarb Root is a strong liver cleanser, which has also been used for many centuries. This herb is extremely high in its vitamin and mineral content, including B-Complex, C, P, calcium, phosphorous, potassium, iodine, copper, sulphur, zinc, silicon, magnesium, manganese. The acidic contents include gallic, malic, oxalic and tannic acids.

Slippery Elm Bark is well known for its highly nutritive qualities. It helps in revitalizing a debilitated system. It contains vitamins A, B-Complex, C, K, and P, and is high in minerals and gallic acids. It is a demulcent rich in mucilage and this quality reduces irritation and reduces sensitivity to acids.

There are many reports that "Essiac" has cured cancer. One can only take the word of those who have survived. The truth of the matter is that it is still difficult to tout any one formula as the absolute cure for this complicated disease. All cancers are different and all people are different. In addition, most people combine a variety of protocols.If you are looking to cure cancer, you well advised to embrace a fully holistic and nutritional program in addition to anything else you may choose to do. This Ojibwa formula may only be one part of this holistic and nutritional protocol. Many mainstream practitioners and scientists are now starting to realize the value of nutrition.

For those who are using this formula in the hope of preventing cancer, there are given no guarantees that this will work. However, it is something that I do every four months for two weeks to one month. In these cases the amount used should be half that of someone who has cancer, that is 4 oz per day. Also, one should take breaks between use.

During such breaks, there are many other herbs one can use, such as Pau De Arco, Watercress, Red Clover. If you have arthritis, you should exercise caution in using Essiac due to high oxalic acid content. also recommend a strong Immune system program for prevention, in between Essiac use, such as Blood Purifiers, (Red Clover, Echinacea, Burdock, Hyssop) Colon Liver cleansing (Milk Thistle, Dandelion, Gentian, Yellow Dock) and building formulas (Damiana, Ginsengs, Gotu-Kola, Ginkgo, Fo-Ti).

The key to good Essiac is using fresh, quality, organic herbs. When purchasing the essiac teas, do not simply choose any brand off a store shelf. Be sure it contains organic, recently harvested quality herbs. It is best to find the bulk herbs that have not been mass produced. Avoid capsulated essiac formulas as it should be only brewed as a tea, firstly for effectiveness and secondly to minimize the oxalic acid content.

Things You'll Need:
Supplied needed are:
· 4 gallon stainless steal pot with lid,
· 3 gallon stainless steal pot with lid,
· stainless steal fine-mesh double strainer,
· stainless steal funnel,
· stainless spatula or spoon,
· 12 or more 16-oz strainer

Herbs needed

. 6-1/2 cups Burdock root - cut
· 16 oz Sheep Sorrel herb - powdered
· 1 oz Turkey Rhubarb root - powdered
· 4 oz Slippery Elm Bark
· 2 gallons of sodium-free distilled water.

Preparation:
· Mix dry ingredients thoroughly.
· Bring distilled water to a rolling boil in 4 gallon pot with lid on.
· stir in 1 cup of dry ingredients, replaced lid and continue to boil for 10 minutes.
· Scrape down sides of pot and mix thoroughly, replace lid and let sit for 12 hours. After the 12 hours bring pot back to almost a boil.
· Strain into the 3 gallon pot, then restrain back into the cleaned 4 gallon pot. Use funnel to pour hot liquid into bottles and tighten caps.
· Refrigerate tea as it has no preservatives.
· measure out 1-2 oz of tea and mix with equal parts of bottled hot water and sip slowly 1 hour before eating or on an empty stomach before bed.

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Lupus .. (Systemic Lupus Erythematosus)

Lupus Overview
Systemic lupus erythematosus (lupus, SLE) is an autoimmune disease in which a person's immune system attacks various organs or cells of the body causing damage and dysfunction. Lupus is called a multisystem disease because it can affect many different tissues and organs in the body. Some patients with lupus have a very mild condition, which can be treated with simple medication , whereas others can have serious, life-threatening complications. Lupus is more common in women than men, and its peak incidence is after puberty -the reason for this is unknown.

While lupus is a chronic illness, it is characterized by periods when the disease activity is minimal or absent (remission) and when it is active (relapse or flare). The outlook for patients with SLE today is much better than years ago because of greater awareness and better tests leading to earlier diagnosis and treatment and more effective and safer medications.

Lupus Causes Genetic link
As with other autoimmune diseases, people with lupus share some type of common genetic link. An identical twin has a 3- to 10-fold greater risk of getting lupus than a nonidentical twin. Also, first-degree relatives (mother, father, brother, sister) of people with lupus have an 8- to 9-fold increased risk of having lupus than the general public.

Environmental factors
Although an identical twin is much more likely to have lupus if her identical sibling has lupus, the likelihood of developing the disease in the unaffected twin is not 100%. Despite the nearly identical genetic makeup of identical twins, the probability of the unaffected twin developing the disease if the other twin has it is around 30-50% or less. This implies that environmental factors may help determine whether or not the disease develops in a person. Outside of random occurrences of lupus, certain drugs, toxins, and diets have been linked in its development. Sun exposure (ultraviolet light) is a known environmental agent that can worsen rashes of lupus patients and sometimes trigger a flare of the entire disease.

Reversible drug-induced lupus
In the past, the drugs most frequently responsible for drug-induced lupus are procainamide (Procanbid), hydralazine (Apresoline), and isoniazid (Laniazid). However, newer medications have been associated with drug-induced lupus, such as the new biological agents used to treat rheumatoid arthritis, etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira). Generally, lupus that is caused by a drug exposure goes away once the drug is stopped.

Association with pregnancy and menstruation
Many women with lupus note that symptoms may be worse after ovulation and better at the beginning of the menstrual period. Estrogen has been implicated in making the condition worse and this problem is currently being studied. For this reason, women with lupus who are on birth control medications are encouraged to take those that contain little or no estrogen.

Lupus Symptoms
At the onset of lupus, the symptoms are commonly very general and therefore make diagnosing the disease difficult. The most common initial complaints are fatigue, fever, and muscle and joint pain. This is called a "flulike syndrome."

· Fatigue is the most common and bothersome complaint. It is also often the only symptom that remains after treatment of acute flares. A flare in lupus is an acute increase in symptoms.
· Fever during lupus flares is usually low-grade, rarely exceeding 102°F. A temperature greater than this should stimulate a search for an infection as the source of the fever. However, any fever in lupus should be considered an infection until proven otherwise.
· Muscle pain (myalgia) and joint pain (arthralgia) without or with joint swelling (arthritis) are very common with the new onset of lupus and with subsequent flares.
Although lupus is a multisystem disease, certain organs are affected more commonly than others:
· Musculoskeletal system: Joint pains are more common than arthritis in people with lupus. The arthritis of lupus is usually found on both sides of the body and does not cause damage to the joints. The most frequently involved joints are those of the hand, knees, and wrists. People with lupus, especially those needing high doses of corticosteroids (steroids, prednisone), can suffer from a certain type of low blood flow injury to a joint causing death of the bone in the joint. This is called avascular necrosis and occurs most commonly in the hips and knees. The muscles themselves can sometimes become inflamed and very painful contributing to weakness and fatigue.

· Skin and hair: The skin is involved in more than 90% of people with lupus. Skin symptoms are more common in whites than in African Americans. While the classic lupus rash is a redness on the cheeks (malar blush) often brought on by sun exposure, many different types of rashes can be seen in SLE. Discoid lupus with the red skin patches on the skin and scaliness is a special characteristic rash that can lead to scarring. It usually occurs on the face and scalp and can lead to loss of scalp hair (alopecia). It is more common in African Americans with lupus. Occasionally, discoid lupus can occur as an isolated skin condition without systemic disease. Hair loss can occur with flares of SLE even without skin rashes in the scalp. In this situation, the hair regrows after the flare is treated. Hair loss can also occur with immunosuppressive medications.

Kidney system: The kidney is involved clinically in more than half of all people with lupus. Severe kidney disease often requires immunosuppressive therapy. All patients with newly diagnosed SLE should have the urine checked for blood and protein because kidney inflammation can be silent in the early stages

· Heart and blood vessels: Inflammation of the sac holding the heart (pericarditis) is the most common form of heart problem in people with lupus. This causes chest pain and can mimic a heart attack. Also, growths (vegetations) can form on heart valves causing heart problems. Hardening of the arteries (atherosclerosis) can lead to angina and heart attacks in lupus patients who have required long-term prednisone therapy for severe disease. In some people with lupus, the arterial blood supply to the hand can experience intermittent interruptions due to spasm of the artery. This causes whiteness and blueness in the fingers and is called Raynaud syndrome. It is brought on by emotional events, pain, or cold temperatures.

· Nervous system: Serious brain and nerve problems and acute psychiatric syndromes occur in about 15% of patients with lupus. Potential disorders include seizures, nerve paralysis, severe depression, psychosis, and strokes. Spinal cord inflammation in lupus is rare but can cause paralysis. Depression is common in SLE. Sometimes it is directly related to active disease and sometimes to emotional difficulties in coping with a chronic illness or to the medications used to treat it, especially high doses of prednisone.

· Lungs: More than 50% of people with lupus have some sort of lung disease. Inflammation of the lining of the lung (pleurisy) is the most common problem. This can lead to chest pain and shortness of breath and can be confused with clots in the lung or lung infection (pneumonia). Collections of water in the space between the lung and the chest wall occur as well (called pleural effusions). Pneumonia can occur in lupus patients who are taking immunosuppressive medications.

· Blood and lymph system: About half of people with lupus have anemia (low red blood cell counts), and up to half can have thrombocytopenia (low platelet counts) and leukopenia (low white blood cell counts). Low platelet counts can lead to bleeding and bruising in the skin and if severe, it can cause internal bleeding. Some lupus patients are predisposed to developing blood clots in veins (leading to phlebitis) or arteries (leading to strokes or other problems). This is most likely to occur in patients who have certain autoantibodies in their blood called antiphospholipid antibodies. Patients with these clinical problems and these antibodies may need to take blood thinners (anticoagulants) for prolonged periods of time. Women with these antibodies can also suffer from a high frequency of spontaneous miscarriages.

· Stomach, intestines, liver, and associated organs: Many patients with lupus develop painless ulcers in the mouth and nose at some point in their disease. Abdominal pain in lupus can be due to inflammation of the lining of the abdomen, infection of the intestines, low blood flow to the intestines caused by a clot, or inflammation of the vessels flowing to the intestines. If the person has a lot of free-floating fluid in the abdomen, this fluid may also become infected causing severe pain. The liver is rarely involved.
· Eyes: The eyes are rarely involved in lupus, except for the retina. People with lupus often have to be screened by an ophthalmologist if they are taking the antimalarial drugs chloroquine or hydroxychloroquine.

When to Seek Medical Care
· High fever
· Unusual headache
· Blood in the urine
· Chest pain
· Shortness of breath
· Swelling of the legs
· Weakness of the face, arms, or legs, on one side
· Unusual abdominal pain
· Unusual joint pain
· Recurrent pregnancy loss (miscarriages)
· Visual disturbances

When to go to the hospital
· Fever greater than 102°F
· Rapidly decreasing urine volume
· Chest pain
· Sudden onset or unusual shortness of breath
· Sudden onset of weakness
· Severe headache
· Acute visual changes
· Sudden onset of abdominal pain
· Inability to bear weight or move a swollen joint due to severe pain
· Rapid swelling of one or more extremities (arms, legs, hands, or feet)

Seal’s facial scars are the result of discoid lupus

Exams and Tests Medical evaluation in the emergency department
The nature of the medical evaluation in an emergency department depends on the person's complaint or problem. The goal of the emergency physician is to decide whether there are acute concerns on top of a chronic disease such as lupus. For someone without a known diagnosis of lupus, the doctor will evaluate but likely never provide a primary diagnosis of lupus unless there are clear and unmistakable features. Evaluation of chronic (not acute) diseases is done in a medical office setting.

The vast majority of blood tests looking for specific markers for lupus do not return results for several days, so definitive blood tests do not occur on the spot. However, certain tests to assess the possibility of organ damage including some blood and urine tests, imaging studies, and heart tracings will allow the doctor to assess for acute disease if someone with lupus seeks treatment in an emergency department.

The job of the emergency doctor is to address, evaluate, and treat acute issues and then refer the person to more appropriate specialists for further assessment and evaluation.

Criteria for diagnosing lupus
The diagnosis of lupus is a clinical one made by observing symptoms. Lab tests provide only a part of the picture. The American College of Rheumatology has designated 11 criteria for classification.

To be classified as having lupus, a person must have 4 or more of these criteria:
· Malar rash: This is a "butterfly-shaped" red rash over the cheeks below the eyes. It may be a flat or a raised rash.
· Discoid rash: These are red, raised patches with scaling of the overlying skin. A subgroup of patients have "discoid lupus" with only skin involvement and do not have systemic lupus erythematosus. All patients with discoid lupus should be screened for systemic involvement.

· Photosensitivity: A rash develops in response to sun exposure. This is not to be confused with heat rash that develops in body folds or moist areas of the body with exposure to heat.
· Oral ulcers: Painless sores in the nose or mouth need to be observed and documented by a doctor.

· Arthritis: The arthritis of lupus usually does not cause deformities of the joints. Swelling and tenderness must be present.
· Serositis: This refers to an inflammation of various "sacs" or membranes that cover the lung, cover the heart, and line the abdomen. Inflammation of these tissues causes severe discomfort in the areas affected.
· Kidney disease: There is persistent loss of protein in the urine, or a microscopic analysis of the urine demonstrates inflammation of the kidneys.
· Neurological disorder: This can present as seizures or as a primary psychiatric disorder.
· Blood disorder: Low blood counts of various blood components are known to occur.
· Immunologic disorder: This requires special laboratory testing for specific markers of disease in lupus. These tests include antibodies to DNA, a nuclear protein (Sm), or phospholipids (which includes the falsely positive test result for syphilis). The presence of these and other antibodies that can react with the body's own tissues is why lupus is called an autoimmune disease.
· Positive antinuclear antibody: A more general marker in the blood for the presence of an autoimmune disease, these "ANA" levels increase with age, thereby somewhat increasing the rate of an incorrectly positive test as a person gets older. The ANA test is most useful when the result is negative, which essentially rules out the diagnosis of SLE, since up to 98% of people with lupus have a positive ANA test result.

HeLa Cell Histones

Laboratory Tests for Lupus
Many different laboratory tests are used to detect physical changes or conditions in your body that can occur with lupus. Each test result adds more information to the picture your doctor is forming of your illness.

Routine Blood Tests
Usually your doctor will first request a complete blood count (CBC). Your blood is made up of red blood cells, white blood cells, platelets, and serum. The complete blood count measures the levels of each. In cases of lupus, these blood tests may reveal low numbers.
· Red blood cells carry oxygen to all parts of the body.
· White blood cells (lymphocytes and others) help the immune system to protect the body against foreign invaders. The white blood cells called T cells and macrophages are directly involved in this protection. Other white blood cells called B cells are indirectly involved, by producing antibodies to the foreign substances.

· Platelets form in bone marrow; they go to the site of a wound to begin the blood-clotting process.
· Blood serum is the fluid portion of whole blood from which certain substances in the clotting of blood have been removed.

Urine Tests
Because your body’s waste is processed by the kidneys, testing a sample of urine (called a 'spot urine' test) can reveal any problems with the way your kidneys are functioning. Lupus can attack the kidneys without any warning signs, so these tests are very important. The most common urine tests look for cell casts (bits of cells that normally would be removed when your blood is filtered through your kidneys), and proteinuria (protein being spilled into your body because your kidneys are not filtering the waste properly). A collection of your urine over a 24-hour period can also give important information.

Antibodies
The antibodies your body makes against its own normal cells and tissues play a large role in lupus. Many of these antibodies are found in a panel, or group, of tests that are ordered at the same time. The test you will hear most about is called the ANA test. This is not a specific test for lupus, however.

Antinuclear antibodies (ANA) are antibodies that connect, or bind, to the nucleus -- the "command center" -- of the cell. This process damages, and can destroy, the cells. The ANA blood test is a sensitive test for lupus, since these antibodies are found in 97 percent of people with the disease. When three or more typical features of lupus are present -- such as involvement of the skin, joints, kidneys, lungs, heart, blood, or nervous system -- a positive ANA test will confirm a diagnosis of lupus. However, a positive ANA test result does not always mean you have lupus. The ANA can be positive in people with other illnesses, or positive in people with no illness. The ANA can also change from positive to negative, or negative to positive, in the same person. Still, lupus is usually the diagnosis when these antinuclear antibodies are found in your blood.
In addition to the ANA, doctors trying to diagnose lupus often look for the following specific antibodies.

Antibodies to double-stranded DNA (anti-dsDNA) are antibodies that attack the DNA -- the genetic material -- inside the cell nucleus. Anti-dsDNA antibodies are found in half of the people with lupus, but lupus can still be present even if these antibodies are not detected.

Antibodies to histone -- a protein that surrounds the DNA molecule -- are sometimes found in people with systemic lupus but are more often seen in people with drug-induced lupus. This form of lupus is caused by certain medications, and usually goes away after the medication is stopped.

Antibodies to phospholipids (aPLs) can cause narrowing of blood vessels, leading to blood clots in the legs or lungs, stroke, heart attack, or miscarriage. The most commonly measured aPLs are lupus anticoagulant, anticardiolipin antibody, and anti-beta2 glycoprotein I. Nearly 30 percent of people with lupus will test positive for antiphospholipid antibodies. Phospholipids found in lupus are also found in syphilis, and the blood test cannot always tell the difference between the two diseases. A positive result to a syphilis test does not mean that you have or ever had syphilis. Approximately 20 percent of those with lupus will have a false-positive syphilis test result.

Antibodies to Ro/SS-A and La/SS-B (Ro and La are the names of proteins in the cell nucleus) are often found in people with Sjögren’s syndrome. Anti-Ro antibodies in particular will be found in people with a form of cutaneous (skin) lupus which causes a rash that is very sun-sensitive. It is especially important for your doctor to look for the Ro and La antibodies if you are pregnant, as both autoantibodies can cross the placenta and can cause neonatal lupus in the infant. Neonatal lupus is rare and not usually dangerous, but it can be serious in some cases.

Antibodies to Sm target Sm proteins in the cell nucleus. Found in 30-40 percent of people with lupus, the presence of this antibody almost always means that you have lupus.
Antibodies to RNP target ribonucleoproteins, which help to control chemical activities of the cells. Anti-RNPs are found in many autoimmune conditions and will be at very high levels in people whose symptoms combine features of several diseases, including lupus.

Other Blood Tests
Some blood tests measure levels of proteins that are not antibodies. The levels of these proteins can alert your doctor that there is inflammation somewhere in your body.
Complement is the name of a group of proteins that protect the body against infections. They work by strengthening the body’s immune reactions. Complement proteins are used up by the inflammation caused by lupus, which is why people with inflammation due to active lupus often have low complement levels. There are nine protein groups of complement, so complement is identified by the letter C and the numbers 1 through 9. The most common complement tests are CH50, C3, and C4. CH50 measures the overall function of complement in the blood. Low levels of C3 or C4 may indicate active lupus.

C-reactive protein (CRP) is a protein produced by the liver, and high levels of CRP in your blood may mean you have inflammation due to lupus.
Erythrocyte sedimentation rate (ESR or "sed" rate) is another test for inflammation. It measures the amount of a protein that makes the red blood cells clump together. The sed rate is usually high in people with active lupus, but it can also be high due to other reasons, such as an infection.

Blood Clotting Time Tests
The rate at which your blood begins to clot is important: if it clots too easily, a blood clot, called a thrombus, can break free and travel through the body. Blood clots can cause damage such as a stroke or miscarriage. If your blood does not clot quickly enough, you could be at risk for excessive bleeding if you are injured.
Prothrombin time (PT) measures blood clotting and can show whether you may be at risk for not clotting quickly enough at the site of a wound.
Partial thromboplastin time (PTT) also measures how long it takes for your blood to begin to clot.

Modified Russell viper venom time (RVVT), platelet neutralization procedure (PNP), and kaolin clotting time (KCT) are other, more sensitive blood-clotting time tests.

Tissue Biopsies
A biopsy procedure involves removal of a small bit of tissue which the doctor then examines under a microscope. Almost any tissue can be biopsied.
· The skin and kidney are the most common sites biopsied in someone who may have lupus.
· The results of the biopsy can show the amount of inflammation and any damage being done to the tissue.
· Further tests can be performed on the tissue sample to look for autoimmune antibodies and to determine whether the problem is due to lupus or is caused by some other factor, such as infection or medication.

Lupus Treatment Self-Care at Home
Home care for lupus generally involves taking the prescribed medications and adhering to good practices such as using sunscreen because there is often a history of skin sensitivity to sunlight.
· People with sun-induced rashes should always wear a high SPF lotion that blocks both UVA and UVB types of ultraviolet light.
· Those taking oral steroid therapy or immune suppressing agents should be vigilant if a fever develops, since fever can occur with lupus flares or with a superimposed problem, especially infection.
· A combination of rest, especially during flares, and exercise for joints and muscles is important and should be supervised by the treating physician and physical therapists.

Medical Treatment
For a person known to have lupus and already taking medications for it, every effort will be made in the emergency department to avoid the addition of potentially dangerous medications with significant side effects.

· The use of ibuprofen (Motrin, Advil) and medications like ibuprofen in treating lupus requires some caution. Ibuprofen and similar drugs can harm kidney function, especially in people who already have kidney problems. In addition, ibuprofen and related agents can rarely cause inflammation of the lining of the brain resulting in a severe headache.

· Many people with lupus can experience significant relief of their symptoms without the use of steroids or other immune-suppressing agents (such as azathioprine or cyclophosphamide).

However, certain acute complications (such as acute kidney failure) caused by lupus may require high doses of oral or intravenous steroids along with other immune-suppressive drugs. Some people will require long-term treatment with steroids and immune-suppressing agents.

· Antimalarial drugs such as hydroxychloroquine and chloroquine are excellent alternatives for people with lupus who do not respond well to ibuprofen or aspirin. Many people on antimalarial drugs experience significant relief of their symptoms, especially rashes, fatigue, and joint and muscle pains. Hydroxychloroquine has been shown to decrease the frequency of flares in patients with systemic lupus erythematosus. Based on these data, it is widely believed that all patients should be treated with hydroxychloroquine indefinitely, unless they develop adverse effects. However, with antimalarial use, careful periodic evaluation of the eyes is required to prevent serious complications.

· For people with sun-sensitive lupus rashes, appropriate use of ultraviolet-blocking sunscreens and protective clothing is critical. Heat, infrared light, and, rarely, fluorescent light can also bring on flares. Topical steroid creams are also helpful for lupus-associated rashes, once they develop. A doctor should closely monitor extended use of steroid creams, especially on the face and covered areas.

· Treatment of seizures or psychiatric disturbances usually involves therapy directed at the type of disturbance itself (the use of anticonvulsants for seizures, for example, and the use of antidepressants for severe depression).

· Steroid use is associated with a number of complications including psychiatric disturbances, increased susceptibility to infection, fragile bones, cataract formation, diabetes and worsening of existing diabetes, high blood pressure, thinning of the skin, puffiness of the face, and avascular necrosis. Steroids are often reserved for lupus patients with serious organ involvement or lupus that does not respond to other medications.

o An important side effect of steroids and other immune-suppressing agents is an increase in the susceptibility to dangerous infections.
o In pregnancy, the preferred steroid is prednisone because it crosses into the fetus much less than other steroid agents.
o Steroids should not be stopped abruptly if you have been taking them for more than several months. Your health care provider will direct you how to taper the medicine.
o If blood clots form spontaneously in the body, treatment with an agent that prevents clot formation is critical. For this reason, use of heparin or warfarin (Coumadin) is advised. In pregnancy, heparin is the agent of choice because of the adverse fetal effects of warfarin.

Next Steps Outlook
The prognosis varies depending on whether there is serious organ inflammation (for example kidney or brain involvement).

Many lupus patients have very limited disease and live relatively normal lives with minimal problems. Others have multi-organ involvement with kidney failure, heart attacks, and strokes. The diversity of outcomes reflects the diversity of the disease.

With respect to fertility, women with lupus are just as capable of becoming pregnant and having children as the general population. However, there is a much higher occurrence of complications in pregnancy-especially if the kidneys are involved.

Women whose lupus has been inactive for 6-12 months are more likely to have a successful pregnancy. In addition, antibodies formed in the mother that are transferred from mother to fetus can occasionally affect the infant, leading to rashes, low blood counts, or more seriously a slow heart rate due to complete heart block (neonatal lupus). For these reasons, all women with lupus who are or who desire to become pregnant should consult with their treating rheumatologist or other treating physicians and should be referred for "high-risk" obstetric care.

TREATMENT SYSTEMIC LUPUS ERYTHEMATOSIS (SLE) WITH CHINESE HERBS
Chinese medical journals have relayed information about lupus treatment throughout the 20th Century and it remains a subject of intense interest. In most cases, lupus is treated in China with corticosteroids; in addition, herbal therapies are frequently employed as an adjunct to steroids. The modern Chinese literature focuses on two primary means of treating lupus with herbs: using antitoxin herbs (usually in conjunction with herbs that vitalize blood circulation) and using ching-hao or its active components.

The basic herb formula was composed of the toxin-cleaning, stasis-resolving, and yin-nourishing agents (the latter help control the heat syndrome)
The nephrotic syndrome that often accompanies lupus after several years of flare-ups is one of the life-threatening complications, though modern drug therapy and renal transplant technology can prevent loss of life. the syndrome is usually marked by a large quantity of albumin (protein) in the urine, with corresponding decline of serum albumin, and with some edema. From the perspective of traditional Chinese medicine, most of these patients suffer from qi and/or yang deficiency of the spleen and kidney, often with complications of blood stasis.

We do have the following herbs; which are beneficial to treat patient with systemic or discoid lupus.

Artemisia leaf, isatis leaf, oldenlandia, red peony, moutan bark, cimicifuga, rehmannia, ophiopogon and more

Please ask for it, we deliver our herbs all over the world

Uterine Fibroids

What Are Fibroids?

Fibroids are growths of tissue that are usually found in the wall of the uterus, or womb. They are made of a mixture of muscle tissue from the uterus and threadlike fibers of connective tissue.

Although they are called tumors, fibroids are not cancerous. Fibroids usually shrink after menopause. New fibroids do not develop before puberty or after menopause.

Fibroids are very common. They occur in 2 or 3 out of every 10 women over age 35. They occur most often in women between ages 30 and 50, although women in their 20s sometimes have them.
It is common to have more than one fibroid. Some women may have as many as a hundred. Fibroids can be as small as a pinpoint or as large as a basketball. They are usually round or oval in shape, like a ball or an egg. Their texture is firm, like an unripe peach.

Medical names for a fibroid are leiomyoma, myoma, and fibromyoma.
Fibroids can grow in different parts of the uterus. They are named according to which part of the uterus they are found
Fibroids that grow inside the wall of the uterus are called intramural fibroids. They are the most common type of fibroid.
Fibroids that grow outward from the wall of the uterus into the abdominal cavity are called subserous or subserosal fibroids.
Fibroids that grow inward from the uterine wall, taking up space within the cavity of the uterus, are called submucous or submucosal fibroids.

A fibroid that is attached to the uterus by a thin stalk is called a pedunculated fibroid.

Facts about fibroids

· Fibroids are very common. They occur in 2 or 3 out of every 10 women over age 35.
· It is common to have more than one fibroid. Some women may have as many as a hundred.
· Fibroids occur most often in women between ages 30 and 50, although women in their 20s sometimes have them.
· Three out of every 10 hysterectomies in the United States are performed because of fibroids.

What Causes Fibroids?
A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumor cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be "programmed" from birth to develop into a fibroid sometime-perhaps many years-after puberty (the start of menstrual periods).

After puberty, the ovaries produce more hormones, especially estrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.
Symptoms Of Fibroids
For many women, fibroids cause no problems. More than half of women with fibroids do not know they have them until their doctor tells them so.

The most common problems caused by fibroids are:
· Heavy or long menstrual periods. Periods may last more than seven days and menstrual flow may be very heavy. Some women find they need to change sanitary napkins or tampons so often that they cannot function normally during their period. Heavy menstrual flow can sometimes lead to anemia.

· Pressure on other organs. Large fibroids may press on organs in the pelvis.
o If fibroids press on the bladder, a woman may feel the urge to urinate frequently. She may pass only small amounts of urine and she may feel as though she has not completely emptied her bladder.
o If fibroids press on the bowel, she may feel constipated or full after eating only a small amount of food.
o If fibroids press on one or both ureters (the tubes connecting the kidneys to the bladder), they may partially block the flow of urine. A woman may not be aware of this because it often isn't painful. Over time, however, this kind of blockage can lead to kidney infections or other serious kidney damage.
· Pain in the pelvis. The pressure of large fibroids on other organs may cause pain in the pelvis. Sometimes, if fibroids do not get the blood flow they need to sustain themselves, they degenerate or die. This may cause severe pain lasting for days or weeks. Pain may also occur if the stalk of a fibroid twists, cutting off blood supply to the fibroid. Rarely, a fibroid may become infected and cause pain.

Need To Know
Problems like those caused by fibroids can also have other causes. It is important to rule out these other possible causes of any problems a woman is having. For example, an imbalance of hormones may cause heavy periods. A bladder infection can cause a frequent need to urinate.

Who Is Likely To Get Fibroids?
Fibroids can occur in any woman of reproductive age. African American women are three times as likely as Caucasian women to have fibroids. It is not known how common fibroids are in women of other races and ethnic backgrounds.

How Does The Doctor Find Out You Have Fibroids?
Many women learn they have fibroids when their doctor performs a routine pelvic exam. A uterus that is enlarged or irregular in shape is a sign that a woman may have fibroids. Certain tests help the doctor to be sure of the diagnosis.

· Ultrasound. During this test, sound waves too high-pitched to be heard travel from a handheld instrument that is placed gently on the abdomen or in the vagina. The sound waves "bounce" off of internal organs and return to the instrument. This creates a picture of the internal organs that can be seen on a screen. If there are fibroids in the uterus, they can be seen in the picture. The doctor can measure the fibroids and can also see if anything else is causing enlargement of the uterus.

An ultrasound exam usually takes 15 to 30 minutes. The test does not use X-rays and has no known risks. It is safe to do an ultrasound test on a woman who is pregnant. (The handheld instrument is placed on the abdomen of a pregnant woman.) A woman may feel some discomfort because she needs to have a full bladder during the test.

. Magnetic resonance imaging (MRI). This test uses powerful magnets to create a picture of the internal organs. It does not use X-rays, and it is not necessary to have a full bladder. The test takes 30 to 45 minutes. MRI tests are not done routinely because they are much more expensive than ultrasound tests. It is safe to do an MRI test on a woman who is pregnant.

What happens during an MRI test?
The woman lies inside a large hollow tube. If she feels uncomfortable in this enclosed space, a mild tranquilizer may help her relax. She may be given earphones to listen to music or earplugs to block out some of the loud noise made by the magnet (which sounds like a muffled jackhammer).

If the doctor suspects fibroids, why might he or she order an MRI test?
The doctor may decide to order an MRI:
o if the ovaries are difficult to see during the ultrasound test
o if the doctor wants to see the structure of the fibroids in more detail

CT scan. If MRI is unavailable, the doctor may request a CT scan of the pelvis. CT stands for computerized tomography. A CT scan uses X-rays. It is more expensive than an ultrasound test and may not provide any more information than the ultrasound test did. For these reasons, it is rare for a doctor to order a CT scan for suspected fibroids. A woman cannot have a CT scan if she is pregnant.

· Hysteroscopy. This test allows the doctor to look directly into the cavity of the uterus. The doctor may decide to do a hysteroscopy if a woman is having heavy bleeding, is having trouble becoming pregnant, or if fibroids are suspected of causing other fertility problems (for example, a miscarriage). A woman cannot have a hysteroscopy if she is pregnant.

What happens during a hysteroscopy?
A thin telescope called a hysteroscope is gently inserted through the cervix and into the uterus. Enlarging the opening of the cervix to insert the hysteroscope can cause cramping and mild bleeding. Doctors generally advise women to take a mild pain medication before and, if necessary, after the procedure.
A hysteroscopy may be done in a doctor's office (with local or no anesthesia) or in an operating room (with local or general anesthesia).

. Uterine X-ray. This test is another option for diagnosing fibroids in women who are having bleeding or fertility problems. A woman cannot have a uterine X-ray if she is pregnant.

What happens during a uterine X-ray?
An instrument is gently inserted into the opening of the cervix. Dye is injected, filling the uterus. The doctor can see the shape of the uterine cavity and can take X-ray pictures of the uterus and fallopian tubes. The doctor can see if the tubes are blocked because the dye will not pass through them.

This test may cause cramping. Doctors generally advise women to take a mild pain medication an hour or so before the test, which is done in a radiology suite (with local or no anesthesia). The dye is harmless (unless a woman has an allergy to iodine or shellfish) and it is quickly removed from the body.
Medical names for this test are hysterosalpingogram (or HSG) and uterotubogram.

· Endometrial biopsy. In this test, a small piece of the lining of the uterus (the endometrium) is removed and examined under a microscope. The doctor may suggest an endometrial biopsy if a woman is having heavy or lengthy periods. The purpose of the test is to rule out other causes for the bleeding, such as infection, a polyp, or cancer.

What happens during an endometrial biopsy?
A thin tube is gently passed through the cervix to obtain a piece of tissue from the lining of the uterus. This takes only a few minutes. The test may cause cramping. It can usually be performed in a doctor's office with local or no anesthesia.
· Dilatation and curettage (D&C). This test is another way to obtain a small (or somewhat larger) piece of the lining of the uterus. It might be done instead of an endometrial biopsy if more tissue is needed or if an endometrial biopsy cannot be done.

What happens during a D&C?
The opening of the cervix is gently enlarged (dilated) by inserting metal probes of increasing thickness. Then, a scraping instrument is passed through the enlarged opening of the cervix to obtain a piece of tissue from the lining of the uterus. A D&C is performed in an operating room. Local or general anesthesia may be used.
The doctor also needs to rule out other problems that can cause the same symptoms as fibroids. For example, an imbalance of hormones may cause heavy periods. A bladder infection can cause a frequent need to urinate.
Can Fibroids Lead To Cancer?
In most women, fibroids do not lead to cancer. Rarely, however, fibroids can turn into a cancer called a leiomyosarcoma. This happens to an estimated 1 in 1,000 women who have fibroids. Some cancerous tumors may develop directly from normal tissue in the uterus. The average age of women with leiomyosarcoma is 55.

Warning signs of cancer may include:
· rapid growth of the fibroids or the uterus
· vaginal bleeding after a woman has passed menopause.
If a woman has either of these problems, she should see a doctor right away.

Do Fibroids Affect Pregnancy?
Most women with fibroids have no more trouble becoming pregnant than women who do not have fibroids, and their risk of a bad pregnancy outcome is no higher.

About 1 in every 15 women with infertility has fibroids, but the fibroids are usually innocent bystanders: They cause only 2% to 3% of cases of infertility. Fibroids that block one or both of the fallopian tubes may prevent sperm from fertilizing an egg. Fibroids that fill the uterine cavity may block implantation of a newly fertilized egg.

Fibroids-especially those located in the cavity of the uterus-may increase the chance of a miscarriage or may cause a woman to go into labor before her due date (premature labor). Fibroids may also increase the chance that the baby is not positioned to come out headfirst. This can increase the need for cesarean section. Rarely, fibroids can cause complications of pregnancy called placental abruption and postpartum hemorrhage.

What Is Placental Abruption?
After childbirth, the afterbirth (placenta) separates from the uterus. Placental abruption occurs when the placenta separates from the uterus too quickly (i.e., before the baby is born). It occurs in one of every 200 pregnancies.
In addition to causing vaginal bleeding and pain, placental abruption can cut off the baby's supply of nutrients and blood. In severe cases, this can threaten the baby's life.

What Is Postpartum Hemorrhage?
Normally, the afterbirth (placenta) separates from the uterus after childbirth. When this happens, the muscle in the uterus usually squeezes the uterus to help stop bleeding. If a fibroid is present, the squeezing of the muscle in the uterus may be less effective and the woman may have more bleeding. Rarely, the blood loss may be significant and the woman may need medications, surgery, and/or a blood transfusion.
Some fibroids grow during pregnancy, but some remain the same size and others shrink.

How Are Fibroids Treated?
The treatment offered for fibroids will depend on whether or not the fibroids are causing any problems.

· If fibroids are not causing problems, they may need no treatment apart from regular medical checkups. This is called watchful waiting. The doctor examines a woman two or three times a year to see if the fibroids are growing and if they are beginning to cause problems. If the doctor cannot feel the woman's ovaries during a pelvic exam, ultrasound should be performed once a year.

· Surgery is the standard treatment for fibroids that are causing pain, heavy or lengthy menstrual bleeding, or other problems. The two kinds of surgery most commonly performed are hysterectomy and myomectomy.

· The two kinds of surgery most commonly performed are hysterectomy and myomectomy (see below).

· There are quite a few newer treatment options that offer alternatives to hysterectomy (click here to go to this section)

· There is also a role for special medications in the treatment of fibroids, either to shrink the fibroid to allow for a simpler type of surgery, or for women just before menopause (fibroids shrink naturally during menopause).

Hysterectomy
Hysterectomy is the surgical removal of the uterus (and usually of the cervix as well). It is the most common treatment for fibroids. Three out of every 10 hysterectomies in the United States are performed because of fibroids. Currently, hysterectomy is the only permanent cure for fibroids. However, a woman cannot become pregnant or carry a baby after having a hysterectomy.

Hysterectomy is often considered when the uterus reaches the size it would be at 12 weeks of pregnancy. In the past, many doctors recommended a hysterectomy because they feared that such large fibroids could hide the presence of cancer of the uterus.

Now, however, tests such as ultrasound and MRI can be used to see whether a fibroid is growing rapidly (a sign of cancer). Increased use of these tests has reduced the number of hysterectomies performed for fibroids.
How is a hysterectomy performed?

A hysterectomy is usually performed through an incision in the abdomen.

Sometimes the ovaries are removed in addition to the uterus and cervix. The decision to remove the ovaries depends on the woman's age and on whether the ovaries are diseased. (The ovaries are responsible for producing hormones such as estrogen. After menopause, however, the ovaries produce much less estrogen than they did before.)

What is a vaginal hysterectomy?
Sometimes, for smaller fibroids, the uterus can be removed through the vagina. This is known as a vaginal hysterectomy. After a vaginal hysterectomy, the only stitches are inside the vagina. The body absorbs the stitches in four to six weeks.

Occasionally a surgeon will perform a vaginal hysterectomy assisted by laparoscopy. This is called a laparoscopic-assisted vaginal hysterectomy.

What are the risks of a hysterectomy?
Like all operations, a hysterectomy has risks. These include:
· infection requiring treatment with antibiotics (1 in 5 women)
· internal bleeding (hemorrhage) requiring a blood transfusion (1 in 15)
· injury to other pelvic organs such as the bladder, bowel, or ureters (less than 1 in 100)
· death (1 in 2,000)

What happens after a hysterectomy?
A woman usually stays in the hospital for two to five days after an abdominal hysterectomy. Full recovery usually takes about six weeks. Women are generally advised to avoid driving and heavy lifting for two to four weeks after surgery. Light exercise may begin after four weeks. Vigorous exercise and sexual intercourse should be avoided for six weeks after surgery.

After a vaginal hysterectomy, a woman may stay in the hospital for two to four days and recover fully in three to four weeks. She can expect to have a light-brown vaginal discharge for about six weeks after surgery. Women are usually advised not to have sexual intercourse for six weeks after a vaginal hysterectomy. Intercourse should only resume after the surgeon has examined her vagina to assure that it has completely healed.

Myomectomy
Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman's ability to bear children. However, a successful pregnancy is not guaranteed. Only 4 or 5 out of 10 women become pregnant and give birth after a myomectomy.

Heavy bleeding can occur when the fibroids are removed. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy. She is also at higher risk for problems such as infection and blood clots in the legs.
Fibroids may grow back after a myomectomy, and another operation may be needed later to remove them. The risk of regrowth is related to the number, not the size, of fibroids removed. If more than three fibroids are removed, the risk of regrowth is about 50-50.

How is a myomectomy performed?
Like a hysterectomy, a myomectomy is usually performed through an incision in the abdomen. The risks and recovery time are about the same as for a hysterectomy. Sometimes a myomectomy can be performed with the assistance of a laparoscope or hysteroscope.

Why can it be difficult to become pregnant after a myomectomy?
When the uterus heals after surgery, scarring can occur. Scars may cover the ovaries or block one or both of the fallopian tubes (the tubes through which eggs travel from the ovaries to the uterus). Scarring can make it impossible for the tubes to pick up the eggs after their release from the ovaries (ovulation).

A woman who becomes pregnant after a myomectomy may be advised by her doctor to have a cesarean section without going into labor. This is because the surgery can weaken the wall of the uterus. The doctor may be concerned that labor contractions could tear or rupture the wall.

Newer Treatment Options
Several new procedures offer alternatives to hysterectomy or myomectomy, especially for the removal of smaller fibroids. An advantage of these new procedures is that they do not involve abdominal surgery. They may be performed on an outpatient basis, or they may require only an overnight hospital stay. Recovery time is usually quicker, too. However, because these procedures are new, many doctors have little experience with them.

· Hysteroscopic resection. This procedure uses a hysteroscope, a thin telescope that is inserted through the cervix. It enables the surgeon to see inside the uterus. The surgeon may then remove the fibroids with a laser or an electrical knife, wire, or probe. No incision is made. The procedure may be done with local or general anesthesia. The woman may stay overnight in the hospital or be treated as an outpatient. Full recovery takes a week or two.

· Embolization. uterine fibroid embolization (UFE) procedure. This procedure shrinks fibroids by cutting off their blood supply. Guided by an X-ray image, the doctor threads a small catheter (a thin flexible tube) through a tiny incision in the groin into the main arteries that supply blood to the uterus. He or she then injects particles of inert plastic through the catheter to block these blood vessels. The uterus itself is not damaged because smaller arteries continue to supply the nutrients and oxygen it needs.

The procedure takes about an hour. It may be performed with local or general anesthesia. The woman must lie flat on her back for six hours afterward to stop bleeding from the incision in the groin. Cramps in the pelvis are common, and the doctor usually prescribes a pain medication for them. Some women may have a fever for a couple of days after the procedure. Some women stay overnight in the hospital, while others go home the same day. Full recovery takes about a week.

Embolization has been used to treat fibroids in the United States for only a few years. Typically, the procedure shrinks fibroids to about half their previous size. The fibroids also become softer and press less on other pelvic organs. It is not known, however, whether the fibroids eventually grow back.

· Laparoscopic surgery . Some procedures can be performed using a laparoscope, a pencil-thin surgical telescope similar to a hysteroscope. The surgeon inserts the laparoscope and tiny surgical instruments through one or more small incision in the abdomen.

If the fibroids are small and easy to reach, the surgeon makes an incision in the uterus and removes them. This is called a laparoscopic myomectomy. It may require an overnight hospital stay.

When the fibroids are larger or harder to reach, the surgeon may use a laser or an electric needle to destroy or shrink them. This procedure is known as laparoscopic myolysis. Women who have this procedure done can often go home the same day.

Full recovery from laparoscopic surgery generally takes less than 7 days.

Can Fibroids Be Treated With Medication?

Doctors may prescribe drugs called gonadotropin-releasing hormone agonists (GnRH agonists) to treat fibroids. Most fibroids shrink by one-third to one-half of their original size after two to three months of treatment with these drugs. Smaller fibroids may cause fewer problems and they are often easier to remove surgically.

Women should not take GnRH agonists for more than six months. After that, the drugs can cause rapid bone loss, leading to osteoporosis. Fibroids generally start to grow again once drug treatment stops. Most women stop having menstrual periods while they are taking GnRH agonists.

What Are GnRH Agonists?
GnRH agonists are drugs that are chemically similar to gonadotropin-releasing hormone (GnRH). This hormone is produced by the hypothalamus, a region in the brain.

GnRH stimulates the release of other hormones from the pituitary gland, a pea-sized gland at the base of the brain. These other hormones are luteinizing hormone and follicle-stimulating hormone. They, in turn, stimulate the ovaries to produce estrogen. GnRH agonists block that process, shutting down estrogen production. Deprived of estrogen, fibroids shrink.

GnRH agonists are approved by the U.S. Food and Drug Administration to treat endometriosis in women and prostate cancer in men. Some are also approved to treat fibroids in women with anemia (low blood count) who are planning to undergo surgery. Names of GnRH agonist drugs include:

· Lupron (leuprolide)
· Synarel (nafarelin)
· Zoladex (goserelin)

How Are GnRH Agonists Used To Treat Fibroids?

Doctors may use these drugs in more than one way to treat fibroids.
· If a woman is close to menopause, a doctor may prescribe GnRH agonists for a few months to shrink her fibroids. After menopause, fibroids shrink naturally because estrogen levels in the body decline.
· A doctor may prescribe GnRH to shrink fibroids before a woman has surgery. Smaller fibroids may make it possible for a woman to have a vaginal hysterectomy instead of an abdominal one. She may also be able to have laparoscopic surgery, which requires a shorter hospital stay and has a faster recovery time.

What Side Effects Do GnRH Agonists Have?
By blocking estrogen production, GnRH agonists mimic a process that occurs naturally at menopause. The side effects of these drugs are similar to the problems many women have when they go through menopause.

The most common problem (experienced by about 9 out of 10 women) is hot flashes-episodes of suddenly feeling very warm in the face or upper body. During a hot flash, a woman may blush, perspire, or feel her pulse racing. A cold chill may follow the hot flash. Hot flashes are caused by declining or unstable estrogen levels in the body.

Other less common side effects of GnRH agonists include:
· vaginal dryness
· irregular vaginal bleeding
· headaches
· thinning of the hair
· pain in the bones, joints, and muscles
· sleep problems
· mood changes
· loss of sex drive

Doctors may also prescribe synthetic hormones to reduce heavy bleeding caused by fibroids. Progestogen is a synthetic version of the female hormone progesterone, which-like estrogen-is made by the ovaries. Androgens (male sex hormones) may also be used to control excessive bleeding caused by fibroids.

These synthetic hormones do not shrink fibroids.
Some doctors may prescribe a GnRH agonist in combination with a low dose of estrogen or progestogen. Low doses of these hormones may reduce the side effects of GnRH agonists, which may allow women to be treated safely with these drugs for a longer time.

Choosing The Best Treatment For Fibroids

No treatment for fibroids is best for all women who have this problem. Every woman should discuss the treatment options with her doctor. The treatment that is best for any individual woman will depend on a variety of factors.

· Are the fibroids causing problems? Fibroids that are not causing problems may need no treatment at all. A woman should be checked by her doctor every few months to see if the fibroids are growing. If the fibroids begin to cause problems, it's time to consider treatment options.

· What problems are the fibroids causing? The best treatment choice may be different if fibroids are causing severe pain than if a woman's major problem is heavy bleeding. Treatment that shrinks fibroids (embolization, treatment with a GnRH agonist drug) often relieves pain. Heavy bleeding may be treated by combination therapy with a GnRH agonist and a low-dose hormone.

· Do you want to have more children? Fibroids in the uterus usually do not prevent a woman from becoming pregnant. However, a woman cannot become pregnant or carry a baby after having a hysterectomy (removal of the uterus). A myomectomy preserves the uterus but may make it more difficult to become pregnant.

· Do you want to avoid having major surgery? A hysterectomy is major surgery, requiring two to five days in the hospital and about six weeks to recover fully.

Some women-and some doctors-feel that a hysterectomy is undesirable for a problem such as fibroids that is not life-threatening. However, a myomectomy is also major surgery, requiring about the same length of time in the hospital and about the same recovery time as a hysterectomy.

Women who want to avoid major surgery may wish to consult a doctor who has experience in one or more of the new procedures that in some cases offer alternatives to hysterectomy or myomectomy.

· Are you close to menopause? Fibroids shrink naturally after menopause when estrogen levels in the body decline. If a woman who is close to menopause has pain caused by fibroids, a doctor may prescribe GnRH agonists. Treatment with these drugs for a few months will shrink her fibroids, which should relieve her pain until the fibroids begin to shrink naturally after menopause.

Putting It All Together
Here is a summary of the important facts and information related to fibroids.
· Fibroids are growths of tissue that are usually found in the wall of the uterus. They can be as small as a pinpoint or as large as a basketball.
· Although they are called tumors, fibroids are not cancerous.
· More than half of women with fibroids do not know they have them until their doctor tells them so.
· The most common problems caused by fibroids are heavy or long menstrual periods, pressure on other organs, and pain in the pelvis. For many women, however, fibroids cause no problems.
· In most women, fibroids do not lead to cancer.
· If fibroids are not causing problems, regular checkups may be the only management they need.
· Surgery is the standard treatment for fibroids that are causing problems. The two kinds of surgery most commonly performed are hysterectomy (removal of the uterus) or myomectomy (removal of fibroids without removing the uterus).
· Several new procedures offer alternatives to hysterectomy or myomectomy, especially for the removal of smaller fibroids. In some cases, fibroids may also be treated with medication.
· Fibroids usually shrink after menopause.
· New fibroids do not develop before puberty or after menopause

Endometriosis, the mysterious disease of the modern age!

Endometriosis is one of the most far-reaching, devastating and misunderstood diseases in the world today. It is estimated that there are over 70 million women and girls who have Endometriosis world-wide. It is more common than breast cancer or Aids, and many other diseases, that are well known. Despite the huge numbers of women who suffer from this disease, few people have actually heard of it, but this is gradually changing, though very slowly.

This disease is becoming more and more common. It seems to be gaining ground. This could be for a variety of reasons.

The methods of detecting and diagnosing the disease are improving all the time, so statistics reflect this as growing numbers of cases are detected.
The seriousness of the disease is gradually gaining momentum and more people are finally beginning to hear about it. This may be through television programs, magazine articles, the internet, or talking to friends. So there is an ever increasing public awareness. This public awareness helps to alert women who have concerns about their health, especially regarding pelvic and menstrual pain, so more women are able to determine whether they have Endometriosis.

More women are taking their pelvic pain and period pain seriously, rather than thinking of it as normal, so they are pursuing answers from the medical profession.
Finally, the numbers of women who have the disease appears to be increasing in actuality, especially in the last 30 years or so. It is also more common in industrial countries, where pollution is higher.

SO WHAT IS ENDOMETRIOSIS AND WHAT DOES IT DO?
Fundamentally, Endometriosis is a serious biological malfunction which focuses on the reproductive organs and the pelvic region of a woman’s body. This disease will start quietly, insidiously and unnoticed. Then gradually symptoms of painful periods, pain at other times of the month, and a general feeling of being run-down, will start to develop.

In women with Endometriosis, the natural bodily processes of the reproductive system goes seriously wrong. The disease is linked and affected by the menstrual cycle and the hormones that make menstruation happen.

Physically, what happens is that tiny, and sometimes microscopic particles that are similar to the lining of the womb, find their way into the pelvic cavity. These particles behave in the same manner as the lining of the womb. The lining of the womb is called the endometrium, which is where this disease gets its name.

The natural process of the endometrium is to react with hormones produced in the body and each month the endometrium builds up with blood cells and other chemicals to prepare for pregnancy. When pregnancy does not occur then the endometrium sheds this blood and women have a period.

A similar reaction takes place in the stray cells that have found their way into the pelvic cavity. Each month they react to hormones, and break down and bleed, but the blood and tissue shed from these endometrial growths has no way of leaving the body. This results in internal bleeding, breakdown of the blood and tissue from these sites and leads to inflammation.

This process continues for months, or even years before symptoms of serious pain begins to develop. Many women start to suspect something is wrong because the amount of pain they feel with their periods starts to get worse and worse as the months go by. It is then that women start to investigate and question the state of their health.

For other women the disease may not throw up any noticeable symptoms, but they may be having problems with their fertility and are not successful in conceiving. It is then that they seek medical advice which could lead to having a laparoscopy. It is during this procedure that the disease may be found.

As time goes by, this disease will progress and start to do more damage in the pelvic cavity. Eventually it can lead to scar tissue formation, adhesions, bowel problems, as well as a gradual decline in general health.

ENDOMETRIOSIS IN CONTEXT
Endometriosis is not usually fatal (though there can be rare occasions where the symptoms can pose a serious threat to life and it is not cancer. It is not a disease that you catch from another person, nor is it a micro-organism that starts this disease like the processes of other infectious diseases. Basically it appears that the body, and its natural healing processes are defective. It can strike women at any time of their reproductive life but we are seeing more and more cases of young girls who have Endometriosis.

Recent studies are beginning to indicate that women with the disease are at greater risk of other health problems, but this could be an indicator that women with this disease are actually suffering from a break-down in the immune system. This situation seems to ‘ring true’ as many women who have Endometriosis seem to suffer from a myriad of other health problems.

Endometriosis is serious. It is affecting millions of women around the world. It is not simply disrupting women’s lives, it can be devastating for most women. It affects her health, her quality of life, her possibilities of having children, her income earning potential, her emotional well-being, her relationships, her sex life, her economics if she lives in a country where she has to pay for treatment, her social life; in essence it affects her entire life.

These are the hard facts that surround Endometriosis today. Many women suffer for years and years. They may have one surgical procedure after another. They may spend thousands of dollars on treatment, especially if their health insurance does not cover it. They may travel miles in pursuit of sympathetic and informed medical treatment. This list goes on and on.
But there are some glimmers of hope beginning to appear. Many women today are beginning to take care of their own health with regard to dealing with Endometriosis. They are starting to realize that all is not clear cut with the objectives and priorities regarding health care in the modern world.

The hope and courage for many women is gained through gathering and sharing information, especially from other women who have the disease. Many self-help measures are being exchanged between fellow sufferers, and where these measures are proving successful, this instills the value and proof that these methods will help.

How do you know that you have endometriosis?
Currently, health care providers use a number of tests for endometriosis. Sometimes, they will use imaging tests to produce a "picture" of the inside of the body, which allows them to locate larger endometriosis areas, such as nodules or cysts. The two most common imaging tests are ultrasound, a machine that uses sound waves to make the picture, and magnetic resonance imaging (MRI), a machine that uses magnets and radio waves to make the picture.

The only way to know for sure that you have the condition is by having surgery. The most common type of surgery is called laparoscopy . In this procedure, the surgeon inflates the abdomen slightly with a harmless gas. After making a small cut in the abdomen, the surgeon uses a small viewing instrument with a light, called a laparoscope, to look at the reproductive organs, intestines, and other surfaces to see if there is any endometriosis. He or she can make a diagnosis based on the characteristic appearance of endometriosis. This diagnosis can then be confirmed by doing a biopsy, which involves taking a small tissue sample and studying it under a microscope.

Your health care provider will only do a laparoscopy after learning your full medical history and giving you a complete physical and pelvic exam. This information, in addition to the results of an ultrasound or MRI, will help you and your health care provider make more informed decisions about treatment.

Endometriosis Symptoms
The symptoms of Endometriosis vary from one woman to another but the most common symptom is pelvic pain.

One of the biggest problems regarding Endometriosis is that the signs of this disease in the early stages, appear to be the ‘normal’ bodily changes that take place with the menstrual cycle.It is only as time goes by that a woman begins to suspect that what is happening, and the symptoms she feels, are not normal. The pain of her menstrual cycle gradually and steadily becomes worse and worse as the months go by.

This is only the beginning of what will become a gradual decline in a woman’s general health, as well as the health of her reproductive system.Having said that, there are odd instances where some women do actually have Endometriosis, but they are nearly free of any symptoms. These women will only be diagnosed by default, for example when they have surgery for other issues, and only then is Endometriosis found. That is what makes this disease so mysterious.
Endometriosis does not follow any distinct pattern, which is why it is difficult for the medical profession to know that a woman has the disease.

Some of the symptoms will mimic those of other health problems, including:
. ovarian cysts
. ectopic pregnancy
. Pelvic Inflammatory Disease
. irritable bowel syndrome
. ovarian cancer
. fibroid tumors
. colon cancer
. appendicitis

The most common symptoms of Endometriosis are:
Pain before and during periods
Pain with intercourse
General, chronic pelvic pain throughout the month
Low back pain
Heavy and/or irregular periods
Painful bowel movements, especially during menstruation
Painful urination during menstruation
Fatigue
Infertility
Diarrhoea or constipation

Other symptoms which are common with Endometriosis include:
Headaches
Low grade fevers
Depression
Hypoglycaemia (low blood sugar)
Anxiety
Susceptibility to infections, allergies

In the later stages of Endometriosis, adhesions usually develop in the pelvic cavity, which are caused by untreated cysts, which can ‘glue’ pelvic organs together. These adhesions will seriously interfere with normal functions of organs in the pelvis, causing bowel obstructions, digestive problems, infertility, urinary problems, agonizing pains when the adhesions are pulled, mobility problems.

As Endometriosis develops a woman’s immune system becomes more and more impaired and this leads to further health problems. Due to increased research, as well as surveys of Endometriosis patients, it is now becoming clear that women with the disease are susceptible to other serious health problems including:

. Chronic Fatigue Syndrome (100 times more common in women with endometriosis)
. Hypothyroidism - under-active Thyroid gland (7 times more common in women with endometriosis)
. Fibromyalgia
. Rheumatoid arthritis

It does seem clear that as women with Endometriosis are more receptive to other health problems, then their immune system is the key to their problems.

No two women will have the same symptoms for Endometriosis, and will not suffer the same knock-on health problems, but the most common symptom experienced among Endometriosis sufferers is acute pain.In some instances the pain of Endometriosis can prohibit a woman to contribute in every day activities as well as her ability to sustain a career.

Possible Locations of Endometriosis

Endometriosis symptoms in relation to location of the disease in the body

There are various areas where endometrial tissue can develop in the pelvic cavity including:

. Ovaries
. The outside surface of the uterus
. Fallopian tubes
. Ligaments supporting the uterus
. Internal region between the rectum and the vagina
. Lining of the pelvic cavity
. Intestines
. Bowels

Other organs within the abdomen

Pelvic pain
Pelvic pain is one of the most common symptoms of Endometriosis. The pelvic pain of Endometriosis can be excruciating and debilitating for many women. It may be experienced constantly, it may be intermittent or it may be related solely to the menstrual period. Pain can be provoked by certain activities such as walking, standing too long etc., or it may occur unpredictably.

Occasionally abdominal and pelvic pain may be caused by Irritable Bowel Syndrome (IBS). These two diseases are quite common together, so it is advised to take note of the times you experience pelvic pain, as it may coincide after meal times.

Lower Back Pain
Lower back pain is another common but poorly recognized symptom that often accompanies period pain. It is commonly associated with endometriosis in the pouch of Douglas, uterosacral ligaments, and rectovaginal septum.

Ovulation Pain
Ovulation pain can occur in women who do not have Endometriosis, but this pain will normally be a small twinge. In women with Endometriosis, ovulation pain can be rather acute. Pain usually begins 12-24 hours before ovulation and may last for a few days. It results from the normal enlargement of the ovary during ovulation which causes stretching of endometrial implants and adhesions lying on the surface of the ovary. The pain is often described as ‘stabbing’ and it may radiate throughout the pelvic area and into the buttocks and thighs.

The Main Reproductive symptoms of Endometriosis are:

. Chronic or intermittent pelvic pain
. Ectopic (tubal) pregnancy
. Dysmenorrhea (painful menstruation is not normal!)
. Infertility
. Miscarriage(s)
. Painful ovulation

Uterosacral/Presacral Nerve Endometriosis

. Backache
. Leg pain
. Painful Intercourse

Cul-de-sac ("Pouch of Douglas") Endometriosis

. Dyspareunia (pain during intercourse)
. Gastrointestinal symptoms
. Pain after intercourse
. Gastrointestinal Endometriosis
. (rectosigmoid colon, rectovaginal septum, small bowel, rectum, large bowel, appendix, gallbladder, intestinal tract)

The bowel symptoms of endometriosis are often overlooked or dismissed because many people think endometriosis affects only the reproductive organs. Many bowel symptoms are caused by irritation to the bowel from endometrial implants lying on adjacent areas such as the Pouch of Douglas and the back of the uterus, but some are due to endometrial deposits lying on the outside of the bowel wall.

The gastrointestinal disorder which is most common with Endometriosis is Irritable Bowel Syndrome which can cause many of the bowel symptoms mentioned above. Candida has also been found to be prevalent in women with Endometriosis, and this too can cause many distressing digestive upsets and discomfort.

The main gastrointestinal symptoms of Endometriosis are:
Nausea
Diarrhea
Blood in stool
Bloating
Vomiting
Rectal pain
Rectal bleeding
Tailbone pain
Abdominal cramping
Constipation
Sharp gas pains
Painful bowel movements

Other Locations and Symptoms of Endometriosis
Urinary Tract (bladder, kidneys, uretheras, and urethra) Endometriosis
The urinary tract symptoms of Endometriosis are usually the result of endometriosis lying on the outside of the bladder or irritation from endometrial implants lying on the front of the uterus.

The main symptoms of urinary tract Endometriosis are:
Blood in urine
Painful or burning urination
Hypertension
Tenderness around the kidneys
Flank pain radiating toward the groin
Urinary frequency, retention, or urgency

Pleural (lung & chest cavity) Endometriosis
Very occasionally Endometriosis can travel to the lungs, which will give rise to strange symptoms, and are usually relate to the menstrual cycle.

. Coughing up of blood or bloody sputum, particularly coinciding with menses
. Accumulation of air or gas in the chest cavity
. Constricting chest pain and/or shoulder pain
. Collection of blood and/or pulmonary nodule in chest cavity (revealed under testing)
. Shortness of breath

Sciatic Endometriosis/ Hip pains
Hip pain or pain that radiates from the buttock and down the leg is common in women where endometriosis has affected the sciatic nerve. Also, endometriosis in the groin area can feel like hip pain.On occasion endometrial adhesions can restrict the hip ligaments, causing pain and limping. Hip joint pain that worsens in a cyclical fashion in line with the menstrual cycle will usually be caused by endometriosis.Surgical treatment to remove endometrial implants is sometimes under taken in hope of relieving the hip joint pain associated with endometriosis.

Skin Endometriosis

Painful nodules, often visible to the naked eye, at the skin's surface. Can bleed during menses and/or appear blue upon inspection.

Dyspareunia (painful sexual intercourse)
Dyspareunia is a common symptom of Endometriosis. Pain may be felt during intercourse as well as up to 48 hours after sexual activity. It is often associated with endometriosis in the pouch of Douglas or adhesions in the pelvic cavity.

Fatigue

Fatigue and Endometriosis seem to go hand in hand. No-one knows what causes the acute fatigue women suffer with Endometriosis, and is not often recognized as a symptom of Endometriosis.
Fatigue can be one of the most debilitating aspects of the disease, and most women with endometriosis experience fatigue around the time of their period and some experience it throughout the month. The fatigue may be related to the constant pain and/or medication, or it could be the bodies reaction to the disease at a deeper level.

Abdominal Bloating
Abdominal bloating may be a sign of endometriosis. It is thought to be due to inflammation in the pelvic cavity caused by the endometriosis. As mentioned above, Irritable Bowel Syndrome (IBS) can cause pelvic pain, and can also cause severe abdominal bloating. With IBS, the bloating is usually caused by intestinal gasses which expand and distend the abdomen and can cause severe pain and discomfort. IBS is very common in women with Endometriosis.

Diagnosis of Endometriosis

The Undetected Disease
Obtaining a true and correct diagnosis for Endometriosis can be one of the most drawn out, frustrating, and distressing experiences for many women. These women know there is something wrong with their health as time goes by, but in most cases they are dismissed by their doctors as being neurotic, or told that their symptoms are normal, or they are given an inaccurate diagnosis, which in many cases is that of Pelvic Inflammatory Disease.

If you are suffering from any of the symptoms associated with Endometriosis, you need to get a diagnosis of what is causing your problems. If your doctor appears unsympathetic or dismisses your symptoms, then you need to assert your suspicions of the seriousness of your health problems. If you have no success then change your doctor or get a second opinion. The longer that this disease goes undiagnosed the more damage it can do. It is well documented that for many women, it can take anything up to ten years to finally get a true diagnosis.

Part of the problem that causes the delay in diagnosis of Endometriosis, is that many people in the medical profession are not fully aware of the extent of this disease today. It is suspected that between 10 to 20 percent of women of reproductive age have Endometriosis.
Also, many women have not even heard about Endometriosis, so they do not seek help when they do have symptoms, because many women think their symptoms are normal. In fact a lot of women have only found information on Endometriosis in magazines and from friends rather than from their doctor.

Another reason there is a delay in diagnosis, is that the symptoms may initially be attributed to a variety of other health problems like fibroids, kidney stones, irritable bowel syndrome, as well as pelvic inflammatory disease.

METHODS OF DIAGNOSIS
There are a variety of methods that can be used to assess whether a woman has Endometriosis, but the only reliable way to confirm the presence of the disease is by visually inspecting the abdominal organs by a procedure called a laparoscopy. Before a laparoscopy is done a full gynecological evaluation should be done covering the patient’s medical history.

Diagnosis methods of Endometriosis can include:

Physical examination
A pelvic examination involves the physician feeling and looking for abnormalities that are associated with endometriosis. Physical findings depend on the severity and location of the disease. There may be palpable nodules or tenderness in the pelvic region, enlarged ovaries, a tipped-back (retro-displaced) uterus, or lesions on the vagina or on surgical scars.

Laparoscopy
A laparoscopy is an exploratory procedure that allows the physician to see inside the pelvic region to observe and check for endometrial growths. The procedure involves making a small incision near the navel and inserting a laparoscope (a long, thin, lighted instrument) into the abdomen. The abdomen is distended with carbon dioxide gas to make it easier to see the abdominal organs. Usually, the endometrial growths can easily be seen.

Because Endometriosis implants or growths vary in appearance and can be mistaken for other conditions, the lesions should be surgically removed and examined under a microscope to confirm the presence of the disease.

Imaging tests
Imaging tests (e.g. pelvic ultrasound, magnetic resonance imaging) may be used to identify individual endometrial lesions, but they are not used to determine the extent of the disease. The implants are not easily identified using this method.

Biochemical markers
There has been extensive investigation of a membrane antigen called CA-125 in women with Endometriosis. Several reports suggest that levels of CA-125 are elevated in women with Endometriosis, particularly those in the advanced stages of the disease. A recent study of this antigen level, showed it to be high in 90 percent of women with Endometriosis. Possible diagnosis with a blood test to check levels of CA-125 could be used to check for Endometriosis.

Stages of Endometriosis
Endometriosis is categorized in four stages based on the severity, location, amount, depth and size of growths.
Stage 1 - minimal disease, superficial and filmy adhesions
Stage 2 - mild disease, superficial and deep endometriosis
Stage 3 - moderate disease, deep endometriosis and adhesions
Stage 4 - severe disease, deep endometriosis, dense adhesion

The stages of the disease do not indicate the level of pain, infertility or symptoms.

What does Endometriosis look like!
Endometriosis can develop in almost any color, shape, size and location. This includes clear, microscopic implants that can lodge themselves on the underside of organs or beneath the skin. The implants can be black, blue, red, brown, clear, and vary from microscopic to clearly visible in size. The implants or growths can be spread throughout the entire abdominal cavity including the bowel, bladder as well as the outer walls of the uterus, the ovaries and fallopian tubes. One of the most common sites for endometrial growths is on the ovaries.

Treatment options for Endometriosis
The treatment for Endometriosis is an intensely debated subject both in the medical profession and among women who suffer this disease. One of the key problems is that no-one really knows what causes Endometriosis. So trying to find a successful remedy for this particular disease is like trying to fix something even though the cause is not actually known. This can lead to treatment methods which are not relevant or safe and carry the risk of serious side-effects. Until a concise answer is found to the cause of Endometriosis, then the treatment being offered is unfortunately no more than a stab in the dark.

The options for treating Endometriosis being offered by conventional modern medicine depends on the severity of the disease, with the main aim being to help alleviate the key symptoms. These being the symptoms of pain and infertility. There are general points which should be taken into consideration when helping a woman decide which treatment option to go for.

These should include:
The severity of the symptoms
The type of symptoms
The age of the patient
The desire to get pregnant or not
Length of treatment
Coping with side-effects of drug treatment
Cost (in countries where women have to pay for treatment)

How does the treatment work
Endometriosis fed by estrogen. Estrogen is the hormone that is produced in a woman’s body continuously, but each month there is a surge of this hormone, which causes the uterine lining to thicken to prepare for pregnancy. Then the estrogen levels drop and if there is no fertilization of the egg that month, the lining of the uterus shed and a woman has her period.

The aim of some treatments is to reduce or stop the estrogen produced in a woman’s body, so that it does not continue to feed the Endometriosis growths. This achieved by hormone drug therapy. This type of treatment is only successful for milder cases of Endometriosis where the growths are relatively small and few in numbers. In more severe cases then treatment with surgery is usually need to remove the growths.

You may find many different references and names for the growths relating to Endometriosis. They can call cysts, lesions, endometrial tissue, endometrial cells, as well as endometrial implants. These different terms are sometimes using to define different stages of the disease.

Treatment options
The options for which treatment to have are usually dependent on the extent or severity of the disease.

The options include:
. Observation with no medical intervention
. Hormone treatment
. Surgery
. Combined treatment

Observation with no medical intervention
This approach can be use for milder cases of Endometriosis, with regular visits to your doctor or gynecologist to monitor your health. Analgesics may prescribe to help with any pain, and non-steroidal anti-inflammatory drugs can help.

Hormone treatment
Treatment of endometriosis with hormone drugs can result in temporary improvement of symptoms such as painful periods, pain on intercourse and pelvic pain, but there are many side effects with all drug treatments offered for Endometriosis.
Medical treatment does not improve the chances for pregnancy, and as the treatment is hormonally based, it will delay conception even further due to the hormonal imbalances introduced into the body.

Medical treatment suppresses endometriosis, rather than removing it and is effective only for short-term management of symptoms, the active endometriosis returning gradually over 12-24 months after stopping the drugs.
The aim of drug therapy is to break the cycle of stimulation and bleeding. By stopping the ovary's usual hormonal cycle and reducing estrogen levels, the endometrial deposits shrink down and become inactive. The endometriosis is still there, and will gradually become reactivated when the normal menstrual cycle starts again.

Ovarian endometriomas of greater than 3cm diameter are unlikely to respond to medical treatment, and similarly if there is a significant amount of adhesions - these will respond best to laparoscopic surgery.

This aim of drug treatment is to alter the chemical and hormone levels in the body which in turn will affect the natural bodily processes. This will also affect the behaviour of the Endometrial growths.

Pseudo-pregnancy - a state resembling pregnancy - used as one method to treat Endometriosis, and this can be achieved through hormone drug therapy. This approach was developed by observations that Endometriosis would regress during pregnancy. Pseudo-pregnancy can be induced by using oral contraceptives containing estrogen and progesterone.

Pseudo-menopause - a state resembling menopause - was developed as another means of treatment because it was observed that Endometriosis also regressed after menopause.

Drugs Commonly used to Treat Endometriosis
All of these treatments can have various side effects. Some women suffer more than others do, but it is advised to be well informed about them before you decide on treatment.

Contraceptive pill - The Pill is one of the most commonly used treatments for endometriosis, and is often prescribed for young women with mild disease who also require effective contraception. Despite its long-established use, there has been only one study on the use of the Pill for endometriosis.

It compared the Pill with GnRH agonists and found an equal improvement with both drugs with regards to pelvic pain, painful periods and painful sex. When taking BCP for endometriosis rather than for contraceptive reasons you will take the pills continuously. This means that you will not have a period, as your body thinks that it is pregnant. By doing this you may find you have some spotting as your body adjusts to the pill. There are some side effects to bear in mind though and you will need to decide whether the pain of the endometriosis outweighs the risks of taking the pill. Side effects can include weight gain, acne and hair growth on the face.

Gestrinone - is a synthetic hormone that effects the production of estrogen by the ovaries. It is taken twice weekly rather than daily. Side effects of Gestinone include: weight gain, acne depression, mood swings, hot flushes and loss of libido. Gestrinone is a treatment used more commonly in Europe. It works in much the same way as danazol with similar, but milder, side effects.

Danazol - is a mild form of the male hormone testosterone and reduces the amount of estrogen produced by the ovaries to around the same level as during menopause. This is the drug that mimics Pseudo-menopause. Side effects include: weight gain, increased body and facial hair growth, acne, smaller breasts, increased muscle mass, voice deepening and mood swings. Danazol can also cause gastointestinal upsets, depression and liver disease.

GnRH agonists - GnRH stands for Gonadotrophin Releasing Hormone and an agonist is a drug that acts the same way as the body's own hormone. The body normally makes GnRH in a small gland in the brain (the pituitary) and it is this hormone that stimulates the ovary to develop eggs and produce estrogen, leading to the normal menstrual cycle.

If you give GnRH agonists, this floods the system and confuses the delicately controlled balance, leading to a complete block of egg development, estrogen production and menstrual cycle. It effectively makes you 'menopausal' for the time that you use the treatment and without the estrogen stimulation, endometriosis shrinks down and becomes inactive.

There are several GnRH analogues available. Examples of GnRH agonists include: goserelin (Zoladex), nafarelin (Synarel), Buserelin (Suprecur) and leuprorelin (Prostap). They are all either given by injection or nasal spray - tablet forms are not available.

Side effects of GnHR agonists include: menopausal symptoms such as thinning of the bones, hot flushes, dry vagina, headaches, depression, loss of libido and night sweats. These side effects can be relieved, by adding back estrogen and progesterone, which does not effect the benefit of treatment.

This is known as Add-back therapy for Endometriosis. There is now evidence that the use of Add-back hormone replacement therapy (HRT) is effective in preventing the bone thinning and the unpleasant side effects of GnRH treatment.

One of the GnRH drugs which has been commonly prescribed for Endometriosis is known as Lupron. There is a lot of information about this drug on the internet, as well as lots of mention of it at Endometriosis chat groups. This drug is also use for other health problems in both men and women. So it is not designed specifically for the treatment of Endometriosis, and some women have found they now have serious long-term health problems caused by this drug.
Progesterone hormone tablets - oppose the estrogen effects on the endometrial growths which causes them to ‘shrink’. Progesterone also prevents ovulation which lowers the estrogen levels. Side effects include: irregular menstrual bleeding, weight gain, mood changes, bloating, fatigue, depression, and nausea.

Progestogens are the most commonly used medical treatment. Examples include the drugs medroxyprogesterone acetate (Provera), dydrogesterone and norethisterone.
It has long been known that progestogens can alter the blood lipids (fats) in an unfavorable way, which might theoretically lead to an increased risk of blood clots (thrombosis). Two recent studies have provided more evidence that this could be the case. Although they looked at progestogens used for period problems, the doses used are similar as would be for treatment of endometriosis, and the risk of thrombosis was around 5-fold higher than expected.

The Mirena Coil - The Mirena Coil is used by some doctors to treat the symptoms of Endometriosis by reducing the amount of blood flow in a woman’s periods.
The Mirena Coil is like many other types of Intrauterine Contraceptive Devices (IUD's or coils) in that it is fitted by a doctor and remains in the womb for a fixed amount of time, after which it must be changed.

Most IUD's make a woman's periods heavier, but the Mirena actually makes periods lighter than usual. Because of this, it is frequently used as a treatment for heavy periods, and is now used as a treatment option for Endometriosis, for the same reason of reducing blood loss with the menstrual cycle.
It is made of a light, plastic, T-shaped frame with the stem of the 'T' a bit thicker than the rest. This stem contains a tiny storage system of a hormone called Levonorgestrel.

This hormone is also used in contraceptive pills. In the Mirena, however, a much lower dose is released than take the Pill (about 1/7th strength), and it goes directly to the lining of the womb, rather than through the blood stream where it may lead to the common progesterone-type side effects.

Although the IUD was originally developed as a contraceptive, the discovery that it leads to much lighter periods was seen as a bonus. Many gynecologists now suggest the Mirena as a treatment for heavy periods if tablet treatment doesn't work.

After 3 months use, the average blood loss is 85% less, and by 12 months the flow is reduced by 97% every cycle About one third of women using the IUS will not have any periods at all. There is no 'build up' of blood, because the hormone in the IUD prevents the lining of the womb from building up at all.

Most of the current drug treatments on offer aim to reduce Endometriosis growths, and in turn reduce symptoms. Most are reasonably effective to different degrees, however, most are associated with nasty side-effects. Many of the drug therapies have no proven benefit in terms of improvements in fertility or reducing recurrence of the disease.

Surgery
Surgical treatment for endometriosis is usually carried out in one of the following situations:

At the time of diagnosis for mild to moderate endometriosis
If medical treatment has not worked
If sub fertility is a problem
If there is moderate to severe endometriosis

When endometriosis recurs
Surgery can either be conservative or radical. The aim of conservative surgery is to return the appearance of the pelvis to as normal as possible. This means destroying any endometriotic deposits, removing ovarian cysts, dividing adhesions and removing as little healthy tissue as possible. Radical surgery means doing a hysterectomy with removal of both ovaries and is reserved for women with very severe symptoms, who have not responded to medical treatment or conservative operations. Sometimes, if there are other reasons to carry out a hysterectomy it is done earlier than this.

Treatment at the time of diagnosis
This approach is rapidly becoming standard practice in the management of endometriosis. It is typically carried out where the endometriosis discovered is mild to moderate and the extra time required to do the surgery will be able to be accommodated within the time of the operation.

Laparoscopy
Laparoscopy surgery used for diagnosis and for treatment of mild to moderate cases of Endometriosis. This is known as conservative surgery, which attempts to restore the pelvic anatomy to as close to normal as possible. A Laparoscopy enables a physician to look directly inside the abdomen and pelvic area and observe the anatomy and health of the abdominal and pelvic cavity.

To perform a Laparoscopy a small incision is made, usually about ¼ inch, right underneath the naval. A very small telescope-like instrument is then inserted. This instrument is attached to a light source which illuminates the pelvic and abdominal cavity. The physician can then look directly inside the cavity. During this procedure any Endometrial growths can be removed.

Laparoscopic management of endometriosis

Mild to moderate disease
The endometriosis spots are destroyed by diathermy, where an electric current is passed down a fine probe burning the lesion. Some surgeons use laser to evaporate the endometriosis.
Improvement in pain symptoms following this type of surgery can be expected in 70% of cases, more so if the location of adhesions divided corresponds to the area of maximum pain.

There has been only one good quality study of the effect of surgical treatment of mild to moderate endometriosis on sub fertility. It found that laparoscopic destruction of lesions resulted in a 13% increase in pregnancy rate - equivalent to, on average, a benefit for one out of every eight women receiving treatment.

Moderate to severe disease
Where endometriosis is more than a few spots, and in particular where there is more severe scarring or an ovarian endometrioma, there is still the option of laparoscopic treatment. The aim of laparoscopy, as usual, is to restore things back to normal. For endometriosis cysts on the ovary, this will mean shelling out and removing the cyst from the underlying normal ovary tissue. An alternative is to make a hole in the cyst wall, empty out the 'chocolate' collection of blood and diathermies the cyst base so all endometriotic deposits are destroyed.

Removal of endometriosis and division of scar tissue can be expected to improve the pain symptoms of endometriosis. The success of surgery in improving subfertility is related to the severity of endometriosis in the first place. It is difficult to give exact estimations, but women with moderate disease can expect pregnancy success rates of around 60%, whereas the comparable figure with more severe disease is around 35%. If a pregnancy does not occur within 2 years of surgery for endometriosis, the chances of success are poor.

Risks of laparoscopy

Keyhole surgery is generally very safe, especially in experienced hands, but it is important to understand that any laparoscopy carries with it some degree of risk, as do all operations. When placing the laparoscope into the abdomen, there is a small risk of accidental injury to bowel, the bladder or blood vessels leading to hemorrhage - this risk is inherent in the procedure. It is greater if the surgery is more advanced involving dividing of adhesions, diathermy of endometriosis, removal of cysts, etc. Not all of these complications will have serious implications, but it might mean an unexpected open operation and a longer hospital stay. Complications are more common where there has been multiple previous open surgeries.

Laparotomy
This procedure is used when Endometriosis is more extensive and widespread and the surgeon requires more room to work in the abdominal cavity. It is a more serious and involved operation and involves opening up the abdominal cavity.

Hysterectomy
There are many, many women who are driven to the drastic measure of having a hysterectomy in the hope that it will rid them of Endometriosis. This extreme step does not solve their problems. Please see the link below.

Combined treatment
This form of treatment involves combining surgery and drug therapy. An example is when Danazol is taken for 6 weeks prior to an operation to shrink the endometrial growths and ease the surgical removal. Following surgical removal of endometrial tissue, birth control pills may be prescribe that contain both estrogen and progesterone, to be taken continuously for up to nine months. This will induce a pseudo-pregnancy, with the aim to allow the body time to rest and heal.

Recurrence of endometriosis after surgery
Recurrence rate for endometriosis has been estimated to be 10% per year. One study found it to recur in 40% of women within 5 years after conservative surgery. There is a 6 times higher risk of recurrence after hysterectomy if the ovaries are not removed. Even in women who have their ovaries removed, there is still a risk of further recurrence of Endometriosis.

Julianne Hough

Return of symptoms
Although much relief can be gained from drug or surgical treatment for Endometriosis, it is very common for symptoms to return and for the disease to flare-up again. Additionally, women who use hormone replacement therapy during menopause may also see a return of the disease. This is because hormone replacement therapy uses estrogen along with progesterone to help alleviate the problems associated with the menopause. The estrogen drug therapy will cause the return of symptoms. It is considered by the medical profession to be uncommon for this to happen, but there are many reported cases of women on hormone replacement therapy for the menopause having a return of Endometriosis.

One of the biggest misconceptions about Endometriosis is that pregnancy will cure the disease. Unfortunately, this is not the case and most women will see a return of their symptoms after pregnancy, especially if the disease was more advanced.

Endometriosis - Alternative and Natural Treatment
Alternative and Natural treatments for Endometriosis - how it works!

Alternative therapies and natural treatments for endometriosis are obtaining excellent results in actively assisting the healing of this disease for many women..

HOLISTIC MEDICINE

Many of the alternative and natural therapies deal with the mental, emotional, and spiritual aspects of health, in addition to the physical body. This is where natural treatments have a huge benefit for women with Endometriosis - because this disease affects the whole person, not just the body. The name ‘Holistic Medicine’ comes from the connection between mind and body. Holistic practitioners treat the whole person as opposed to the individual organs where symptoms occur.

Alternative medicine made up of a rich variety of techniques and medical systems that for the most part, are still unfamiliar to the majority of people in the West. They are therefore, an ‘alternative’ to what most people are using when they need health care.
Much of what is labeled alternative medicine comes from other cultures or from ancient healing traditions. The use of herbs as medicine is an ancient practice found all over the world. Acupuncture comes specifically from ancient China and has been documented as being in use as early as 2697 B.C.

The World Health Organization estimates that between 65 and 80 percent of the world's population rely on traditional medicine as their primary form of health care.

WHAT IS THE DIFFERENCE BETWEEN ALTERNATIVE AND CONVENTIONAL MEDICINE?

Most high quality alternative medicine is founded on six core principles and practices that differ from the principles and historical practices of conventional medicine.

They are:
. The healing power of nature first, and technique and technology second
. Patient centered rather than physician centered
. Do no harm - many alternative medical systems are rooted in the principle of ‘always use the least drastic harmful therapies first’. This means that alternative medical providers, in general, choose techniques and therapies which are the least invasive or harmful to get the desired result
. Results generally take longer - but this ensures long term health and not a quick fix it
. Use of natural and whole substances
. Higher standard of health

The whole area of alternative medicine is becoming more main- stream in western society as a means for people to take care of their health, for reasons including:
the realization that, contrary to previously held beliefs, conventional medicine (the medicine of antibiotics, surgery, chemotherapy etc.) cannot solve all of societies health problems
the growing acceptance that health is more than just ‘the absence of disease’ and involves more that just the physical body
the growing body of scientific research, as well as public awareness, that many alternative medical treatments are more effective, more economical, and less invasive and less harmful than conventional medical treatments

SO WHAT ARE THE DIFFERENT ALTERNATIVE AND NATURAL THERAPIES THAT CAN HELP ENDOMETRIOSIS!

Acupuncture and Endometriosis
Acupuncture is part of Traditional Chinese Medicine and has been practiced in China for thousands of years, but became widely known in the West only in the 1970s, when its use as an anesthetic received sensational press coverage. Practitioners insert fine, sterile needles into specific points on the body as a treatment for disorders ranging from asthma to alcohol addictions, but most often in the West as a means of pain relief.

Chinese Herbalism and Endometriosis
Chinese Herbalism is another part of the Traditional Chinese Medicine system.
Traditional Chinese medicine is able to understand endometriosis based on the different clinical manifestations, or symptoms, associated with each individual. It is important in TCM to diagnose the patient according to their own specific pattern. Each individual has a pattern that marks the foundation and progression of the disorder.

When determining the pattern of disease in the treatment of endometriosis, TCM takes into account the menstrual history, duration of the cycle, as well as pain, including the time that it occurs, the location, and the nature and severity.

Herbalism and Endometriosis
Herbal medicine is the treatment of disease using medicinal plants, both internally and externally, to restore the patient back to health. It is a system of medicine that relies on the therapeutic qualities of plants to help the patient by enhancing the body’s own recuperative powers. It is a natural method of healing based on the traditional usage of herbs coupled with modern scientific developments.

Though there are those in the orthodox medical world who ignore herbal medicine, even condemn it, the constituents of herbs have provided the blueprint for many of the most effective and widely known drugs used today. ‘Orthodox’ medicine has its roots in herbal medicine.
Orthodox medicine is based on drugs isolated from plants, or more often manufactured in the laboratory. The herbalist advocates the use of the whole plant as a gentler and safer way to restoring a patient to health
For the treatment of Endometriosis, one of the first tasks in herbal medicine is to try and re-balance the hormone levels in the body. Then other herbs will be introduced to strengthen the immune system so that the body can then begin to eliminate the disease. As with other alternative treatments, using herbal medicine for Endometriosis will involve a time commitment to achieve success.

WE SELL BULK HERBAL PRODUCT TO HELP WOMEN SUFFRENING FROM ENDOMETRIOSIS, IT IS SAFE AND IT WORKS EFFECIANTLY.

THOSE HERBS LIKE: Bupleurum, Chih-ko, Red peony, Licorice, Platycodon , Tang-kuei , Cnidium, Rehmannia, Persica, Carthamus, Cyathula, AND other herbal formula already available on request.

Aromatherapy and Endometriosis
Aromatherapy is a form of healing that utilizes the natural aromatic aspect of plants - the essential oils - both for their scent and for their inherent medicinal properties. These aromatic oils can be found in a wide range of species and are extracted from the seeds, bark, leaves, flowers, wood, roots or resin according to the type of plant.

Endometriosis - Diet and Nutrition
Diet changes can help reduce the symptoms of endometriosis

Changing your diet to deal with Endometriosis is an excellent foundation to assist you in reducing the symptoms, and will help regenerate your health.
Adjusting what you eat can bring about many positive physical and metabolic changes, as well as improving our health. Many of you may be aware that various illnesses and diseases have responded very positively to changes in diet, and Endometriosis is no exception.
Some of the positive physical changes that take place when we change our diet, will at first not seem reliant on our food intake, but they are.

For example, eating the right kinds of foods can:
. sharpen our mental alertness
. help us to stop feeling so sluggish
. give us more energy
. regulate sleep patterns
. regulate bowel movements
. balance blood sugar levels
. regulate metabolism
. regulate body weight
. control hyperactivity - especially in children

We are very much a reflection of what we eat. When someone has a diet loaded in fats, the first place it will show up is in their complexion, with greasy, sallow skin. When we are constipated, an Iridologist (alternative health practitioner specializing in diagnosis using the iris of the eye) will immediately see this in the lack-lustre appearance of the eyes. With a lack of vital nutrients in our system, the body will eventually give you tell-tale signs.

The diet in modern day western society has become depleted of vital nutrients for many reasons. Intensive farming has robbed the soil of vital trace elements which used to be taken up by the crops as they grew, and in turn we consumed them. We rely so much on convenience foods now, which are very low in goodness. Much of our ‘fresh’ produce like fruit and vegetables, is actually gassed and then stored in warehouses for months.

Many of us eat ‘fast food’, which is not very nutritious - the longer that food is left standing in a heated serving cabinet, the less nutritious value it has. People get lazy, they cannot be bothered to shop for valuable ingredients, yet alone cook good wholesome food anymore.

What the body needs is a simple, balanced, preferably organic diet, which is prepared using fresh ingredients, and is viewed as our means of sustenance rather than being viewed as ‘something to stop us being hungry’. We do have many problems and issues surrounding food in the West, with anorexia, comfort eating, and many other eating disorders. Food is also used in many social situations, but this is no excuse for not being able to feed yourself with good food when you are at home.

Food is our fuel, it makes us function, grow, replace worn out cells, gives us energy, and feeds the entire body. Food is the secondary requirement to life, with oxygen being the first basic requirement. More important than food is our daily requirement for water. We need lots of it; plain, fresh water. Yet most people only drink a small proportion of what the body really needs.

But going back to food; it provides us with energy. The foods we take in include:
. carbohydrates, which provide the chief source of energy for bodily functions and muscular exertions
. fats, which are the most concentrated form of energy. Three fatty acids, are essential in the diet because the body cannot make them itself.
. proteins, which are the building blocks in food, the construction materials for growth and repair of cells
. fibre, indigestible parts of plants which provides roughage and aids digestion
. vitamins and minerals - the organic substances which the body cannot make, but which it requires in small amounts to maintain health

SO WHERE DO WE START!

Let's start with pain and hormones in relation to diet

Endometriosis is an estrogen-sensitive condition, but the painful menstrual cramping that occurs is predominantly due to prostaglandin synthesis in the body. Prostaglandins are naturally occurring fatty acids, which are derived from dietary sources.

The body can produce different types of prostaglandins through a complex series of pathways. There are the ‘good guys’ and the ‘bad guys’ of the prostaglandin group. The goal of a controlled diet is to block the ‘bad guys’ for their negative actions on the body, and increase the ‘good guys’ for their opposite and beneficial actions. The action of the bad guys is to increase uterine contractions, and the good guys have a soothing effect. By changing the types of oils that are taken into the diet, the production of the good guys can be stimulated, which helps with uterine relaxation. These oils are composed of omega-3 fatty acids, which lead to positive prostaglandin production.

Excellent sources of the omega-3 fatty acid producing oils are:

. evening primrose
. Walnut oil
. flax seeds/oil

It is also important to decrease intake of those fatty acids that will stimulate the bad guys which are found in saturated fats, butter, animal and organ meat, lard.

In addition to decreasing bad fat intake, the diet should also consist of high fiber. Not only does this help with good digestion, but it is also thought that a diet high in fiber can decrease total circulating estrogens. It is recommended to incorporate 25 grams per day of fibre.

Good sources are:
. whole grains excluding wheat and rye
. beans, peas and pulses
. brown rice
. vegetable and fruits
. oatmeal

The following foods are recommended to modulate estrogen levels by incorporating one or two servings a day:

. mustard greens
. broccoli
. cabbage
. turnips

FOODS TO AVOID
. wheat * - this includes breads, cakes and pasta products, all based on wheat
. red meats - promotes negative prostaglandins
. refined and concentrated carbohydrates - bread, flour, cakes made from refined flours
. refined sugars and honey - causes inflammatory reaction
. alcohol - consumes vit B stored in the liver
. caffeine which is found in tea, coffee, soft drinks -increases abdominal cramps and increases estrogen levels
. chocolate - as it contains sugars
. dairy produce including all milk and cheese - inflammatory
. fried food, margarine and hydrogenated fats - can stimulate negative prostaglandins
. soy products and soy protein products - tamari can be used in small amounts
. tinned and frozen packaged foods as little as possible
. additives and preservatives - increase chemical load on the system

Note: Meat, dairy and eggs, promote the pro-inflammatory prostaglandins.

FOODS BENEFICIAL FOR THE IMMUNE SYSTEM

. beans, peas, lentils
. onions
. garlic (raw or lightly cooked)
. carrots (contain beta-carotene)
. live yogurt (good for healthy intestinal flora)
. rhubarb
. seeds and sprouted seeds
. ginger
. green tea

HORMONE REBALANCING
Foods containing natural plant sterols (phytoestrogens) can be helpful. They are thought to block the estrogen receptors, so in turn excess estrogen in the body cannot ‘lock-in’ to these receptors.

These include:
. peas, beans and pulses
. red and purple berries
. garlic
. apples
. parsley
. fennel
. brassicas: cabbage, cauliflower etc
. nuts and seeds
. celery, carrots
. rhubarb
. sage

VITAMIN AND MINERAL SUPPLEMENTS

Although the best source of vitamins and minerals is through a well balanced diet, many foods today are depleted in these vital trace elements. Today, most of us need to supplement our diet with some of the vitamins and minerals that our bodies need to function optimally.

The following is a list of supplements that will help women with Endometriosis:

. Magnesium - is a mineral and is believed to ease cramping with menstruation
. Zinc - is essential for enzyme activity, helping cells to reproduce which will help with healing. Zinc is also reported to boost the immune system and helping to create an emotional sense of well-being
. Calcium - levels of calcium in menstruating women decrease 10 to 14 days before the onset of menstruation. Deficiency may lead to muscle cramps, headache or pelvic pain.
. Iron - women with Endometriosis tend to have very heavy periods which can lead to an iron deficiency. This can lead to anemia which is characterized by extreme fatigue and weakness.
. B vitamins - these are important for the breakdown of proteins, carbohydrates and fats in the body. B vitamins are reported to improve the emotional symptoms of Endometriosis, and have proved helpful in dealing with PMT
. Vitamin C - is well known for helping to boost the immune system and help provide resistance to disease. It is also used in the body to build and maintain collagen within the body.
. Vitamin A - is another immune system booster
. Vitamin E - plays an important role by increasing oxygen carrying capacities and also strengthens the immune system
. Selenium - when taken together with vitamin E has been reported to decrease inflammation associated with Endometriosis, as well as immune system booster.

OTHER USEFUL SNIPPETS:
Certain vegetables have substances that activate liver enzymes and help the liver to detoxify chemicals. This allows the liver to eliminate excess estrogen from the body more effectively. These vegetables include: broccoli, cauliflower and brussel sprouts.

. Auto immune diseases are thought to be triggered by free-radicals in the body, which could be an added factor in Endometriosis. Free radicals are destructive molecules and are found naturally in the body but can be made worse by pollution, stress, illness and smoking. There are minerals and vitamins that will help to fight off these free-radicals because of their antioxidant properties, including: vitamins A,C,E, CoQ10, selenium, vitamin B complex, as well as specific supplements being sold specifically as Antioxidants.

• It is very common for women with Endometriosis to suffer from Irritable Bowel Syndrome. I used to suffer from it myself, and it took quite a while to define which foods would trigger it off. These triggers can vary from one woman to another. Even simple things like drinking a hot drink when it was too hot would trigger it off in me. You need to really pay attention as to what your own subtle triggers are, as well as which foods will set it off.

TO SUM UP
• increase omega-3 fatty acids
• avoid meat, dairy products, wheat and sugar
• increase fiber
• modulate estrogen
• avoid caffeine and alcohol
• avoid refined foods, e-numbers, additives
• minimize or avoid soy products as they contain high levels of phytoestrogens, and soy contains a particular toxin which seems to be particularly detrimental for women with Endometriosis
• peel fruit and vegetables to remove toxic chemicals
• eat organic produce wherever possible
• drink lots of filtered or mineral water

WE are waiting your order from our herbal collection to fight Endometriosis

Swine flu around.. Don’t panic, there is a solution

WHO update
Monday 6 July:
94,512 cases worldwide
429 deaths

Swine flu advice - what to look out for

Flu is an illness caused by an infection of the influenza virus. The flu virus constantly changes and there are many different strains of flu. Find out the differences between swine flu, pandemic flu, and ordinary flu.

What is it and how serious is it?
Swine flu is the H1N1 strain of the type A influenza virus found commonly in pigs, although no pigs are known to have it in the UK. Viruses mutate, which is how this strain infected humans.
A new strain of Influenza A (H1N1), also known as swine flu, was confirmed in the UK in April and has spread to more than 100 countries around the world.
Although symptoms have generally proved mild, a small number of patients will develop more serious illness. Many of these people have other underlying health conditions, such as heart or lung disease, that put them at increased risk.

Symptoms
Check your symptoms

Flu symptoms can include:

· fever
· cough
· headache
· weakness and fatigue
· aching muscles and joints
· sore throat
· runny nose

As with any sort of influenza, how bad and how long the symptoms last will depend on treatment and the patient’s individual circumstances.
Most cases reported in the UK have been relatively mild, with those affected starting to recover within a week.

Who is at risk?
Some groups of people are more at risk of serious illness if they catch swine flu. It is vital that people in these higher risk groups get anti-viral drugs and start taking them as soon as possible – within 48 hours of the onset of symptoms.

Health authorities are still learning about the swine flu virus, but the following people are known to be at higher risk:

pregnant women
people aged 65 years and older
young children under five years old
People suffering from the following illnesses are also at increased risk:
chronic lung disease
chronic heart disease
chronic kidney disease
chronic liver disease
chronic neurological disease
Immunosuppression (whether caused by disease or treatment)
Diabetes mellitus
patients who have had drug treatment for asthma within the past three years

Pregnant women are thought to be more susceptible to all types of influenza because of the physiological changes that occur in pregnancy, including changes to the immune system. The baby may also be at increased risk due to the mother's response to infection, such as a high temperature.

Their doctor may prescribe the antiviral medication Tamiflu or Relenza which are most effective if taken as soon as possible after the onset of symptoms. Pregnant women should not take any antiviral medication without consulting their doctor. The doctor will assess the risks and benefits of the medicine on an individual basis and may need to seek advice from an infectious diseases specialist or obstetrician.

Practical steps that pregnant women can take to reduce their chances of exposure to influenza include:
• washing and drying hands frequently

• staying away from people who are sick

• avoiding crowded places

What is an epidemic and a pandemic?
An epidemic is a sudden outbreak of disease that spreads through a single population or region in a short amount of time.

A pandemic occurs when there is a rapidly-spreading epidemic of a disease that affects most countries and regions of the world.
Swine flu is now a pandemic. Pandemic flu occurs when an influenza virus emerges that is so different from previously circulating strains that few, if any, people have any immunity to it. This allows it to spread widely and rapidly, causing serious illness.

Ordinary flu and pandemic flu - the differences

Ordinary flu:

· occurs every year during the winter
· affects 10 to 15 per cent of the UK popuation
· most people recover within 1 or 2 weeks without medical treatment
· can be identified in advance and a vaccine can be made (this immunisation is known as the flu jab and helps protect people from ordinary flu)

Pandemic flu:

· occurs during any season
· affects more people than ordinary flu (up to half the population)
· is a more serious infection
· people of all ages may be at risk of infection
· a vaccine cannot be made because the virus strain has not been identifed
· antiviral medicine is stockpiled to treat people

How the flu virus spreads

How worried should we be?
Most people have had mild symptoms. It is unlike the flu pandemic of 1918, which struck sufferers down within hours. The virus may become more deadly, but it's too soon to tell if this will happen.

How quickly is it spreading?
Swine flu has reached more than 120 countries, with more than 94,000 confirmed cases and 429 deaths.

In the UK, more than 9,000 people have had the virus but there are likely to be many more. Health Secretary has predicted 100,000 new cases a day by the end of August. The reason it is so contagious is because we haven't yet developed immunity. The plan now is to concentrate on treatment as the virus can no longer be contained. Schools will not necessarily close and antiviral drugs will be kept for those with symptoms rather than being given to anyone at risk.

How can I avoid catching it?
It's caught by breathing in droplets when an infected person coughs or by touching contaminated surfaces such as taps or rails.
The virus can live on a hard surface for up to 24 hours and a soft surface for about 20 minutes. Wash your hands thoroughly and regularly clean hard surfaces at home such as door handles. Antibacterial cleaning products are useless against viruses.

Should we wear face masks?
They may do more harm than good. They must be changed often to be effective and may lure us into a false sense of security as they don't protect from infection via hand-contact surfaces.

What are the symptoms?
Like normal flu, a temperature of 38C or higher and a sudden cough. You may also get a headache, tiredness, chills, aching muscles, limb or joint pain, sore throat, runny nose, sneezing, loss of appetite and diarrhoea or stomach upset.

What should I do if I think I've got it?
Don't go into a surgery or hospital to avoid spreading the disease. Instead, call your GP who can diagnose you over the phone. Then get a relative or friend to pick up antiviral medication for you.

Take paracetamol-based cold remedies to reduce fever and other symptoms, drink plenty of fluids and rest. Always cover your mouth when you cough or sneeze and flush used tissues down to avoid spreading the virus. If symptoms get bad and the sufferer is weak, call 999 or similar emergency call in your country.

Will antivirals cure it?
No, but they can help relieve symptoms and lower the risk of complications such as pneumonia. We already have enough of the two drugs, Tamiflu and Relenza, to treat half the population and there are more on order to treat up to 80%.

Relenza

Might they stop working?
The virus could become resistant to antivirals but hopefully, if and when that occurs, the vaccine will be available.

When will that be?
Hopefully next month. Any old vaccine won't do - it has to be adapted so it works for the particular strain of the virus.
Supplies are on order for the whole population but it may take until next year for us all to be vaccinated. Priority will be given to vulnerable groups, plus frontline health workers.

How to Treat Swine Flu Symptoms
Do you have the symptoms of swine flu? It certainly is what everyone seems to be talking about today. As new cases of swine flu continue to be confirmed internationally on a daily basis it seems as if the world may be headed for a global health crisis of significant proportion. Fortunately the majority of people infected in the U.S. have thus far had relatively mild symptoms similar to the common winter cold and influenza. So if you're sick with cold-like symptoms what steps can be taken to make yourself feel better and get well faster?

Treating Swine Flu Symptoms
· Do not go to work. It's likely your co-workers strongly prefer that you keep your viral infection to yourself. Take the time to rest and allow your body to mount a counterattack against the infection.
· Drink plenty of fluids. This will help to prevent dehydration and thin out that thick mucous in your head and chest. The fluids will also help to soothe your sore throat.
· Most people with flu-like symptoms complain most about the body and muscle aches as well as the associated fever. Acetaminophen or ibuprofen products are both effective at reducing these symptoms. Because these medications work differently alternating the two can often produce better results than using one or the other.
· To reduce your annoying cough stick with candy cough lozenges or OTC cough medications which contain dextromethorphan. Avoid cough medications that contain sedating amounts of alcohol. Elevating your head with pillows can provide modest cough relief as well.
· The head congestion and stuffiness can be alleviated by using a decongestant product containing guaifenesin and phenylephrine. There are many available OTC. Avoid using nasal antihistamines like Afrin because of their rebound congestion and addictive potential. If you insist on using nasal sprays then at least limit their use to less than three days.
· If you are diagnosed with swine flu then you might be treated with inhaled Relenza, oral Tamiflu or both. These are anti-viral medications typically used for seasonal influenza. The Center for Disease Control has indicated that both drugs seem to have some effect at combating swine flu.

H1N1 Swine Flu and Chinese Medicine
If you’ve been following the news at all, you’ve undoubtedly seen headlines all over the place about Swine Flu.

To date, over 50 countries have confirmed cases of swine flu totaling 13,394 people, including 95 deaths. More alarmingly, health experts in the U.S. warn that official figure is just “tip of the iceberg”.

Rapid transmission of swine flu is coinciding with the southern hemisphere’s traditional winter flu season. As of 27 May 2009, there are a total of 61 confirmed cases of swine flu across Australia, including 33 in Victoria, 18 in NSW, 5 in Queensland, 3 in South Australia, 1 in the ACT and 1 in Western Australia.

What is swine flu?
Swine influenza refers to influenza caused by any strain of the influenza virus endemic in pigs.
However, the flu outbreak in human that is widely known as “swine flu” apparently is not due to a swine influenza virus. It is actually due to a new strain of influenza A virus subtype H1N1 that is derived from one strain of human influenza virus, one strain of avian influenza virus, and two separate strains of swine influenza virus.

According to the U.S. Centers for Disease Control and Prevention, most cases occur when people come into contact with infected pigs or contaminated objects moving between people and pigs.
When flu viruses from different species infect pigs, they can mix inside the pig and new, mixed viruses can emerge. Pigs can pass mutated viruses back to humans, and these can be passed from human to human. The symptoms are quite similar to those of seasonal influenza, including fatigue, cough, runny nose, fever, vomiting and etc.

With the spike in the number of swine flu cases across the country, many people are too concerned to eat pork. Facts have proved these worries groundless. People cannot catch swine flu from eating pork or pork products. As long as cooking pork to an internal temperature of 160 degrees Fahrenheit (72 degrees Celsius), the swine flu virus along with other bacteria and viruses can be killed.
You are probably interested in what you can do personally to fight against swine flu?

Most importantly, ensure personal hygiene. Then, get adequate sleep on a daily basis, because your immune system regenerates the best when sleeping.
Drink plenty of water each day to stay hydrated. For best result, remember to drink pure water.
In addition, exposure to nature and the great outdoors helps healthy emotions, and this in turn helps with your immune system as well.
On top of that, I would highly recommend using natural immune boosting herbs to give your body as much help as possible.

There are a vast number of Chinese herbs with proven immune enhancing effects, as well as anti-viral and anti-bacterial effects.
On top of the list would be Ganoderma lucidum and Cordyceps sinensis. Both are precious herbs once only available to the Emperors of China.
These herbs have been shown to stimulate and enhance immune system as well as having a wide variety of health benefits.

Ganoderma lucidum

The more we can do to protect ourselves from being infected by the “Swine flu” virus, the less the virus will spread. That’s the least we can do.
If you read the stories on H1N1 influenza written by the mainstream media, you might incorrectly think there’s only one anti-viral drug in the world. It’s name is Tamiflu and it’s in short supply.

That’s astonishing to hear because the world is full of anti-viral medicine found in tens of thousands of different plants. Culinary herbs like thyme, sage and rosemary are anti-viral. Berries and sprouts are anti-viral. Garlic, ginger and onions are anti-viral. You can’t walk through a grocery store without walking past a hundred or more anti-viral medicines made by Mother Nature.

And yet how many does the mainstream media mention? Zero.
The totality of influenza preparedness is defined by the mainstream media as the number of doses of Tamiflu a nation has stockpiled.

Tamiflu comes from an herbTo live in a world that’s saturated with natural anti-viral medicine and then not even acknowledge it in the media is beyond bizarre. It’s Twilight Zone-like. It’s like we’ve been teleported to an alternate universe where anti-viral plants have disappeared… or at least everyone is pretending they have.

Where do you think Tamiflu comes from, by the way?
It’s extracted from the Traditional Chinese Medicine herb called Star Anise. It’s one of hundreds of different anti-viral herbs found in Chinese Medicine, not to even mention anti-viral herbs from South America, North America, Australia, Africa and other regions.

Star anise herb

I find it downright comedic that Big Pharma and the world’s health authorities extract their “champion” anti-viral drug Tamiflu from a Chinese Medicine herb, and then they go out of their way to announce to people that herbs and natural remedies are useless against influenza. If that’s the case then why are they using herbs to make their own medicine?

How many stories have you read that bother to tell you Tamiflu is made from the star anise herb that’s been used for over 5,000 years in Traditional Chinese Medicine? Virtually none. The powers that be don’t want anybody to know they could actually grow their own medicine in a garden or a windowsill. If you can grow cilantro, you can grow medicine. If everybody figured that out, Big Pharma wouldn’t be reaping the enormous profits it’s making right now from Tamiflu sales, and the governments of the world wouldn’t be able to scare and control people by promising to distribute Tamiflu (but only if you behave).

The Tamiflu scam is global

The Tamiflu scam is globalH1N1 influenza is not a hoax. But the way it’s being reported by health authorities and the mainstream media certainly is. The scam in all this is what they leave out of the stories — the fact that human beings live among a huge natural medicine chest of anti-viral drugs found in every city park, every forest, every swamp and every open field.

You cannot walk across any patch of natural land in America and NOT find anti-viral medicine. It’s everywhere! It’s in the weeds growing in the cracks in the sidewalks; it’s in weeds on the side of the stream; and it’s growing in the small patch of dirt left remaining in the median between highway lanes.

In the deserts of the American Southwest, you can’t even drive to work without passing mile after mile of abundant anti-viral medicine grown by Mother Nature and just waiting for humans to wake up and be smart enough to recognize it.

I have a sobering prediction about H1N1 influenza (formerly “swine flu”): If it does become a global pandemic, many of those people who refuse to recognize the anti-viral medicine provided by Mother Nature will die. Their misplaced faith in Big Pharma will literally cost them their lives. In contrast, those who have the wisdom to get their medicine from Mother Nature will not only survive the pandemic, they’ll thrive even as others around them are dying. It is those who embrace Mother Nature’s powerful, synergistic and living medicines who will weather any pandemic storm, and they will emerge as the DNA holders of the future of human civilization.

The reason I bring this particular subject up is because when SARS (Severe Acute Respiratory Syndrome) hit Asia in 2002, it was TCM (Traditional Chinese Medicine) with specific attention to herbs and strict precautionary measures that got Asia through the crisis.

I strongly feel the same approach can be used with relation the Swine Flu outbreak.

So what are the symptoms to watch for? Some of the cases have reported runny nose, sore throat, vomiting and diarrhea. Add these to the normal, seasonal flu symptoms of high fever, lack of appetite and coughing you will have a good idea if you have been infected or not.

Do you think that the common cold and the flu (influenza) are the same? They are not. The common cold virus attaches to the adenoids, the flu attaches to lung tissue. It takes 1-4 days for you come down with the flu. It's to early to tell if the Swine Flu follows the same pattern.

How do you know if someone in close proximity has the swine flu and can infect you with it. It may be impossible to tell as a person can be infected and contagious for 24 hours before they exhibit any symptoms.

Oriental Medicine (OM) establishes 3 phases for most infectious diseases. They are prevention, exposure and full treatment. We are only going to discuss the prevention phase.

It is important that you have a strong immune system. Our immune system is capable of and does protect the human body from diseases of the common cold and influenza to cancer.

Depending on the age of the individual, OM has a different approach. Persons under the age of 40 have a stronger immune system than those over the age of 40. In the younger (under 40) person it is preferred to treat using the yuan qi (pronounced "wan chi") approach.

Oriental Medicine

In Chinese medicine their are many forms of qi. Yuan qi is roughly translated as the qi (the motive force or energy of all living things) that all persons are born with. This could further translate to a strong immune system in a person under the age of 40. Individuals under the age of 40 only need to enhance or boost their immune system with natural herbs like cat's claw, echinacea, maitake, reishi and shitaake mushrooms, probiotics, vitamin C and zinc. There is a 5-mushroom formula that is excellent named Wu Gu Fungi.

Persons over 40 (weaker immune system) need the Wei Qi and the Yuan Qi methods. Wei Qi translates to a defensive mechanism and it is present in the skin. It defends the body against invasion. These individuals need Yu Ping Geng San (commonly known as a Jade Windscreen formula) This formula primarily builds up the resistance (immune system) of the body against the invasion of pathogens.

It normally consists of six Chinese herbs. Astragalus Root , Ledebouriella , Atractylodes macrocephala , Schizandrae , (Pseudostellaria , Radix Oryzae.

This was the basic formula that was used in Asia to combat and treat SARS and it should be good for the Swine Flu as well, but it is really to early to tell.

Other immune system boosters are astragalus (huang qi jian zhong tang), ginseng endurance formula (ren shen pian) and Yin Chiao formula which is quite well known for its ability to expel viruses while they are still in the exterior.

astragalus

This formula could be used in the prevention phase as well as the initial exposure phase.

Vaccines for pandemic influenza A (H1N1)
Influenza vaccines are one of the most effective ways to protect people from contracting illness during influenza epidemics and pandemics. Other preventive and treatment measures include anti-viral and other drugs, social distancing and personal hygiene. These measures must be used both prior to development of a pandemic vaccine and following the availability of a vaccine, expected in limited supply at first.

High Blood Pressure; Hypertension

What is High Blood Pressure?

When you have your blood pressure taken, your health care provider is measuring the pressure, or tension, that blood exerts on the walls of the blood vessels as it travels around the body. In a healthy person, this pressure is just enough for the blood to reach all the cells of the body, but not so much that it strains blood vessel walls.


Blood pressure is measured in millimeters of mercury (mm Hg).
· A typical normal blood pressure is 120/80 mm Hg, or "120 over 80."
· The first number represents the pressure when the heart contracts.
· The second number represents the pressure when the heart relaxes.
· Blood pressure greater than 140/90 mm Hg is considered high.

Generally, blood pressure will go up at certain times - for instance, if you smoke a cigarette, win the lottery, or witness a car crash - and will return to normal when the stressful or exciting event has passed.
But when blood pressure is high all the time, the continuous increased force on blood vessel walls can damage blood vessels and organs, including the heart, kidneys, eyes, and brain.

The medical term for high blood pressure is hypertension.


Need to Know:
Systolic and Diastolic Blood Pressure
Blood travels through blood vessels much like water through a garden hose. The blood in the vessels is under pressure just like the water in a hose when the tap is turned on.

With each heartbeat more blood is pumped into the vessels - like turning up the tap - so the pressure rises. This is the systolic blood pressure, the first number in the blood pressure measurement, which is normally around 120.
Between heartbeats, while the heart is resting, the pressure in the arteries is lower. This is the diastolic pressure, second number in the blood pressure measurement, which is normally around 80.

Indication of high blood pressure
You can increase the pressure in a hose either by turning up the tap or by putting a crimp in the hose (that is, by narrowing the hose). In this same way, the blood pressure in blood vessels will rise if fluid flows more forcefully or if the arteries are narrowed.
Pressure in a hose can be regulated either by controlling the rate at which fluid passes through it or by widening it. Likewise, the pressure in the blood vessels can be controlled, with medications that act on the heart or blood vessels and with certain lifestyle modifications.

Need to Know:
Although high blood pressure can be extremely dangerous, it usually causes no symptoms - so many people don't even realize they have it. High blood pressure can only be detected with accurate and repeated measurements of a person's blood pressure. That's one reason why it's so important to have regular medical checkups.

Even though high blood pressure can be treated safely and effectively, only about one-quarter of people who have high blood pressure take the necessary steps to keep their blood pressure within a normal range.
There are three types of hypertension:
Primary hypertension (essential hypertension). This is high blood pressure for which no cause can be found. Most people with high blood pressure (90 to 95 percent) have this type of hypertension. Doctors suspect that a combination of lifestyle, diet, heredity, age, gender, race/ethnicity, hormone levels, and other factors all contribute to high blood pressure.
Secondary hypertension (non-essential hypertension). This is high blood pressure for which a definite cause can be found. This type of high blood pressure accounts for only 5 to 10 percent of all cases of hypertension. Some of these causes are temporary or controllable - for instance, pregnancy or the use of certain medications - while others are chronic conditions like hormonal diseases, kidney disease, or head injuries.

Isolated systolic hypertension (ISH). Older people are sometimes susceptible to another form of high blood pressure, called isolated systolic hypertension. In people with this condition, blood pressure is higher than normal when the heart beats, but returns to normal in between beats of the heart. The large difference in pressure can place additional strain on artery walls.

Nice To Know:
Q. If I do not feel any symptoms, is there still a problem?

A. Most people with high blood pressure do not experience any symptoms. The presence of symptoms, such as headache or blurry vision, usually indicates severe or long-standing hypertension. However, over time, uncontrolled high blood pressure causes significant damage to important organs including the heart, kidneys, brain, and eyes. In a number of cases, this damage can lead to death. This is why high blood pressure is sometimes referred to as "the silent killer."

Facts about high blood pressure
High blood pressure is a condition in which the pressure, or tension, that blood exerts on the walls of blood vessels goes up and stays high, which can damage the blood vessels, the heart, and other organs.
It is estimated that more than 50 million Americans have high blood pressure.
High blood pressure is one of the most serious health problems in the United States; yet, because high blood pressure has no symptoms, millions of people do not even know they have it.

As many as one in four adults in the United States has high blood pressure.
High blood pressure affects people of all ages, racial and ethnic groups, and walks of life.

Doctors do not know what causes high blood pressure in 90 to 95 percent of people who have it.
High blood pressure is one of the most important risk factors for coronary heart disease.

High blood pressure is the most important risk factor for stroke, which is the third leading cause of death in the United States.
High blood pressure is a common cause of heart failure, the leading cause of death in the United States
High blood pressure is a common cause of kidney disease.

What Factors Affect Blood Pressure?
Blood pumped through blood vessels is always under pressure, much like water that is pumped through a garden hose. This pressure is highest in the arteries closest to the heart and gradually decreases as the blood travels around the body.
Blood keeps moving around the body because there are differences in pressure in the blood vessels. Blood flows from higher-pressure areas to lower-pressure areas until it eventually returns to the heart.

Hypertension is much strain on your heart

Blood pressure is controlled by three things:
1 - How fast the heart beats (heart rate). The pace at which the heart beats, or heart rate, is counted in heartbeats per minute. Generally, when heart rate increases, blood pressure rises. When heart rate decreases, blood pressure drops.
2 - A number of things affect heart rate, including the body's nervous system; chemical messengers called hormones, body temperature, medications, and diseases.
3 - How much blood the heart pumps with each beat (stroke volume). The amount of blood pumped out of a ventricle with each heartbeat is called stroke volume. When you're resting, stroke volume is about the same as the amount of blood that veins carry back to the heart. But under stressful conditions, the nervous system can increase stroke volume by making the heart pump harder.

Stroke volume can also be affected by certain hormones, drugs, and diseases, as well as increases or decreases in the amount of blood in the body, called blood volume.

Nice To Know:
You might also hear the term "cardiac output" used to describe the amount of blood that's pumped through the body. Cardiac output is simply the amount of blood pumped out of a ventricle in one minute:
Cardiac output = Heart rate x Stroke volume (amount of blood pumped with each beat)

As cardiac output increases, so does blood pressure. This is why heart rate and stroke volume are important ways for the body to control blood pressure.
How difficult it is for blood to travel around the body (peripheral resistance). The third major component that affects the blood pressure is the caliber or width of the arteries. Blood traveling in narrower vessels encounters more resistance than blood traveling through a wider vessel (its harder for water to pass through a narrow pipe than a wide pipe).
Depending on what a person is doing, the amount of blood the heart pumps varies enormously. Yet the blood pressure normally remains pretty stable. That's mainly because the body adjusts the resistance of the arteries, either widening or narrowing them as appropriate, to prevent the blood pressure from swinging wildly.

This ability to regulate the width of the blood vessels is called the peripheral resistance. Most of the resistance to blood flow in the circulation occurs in the small-diameter arteries called arterioles.
These arterioles are especially important in the immediate regulation of blood pressure. That's because they contain specialized smooth muscle in their walls that can relax or contract, allowing the blood vessel to get wider or narrower.

These changes are caused by:
· Nervous system stimulation (for example, stress, caffeine, or tobacco)
· Hormones
· Proteins
· Substances derived from the inner lining, or endothelium of blood vessels
· Substances released during the body's inflammatory response, called inflammatory chemicals
· Certain medications
· Various diseases

Nice To Know:
A group of hormones called the renin-angiotensin-aldosterone system (RAAS) is another critical player in blood pressure control. They regulate the amount of fluid in the blood, the width of the blood vessel, and the sodium and water balance by their action on the kidneys and blood vessels.
The kidneys play a vital role in long-term changes in blood pressure. The hormones act on the kidneys to control the amount of sodium and water they excrete. If too much sodium or water stays, the amount of fluid in the blood, called the blood volume, goes up. This increase in blood volume means that the heart has to pump harder to circulate more fluid, and blood pressure goes up.

Keeping The Blood Pressure Normal
Generally, a change in any factor that may cause the blood pressure to rise is balanced by a change in another factor. This is how the body keeps blood pressure in a normal range.

For example, when you begin to exercise, your heart rate increases, as does the amount of blood pumped out of the heart with each beat (the stroke volume). This would normally increase the blood pressure.
But the blood pressure remains normal because the blood vessels widen in order to increase the capacity for the extra blood being pumped while exercising. This helps offset the increase in blood pressure associated with the increase in heart rate and stroke volume associated with exercise.

On the other hand, if blood pressure suddenly drops, a series of changes restores normal blood pressure. These include short-term increases in heart rate, the strength of the heart's contractions, and peripheral resistance. Over a longer period, blood volume also increases due to the actions of hormones on the kidneys.

Pulse Pressure
There is another dynamic component of blood pressure called pulse pressure. Pulse pressure is the difference in pressure between when the ventricles of the heart contract and when they relax. It can be felt as a throbbing beat in an artery, called a pulse.

When the ventricles contract, blood is pumped out of the left ventricle into the main artery leading away from the heart to the body, called the aorta. This creates the highest pressure that occurs in the aorta, called the systolic blood pressure.

The increased pressure and increased blood volume cause the aorta to stretch. Because the blood pressure in the aorta is higher than the pressure in more distant vessels, blood moves forward toward the body's tissues.
When the ventricles relax, blood stops flowing into the aorta and the pressure drops to its lowest level. This is called the diastolic blood pressure.
But blood continues to move forward in the circulation even when the ventricles are relaxed. Because the walls of the aorta and other elastic arteries bounce back, they maintain pressure on the blood moving through them.

Need to Know:
Recent study results suggest that individuals with large pulse pressures are at the greater risk for complications of high blood pressure, such as stroke or heart attack.

Nice To Know:
Most drugs that decrease blood pressure cause blood vessels to widen, making it easier for blood to pass through them, or cause the heart to beat less forcefully. But there's growing interest in factors that determine the pulse pressure, such as the arteries' ability to stretch or to store the blood ejected with each heartbeat. Less flexible arteries have been linked to high blood pressure, while some treatments that lower blood pressure also improve the arteries ability to store blood.

Why Is It Important To Control High Blood Pressure?
High blood pressure is a dangerous condition, and it should be treated appropriately. Over a period of time, once damage to the heart or other organs has begun, it is often irreversible. Uncontrolled high blood pressure damages the heart and other organs, accelerates hardening of the arteries and build-up of cholesterol-laden plaques on arterial walls, and can be lethal.
· If your systolic blood pressure is generally greater than 160 mm Hg, your risk of suffering stroke is four times greater than normal.
· If your diastolic blood pressure is generally greater than 95 mm Hg, your risk of developing coronary artery disease more than doubles.
· If your overall blood pressure is generally greater than 160/95, your risk of developing congestive heart failure is four times greater than normal.

Need to Know:
High blood pressure joins smoking and high cholesterol as one of the most important risk factors for coronary artery disease. High blood pressure is the most important risk factor for stroke.

High Blood Pressure And Your Heart
In people with high blood pressure, the heart has to work harder to keep up the increased pressure in the blood vessels. This puts a strain on the heart in the long term. It can affect the heart in a number of ways, including:
· Coronary heart disease, in which the arteries that feed the heart become narrow and clogged with fat and cholesterol deposits. People with coronary heart disease may experience angina, the chest pain or discomfort in the chest that happens when the heart doesn't receive enough oxygen, or a heart attack, in which part of the heart is deprived of oxygen and becomes damaged.
· Left ventricular hypertrophy, in which the wall of the major pumping chamber of the heart thickens as a result of the increased work by the heart. This can damage the normal functioning of the heart. People with left ventricular hypertrophy are at increased risk for stroke, heart attack, sudden death, and heart failure.
· Congestive heart failure, which occurs when the weakened heart cannot pump enough blood to meet the body's needs. Fluid may build up in the ankles, legs, lungs, and other tissues.

High Blood Pressure And Stroke
High blood pressure is one of the most important risk factors for stroke. People with high blood pressure are up to ten times more likely than people with normal blood pressure to have a stroke.

Like the heart, the brain depends on a constant supply of oxygenated blood. A stroke occurs when the brain's supply of oxygen and other nutrients is cut off. This can happen when the arteries leading to the brain become blocked (ischemic stroke) or when the artery wall tears (hemorrhagic stroke).

This "brain attack" can cause permanent or temporary damage. If the stoppage and damage is temporary, it is called a transient ischemic attack (TIA).

Need to Know:
High blood pressure, especially high diastolic pressure, increases the risk of all kinds of stroke.

Other Damage Caused By High Blood Pressure
The dangers of high blood pressure are not limited to heart diseases and stroke. High blood pressure can damage other organs and cause other problems, including:

· Kidneys - Almost one-third of all cases of kidney failure are caused by high blood pressure.
· Bones - High blood pressure causes more calcium to be excreted in the urine, leading to a loss of bone mineral density called osteoporosis. Postmenopausal women are especially affected and may be at greater risk for fractures and other problems.
· Legs and feet - In people with high blood pressure, impaired blood flow to the legs and feet may cause a condition called peripheral vascular disease. People with peripheral vascular disease often experience leg pain, numbness, loss of leg hair, open sores on the legs, feet, and toes, and difficulty walking.
· Eyes - High blood pressure may cause damage to blood vessels in the eyes, leading to a disease of the retina.
· The brain - In older people, high blood pressure may cause a loss of mental function and contribute to decreased short-term memory and attention, Alzheimer's disease, and dementia, although the reasons why are not clear.
· Sexual drive - High blood pressure is associated with sexual dysfunction in both women and men. In one study, women with high blood pressure experienced vaginal dryness and difficulty achieving sexual satisfaction. About 17 percent of men with high blood pressure experience some form of sexual dysfunction. Some medications used to treat hypertension can also impair sexual function.

Nice To Know:
Are you at risk for developing high blood pressure?
Anyone can develop high blood pressure. But experts have identified some characteristics that increase the risk. Some of these so-called "risk factors" cannot be changed, but some can. While risk factors don't necessarily cause high blood pressure, they can contribute to it or make it worse.

Your risk is greater if one or more of the following statements apply to you:

Risk factors you cannot change:
. You have a close relative with high blood pressure, especially a brother or sister.
. You are a male younger than 50 years of age.
. You are a postmenopausal woman.
. You are black.

Risk factors you can change or control:
. You are overweight.
. You do not exercise regularly.
. Your diet is high in sodium.
. You are a smoker.
. Your cholesterol levels are high.
. Your diet doesn't include enough calcium or potassium.
. You have more than two or three alcoholic drinks a day.
. You are under constant stress.
. You have diabetes.

Need to Know:
It is important to recognize your own personal risk factors. While you cannot change some risk factors like your family history or your age, you certainly can change or control other important risk factors like your smoking habits, your weight and diet amongst others, that will effectively lower your risk of developing high blood pressure.

What Causes High Blood Pressure?
In 90 to 95 percent of people with high blood pressure, doctors do not know what causes it. High blood pressure with an unknown cause is called essential, or primary, hypertension.
Sometimes, an underlying disease or other condition is found to be the cause of the high blood pressure. This type, called secondary hypertension, only occurs in 5 to 10 percent of people with hypertension.

High Blood Pressure With No Known Cause (Essential Hypertension)
Essential hypertension is the term used when no cause can be found for the high blood pressure. Most people with high blood pressure have essential hypertension.

Researchers do know that essential hypertension tends to cluster in families, so heredity is thought to play a strong role. For example, siblings of people with high blood pressure are more likely to have high blood pressure than the general population. Essential hypertension is more common in some racial and ethnic groups, which also suggests a genetic basis.

Family members may also share environment and lifestyle habits associated with an increased risk of essential hypertension.

High Blood Pressure For Which There Is A Cause (Secondary Hypertension)
While most people with high blood pressure cannot attribute it to a specific cause, the other 5 to 10 percent of people with high blood pressure have an underlying condition that causes it.
In a few cases, high blood pressure can be attributed to a specific cause. This form of high blood pressure is called secondary hypertension, because it is secondary to something else.

In these people, treating the underlying cause can often control the high blood pressure.

Causes of secondary hypertension include:
Renal (kidney) disorders, such as:
1. Renal vascular disease - A disease involving the kidneys' blood vessels
2. Renal parenchymal disease - A variety of diseases involving kidney tissue

Endocrine disorders, such as:
1. Hyperaldosteronism - A clinical syndrome caused by excessive secretion of aldosterone, a hormone that influences body sodium and potassium levels

1. Cushing's syndrome - A group of symptoms caused by high levels of the steroid hormone cortisol.
2. Adrenal gland tumors
3. Hyperthyroidism - A condition encompassing several specific diseases of the thyroid gland in which secretion of thyroid hormone is unusually increased.
4. Hyperparathyroidism - A condition caused by excessive secretion of parathyroid hormone, due to disease of the parathyroid glands or chronic low serum calcium levels. This hormone plays a most important role in controlling calcium levels in the body.

Neurological conditions, such as:
1. Increased pressure inside the space within the skull occupied by the brain
2. Lead poisoning - A sudden or ongoing intoxication with lead or its salts, which may cause stomach upset, constipation, abdominal pain, and/or neurological problems
3. Quadriplegia - The paralysis or loss of voluntary movement of all four limbs

Drugs and chemicals, including:
1. Oral contraceptives (birth control pills)
2. Corticosteroids
3. Appetite suppressants
4. Antidepressants
5. Nonsteroidal anti-inflammatory agents (such as Advil or Motrin)
6. Nasal decongestants
7. Cocaine

Miscellaneous causes, including:
1. Pregnancy - Hypertension can develop during pregnancy. If the high blood pressure is sudden and severe, the condition is called pre-eclampsia and can endanger both mother and child.
2. Coarctation of the aorta - Constriction or narrowing of the aorta, the large artery arising from the base of the left ventricle
3. Excessive licorice consumption - Licorice contains substances known to raise blood pressure, although the exact amount a person would have to consume to have an effect on blood pressure is not fully researched.

Need to Know:
Isolated systolic hypertension
Isolated systolic hypertension refers to a situation in which only the systolic blood pressure (the first number of the blood pressure measurement) is high, 140 mm Hg or greater, and the diastolic blood pressure (the second number) is normal or at the high end of normal (below 90 mm Hg).

Causes of isolated systolic hypertension include:
. Advancing age
. Abnormalities of heart valves
. Anemia - A condition in which the number of red blood cells in the blood is decreased.
. Thyrotoxicosis - A condition in which the body produces too much thyroid hormone.
. Paget's disease - A chronic disorder in which areas of skeleton are replaced by soft and enlarged bone.

Potential Causes Of High Blood Pressure
Researchers are studying conditions that may cause hypertension. The list of potential causes includes:

Genetic abnormalities of the renin-angiotensin-aldosterone system - Researchers are studying genes that control a group of hormones called the renin-angiotensin-aldosterone system (RAAS).

The RAAS is a critical player in blood pressure control. It regulates blood volume, blood vessel contraction, sodium and water balance, and the development of cells in the heart.

Abnormalities of this system, which can be genetic, may lead to hypertension by causing an increase in:
. Blood volume (by causing the kidneys to retain too much water and sodium), and/or
. Peripheral resistance (by causing blood vessels to narrow)
. Genetic abnormalities of the "fight or flight" system, called the sympathetic nervous system - . Excessive activity of the sympathetic nervous system can increase blood pressure by increasing heart rate, the force of the heart's contractions, and/or resistance to blood flow.
. Insulin resistance - Insulin is a hormone secreted by the pancreas that acts as the "key" that allows sugar and other nutrients to move from the blood into cells. Insulin resistance refers to a state in which cells are resistant to the effects of insulin. Insulin resistance in skeletal muscle cells causes them to take up less sugar from the blood, leading to high blood sugar levels and eventually, type 2 diabetes, which is linked to high blood pressure.
. Sodium retention in the urine - Usually, the kidneys respond to high blood pressure by excreting sodium in the urine. If this normal mechanism of regulating blood pressure is lost, persistent hypertension can result.
. Resetting of baroreceptors - Large blood vessels contain pressure detectors called baroreceptors, which signal the brain when blood pressure gets too high or too low. These baroreceptors may be "reset" so that higher blood pressures are required before the body recognizes increased blood pressure and acts to lower it.
. Arterial stiffening - Stiffening of the large arteries has been associated with all forms of hypertension. As a blood vessel loses its ability to stretch and to hold fluid, blood pressure increases.
. Blood vessel thickening - Stress, hormones, and genetic defects that cause smooth muscle cells in the walls of smaller arteries to constrict or grow are also being studied. These factors can cause smooth muscle cells in the arteries to increase in size and number, leading to thicker vessel walls and narrowing vessels.
. Deficiencies in vasodilators - A variety of substances in the body cause vessels to dilate, making it easier for blood to flow and reducing blood pressure. Deficiencies in some of these substances have been linked to hypertension.

Nice To Know:
Recent scientific research suggests that a problem of the inner lining of blood vessel walls, called the endothelium, may contribute to hypertension. Substances released from the endothelium can cause blood vessels to dilate or constrict. Some substances also promote or inhibit growth of the smooth muscle cells in the blood vessel wall.

Normally, the actions of these substances are held in balance. But in some people, the constriction chemicals may overpower the relaxation chemicals. Arteries narrow, and blood pressure goes up because it is more difficult for blood to circulate.

How is Blood Pressure Measured?
Blood pressure is measured in millimeters of mercury (mm Hg). A typical normal blood pressure is 120/80 mm Hg, or "120 over 80." The first number represents the pressure when the heart contracts and is called the systolic blood pressure. The second number represents the pressure when the heart relaxes and is called the diastolic blood pressure.

Blood pressure measurement is a painless and simple test. Blood pressure is one of the key identifiers of general health that will almost always be measured at the doctor's office. Reliable machines are available for you to measure your own blood pressure at home.

How To Information:
To help make sure your blood pressure measurement is accurate, avoid smoking and eating or drinking anything that contains caffeine for 30 minutes before the test. Rest for five minutes before the measurement is taken. Your health care provider will usually ask you to sit in a chair, with your bare arm comfortably supported at the level of your heart.

Blood Pressure Measurement In The Doctor's Office
Most people are familiar with having their blood pressure measured during routine visits to the doctor's office or other health care facility. But did you ever wonder exactly what your health care provider is doing? Here are the steps your health care provider should follow when taking your blood pressure measurement:

. Your health care provider will probably use a blood pressure cuff and stethoscope to measure your blood pressure. The blood pressure cuff, also called a sphygmomanometer, consists of a cuff with an inflatable bladder, a rubber hand bulb with a valve used to inflate and deflate the cuff, and a pressure gauge.
. First, the cuff is wrapped snugly around your upper arm. The cuff is then rapidly inflated until the pulse in the upper arm is no longer felt. At this point blood flow in the underlying blood vessel is cut off by pressure in the cuff. The health care provider will continue to inflate the cuff a bit beyond this point.
. Next, a stethoscope is placed over the brachial artery at the elbow and the cuff is slowly deflated, while the health care provider listens for sounds produced by turbulent blood flow in the artery.
. The health care provider listens through the stethoscope until he or she hears the heartbeats. . At this point, cuff pressure matches pressure in the artery, and blood flow resumes. This is the systolic blood pressure (SBP).
. The health care provider continues to slowly deflate the cuff until the sounds stop. This is the diastolic blood pressure (DBP).
. Experts recommend that two or more readings (separated by two minutes) be taken to determine an average blood pressure for the visit. If the first two readings differ by more than 5 mm Hg, additional readings should be obtained and averaged. Your doctor should tell you if your blood pressure should be measured again and/or if you should consider treatment for high blood pressure.

Measuring Your Own Blood Pressure
Stress, caffeine, smoking, pain, and other factors can cause blood pressure to rise temporarily. For some people, just the act of having their blood pressure taken in a doctor's office, clinic, or hospital can cause a rise in blood pressure. At other times, their blood pressure is normal. These people have what is called white coat hypertension.

Because so many different things can cause a temporary rise in blood pressure, your doctor may ask you to measure your own blood pressure at home. Various home monitors are available that simplify the process of measuring your own blood pressure.

Home monitors are reasonably accurate. However, some types of monitors (for example, finger monitors) have been associated with inaccurate blood pressure readings. Be sure to check your home monitor periodically for accuracy. When you visit your doctor, bring your home monitor and ask the person who takes your blood pressure measurement to compare the reading they obtain with a mercury sphygmomanometer to the reading on your home device

Keeping Track Of Blood Pressure On The Go
On-the-go, or ambulatory, blood pressure monitoring may be useful for some people. These include people who suffer from white coat hypertension, those who are not responding to blood pressure medication, or those with other complicating factors.
A variety of reliable, easy-to-use, and accurate ambulatory monitors are available commercially. These monitors can be worn over the shoulder or around the waist and typically record readings every 15 to 30 minutes, 24 hours per day.

Nice To Know:
Blood pressure values obtained with ambulatory monitors are 5 to 10 percent lower than those obtained by other means.

Is Your Blood Pressure Too High?
Most people with high blood pressure do not experience any symptoms, which is why regular blood pressure checks are so important.

High blood pressure can only be diagnosed with repeated blood pressure measurements. The best way to tell if you have high blood pressure is to have your blood pressure measured by a health professional.

Sometimes individuals with severe or chronic high blood pressure experience headache, dizziness, fatigue, or blurry vision. These are danger signs, and medical help should be sought immediately. People with lesser degrees of blood pressure elevation may experience sleep disturbances, emotional upset, or a dry mouth.

Although blood pressure varies from person to person, there are accepted guidelines for what is considered optimal, normal, and high. Since high blood pressure is associated with cardiovascular and other diseases and even death, it is critically important to identify and treat it early. You can use the following chart to help determine whether your blood pressure is too high.

This classification, which comes from the sixth Joint National Committee's report on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), is referred to as the JNC VI Blood Pressure Classification System.
Blood Pressure Classification System.

YOUR BLOOD PRESSURE
If your systolic blood pressure readings are consistently greater than 140 mm Hg and/or your diastolic blood pressure readings are consistently greater than 90 mm Hg, your blood pressure is considered high.

When the systolic blood pressure and diastolic blood pressure fall into different categories, the higher category should apply. For example, a blood pressure of 165/94 mm Hg should be classified as stage 2 hypertension.
Although "optimal blood pressure" is defined as a blood pressure of less than 120/80 mm Hg, unusually low readings should also be evaluated.

Need to Know:
A single blood pressure reading may suggest high blood pressure, but your doctor should obtain a series of blood pressure readings. A variety of factors cause daily fluctuations in blood pressure, including:
. Time of day
. Hormone levels
. Drugs
. Pain or stress
. Certain diseases
. Cigarette smoking
. Drinking caffeine-containing products (such as coffee, tea, or cola)

Based on your initial readings, your doctor will let you know whether you should return for further blood pressure checks and/or treatment.

In short, a diagnosis of hypertension is not based on a single blood pressure reading. High blood pressure can only be diagnosed on the basis of multiple blood pressure readings.
After the initial screening, your doctor should take two or more readings during each of two or more office visits.

Any person 18 years or older who is not acutely ill (for example, with a flu or cold) or taking medication to control hypertension can be diagnosed with high blood pressure for a sustained systolic pressure of 140 mm Hg or greater or a diastolic pressure of 90 mm Hg or greater.

Need to Know:
If your blood pressure is in the normal range, you should have it rechecked in two years. Those with high-normal blood pressure should have it rechecked in one year.
But if your blood pressure reading is above normal, you need to return for one or more blood pressure visits within the next one to two months. Anyone with a systolic blood pressure of 180 mm Hg or more, or a diastolic blood pressure of 110 mm Hg or more, should receive care immediately, or within one week at most.

What Happens if Your Blood Pressure is High?
If your blood pressure readings suggest that you have high blood pressure, your doctor will conduct a thorough evaluation of your health status. In order to determine the best course of treatment for you, your doctor will look for answers to the following questions:

1- Is there an identifiable cause of the hypertension?
2- Are other risk factors for heart disease present?
3- Is there evidence of damage to other organs? If so, what is its extent?
4- Is there another condition that may influence the outcome or treatment?

Need to Know:
Although in most people no cause is found for the high blood pressure, the doctor must first rule out a possible cause. That's because identification and correction of a condition that may be causing the high blood pressure often leads to normal readings.

To evaluate your health status, your doctor will use these tools:

1- Personal Health History
A personal health history is one of the most important tools doctors use to determine the most appropriate treatment for you. Your doctor will ask a series of questions including:

Does anyone in your family have a history of:
. High blood pressure
. Coronary heart disease
. Diabetes
. Stroke
. High cholesterol levels
. Kidney disease
. Do you have any personal habits that could affect your blood pressure, such as smoking, illicit drug use, or a sedentary lifestyle?

1- What dietary factors could be affecting your blood pressure? These include sodium (e.g., table salt), saturated fats, alcohol, and caffeine (e.g., coffee, colas).
2- What prescription, over-the-counter medications (such as decongestants?

3- Have you ever been treated for high blood pressure before? What were the results and, and were there any adverse effects?

4 - Do you have a history of heart disease?
5- What recent changes in weight, physical activity, leisure-time activities, or other psychosocial and environmental factors (such as family situation or occupation) might be influencing your blood pressure?

Physical Examination

The physical examination can also help your doctor to determine the right treatment for you, and can help to rule out specific causes of hypertension that can be corrected. In addition to obtaining additional blood pressure readings, the doctor will look for possible involvement of other organs.

During the physical examination, the doctor will look for:
. Health indicators including blood pressure, heart rate, respiratory rate, body temperature, height, weight, and girth. Blood pressure readings may be obtained in both arms and in different positions (such as while lying down and standing).
. Evidence of damage to blood vessels in the eyes
. Abnormal sounds in blood vessels in neck that may occur with coronary artery disease, called carotid bruits
. Distended neck veins, which are sometimes seen with heart failure
. An enlarged thyroid gland, which may suggest an underlying thyroid condition
. Abnormalities in heart rate, rhythm, or size
. Abnormal heart sounds
. Abnormal crackling or wheezing sounds in the lungs, which may suggest heart failure
. Masses in the abdomen, called bruits
. Abnormal pulsations of the aorta
. Abnormal kidney size, which may suggest kidney disease
. Decreased or absent pulses in the extremities, which may indicate peripheral vascular disease
. Swelling in the lower leg due to accumulation of watery fluid in tissues, which may indicate heart failure or other conditions
. Changes in mental function, sensation, motor control, or reflexes

Routine Tests Your Doctor May Request
Your doctor will use information obtained from your personal health history and physical examination to determine which laboratory tests and imaging studi