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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 studies you should undergo. The following tests are routine:

Urinalysis, or analysis of the urine
Complete blood cell count, which determines the number of each major type of blood cell; involves drawing blood
A 12-lead electrocardiogram (ECG or EKG) that provides a record of the heart's electrical activity

Blood chemistry tests including:
. Potassium level
. Sodium level
. Creatinine level, which is a way to measure kidney function
. Fasting glucose level (level of blood sugar in fasting state)
. Total cholesterol level and triglyceride level
. High-density lipoprotein (HDL) cholesterol level analysis. This is sometimes called "good cholesterol."
. Low-density lipoprotein (LDL) cholesterol level analysis. This is sometimes called "bad cholesterol".

Other Tests Your Doctor May Request
Hypertension due to a known cause is not very common. But if information from your personal health history and physical examination suggest that there may be an underlying cause for your high blood pressure, your doctor may order additional tests. Other tests also may used to determine or confirm the presence of other risk factors for heart disease and damage to other organs.

Other tests your doctor may want you to have include:
. Creatinine clearance, a urine test to screen for kidney disease
. Fasting triglyceride level and low-density lipoprotein (LDL) cholesterol level
. Blood calcium level to screen for hyperparathyroidism
. Blood uric acid level to screen for gout
. Glycosylated hemoglobin to screen for diabetes mellitus
. Thyroid-stimulating hormone to screen for thyroid disease
. Chest x-ray to screen for signs of coarctation of the aorta
. Echocardiography to screen for evidence of heart failure
. Ultrasonography of arteries or measurement of ankle/arm index to screen for peripheral vascular disease

How is High Blood Pressure Treated?
Although high blood pressure can nearly always be brought down to safe levels, your doctor cannot do it alone. You need to become a partner in your own care.

What Are The Guidelines For Treating High Blood Pressure?
Treatment for high blood pressure consists of lifestyle modifications and drug therapy.
To help doctors identify appropriate treatment for high blood pressure, a group of experts has developed a system that establishes guidelines for treatment. These guidelines are based on the level of blood pressure, associated cardiovascular risk factors, and the presence or absence of damage to other organs and heart disease, referred to as target organ damage and clinical cardiovascular disease.

In this system, high blood pressure is classified by stages, depending on:
1- How high your blood pressure readings are, as well as your risk factors that may make you more likely to have high blood pressure
2- Whether there is any existing heart disease
3- Whether there is any damage to other organs

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 Risk Stratification System.

People in risk group A have either a normal blood pressure but in the upper normal limit, or high blood pressure (either stage 1, 2, or 3) without other risk factors, organ damage, or clinical cardiovascular disease.

Those with stage 1 hypertension can first undergo lifestyle modification with frequent blood pressure monitoring. If their target blood pressure is not achieved within one year, drug treatment should then be added.

Those with stage 2 or 3 hypertension are treated with medication
Most people with hypertension fall into risk group B. They may have a number of risk factors other than diabetes, but do not show evidence of organ damage or clinical cardiovascular disease. Depending on the blood pressure stage and number of risk factors, initial drug treatment may be needed. These individuals should also undergo lifestyle modification.

People in risk group C are most in need of prompt drug therapy. These include those with high or high-normal blood pressure who have clinical evidence of target organ damage or clinical cardiovascular disease and/or diabetes, with or without other risk factors. Lifestyle modification is also important in these

What You Can Do to Control Your Blood Pressure
Lifestyle changes play an important role in managing high blood pressure. Although permanent changes in lifestyle and diet are sometimes difficult to achieve, they may eliminate the need for drug treatment or allow reductions in the dosages of medications.

A recent study showed that well-motivated individuals with Stage 1 and 2 hypertension were able to adopt changes in diet and lifestyle that led to significant weight loss, reduced sodium and alcohol intake, and increased physical activity. These people significantly reduced their blood pressures.

Lifestyle changes carry other benefits, as well. They can keep high blood pressure from developing in the first place, reduce other cardiovascular risk factors, and improve your overall health.
Experts recommend the following lifestyle modifications for the prevention and management of hypertension:

Losing Weight Safely

Being overweight goes hand in hand with high blood pressure. Excess abdominal fat is also associated with high cholesterol levels, diabetes, and heart disease.

Fortunately, most people with high blood pressure can significantly reduce their blood pressure by losing as little as 10 pounds. Weight loss also reduces the risk of heart disease and enhances the effects of some medications used to treat high blood pressure.

Any overweight individual who has high blood pressure should take steps to reduce body weight. These measures include dietary changes and exercise. A nutritionist can also help you develop a healthful weight loss diet.

How To Information:
Here are some guidelines for losing weight and keeping it off:
1- Lose weight slowly. Plan to lose no more than two to four pounds a month.
2- Cut down on fatty foods. Eat a balanced diet that includes lots of fruits and vegetables.
3- Get more exercise. Exercise will help you to burn calories, and it will also help you to lose fat, not muscle.
4- Becoming Physically Active
5- Besides reducing the risk of high blood pressure and other cardiovascular disease, physical activity can enhance weight loss and general health. The best type of exercise for preventing and reducing high blood pressure is regular aerobic physical activity, which includes things like walking, cycling, swimming, jogging, aerobic dance classes, rowing, dancing, and skating - in short, anything that raises your heart rate for an extended period of time. Whatever activity you choose, make sure to start slowly and build up gradually.
6- People with high blood pressure can effectively lower their blood pressure with moderate physical activity (such as 30 to 45 minutes of brisk walking most days).

7- People with normal blood pressure can also benefit from exercise. Compared with people who are fit and physically active, sedentary people with normal blood pressure have a 20% to 50% greater chance of developing high blood pressure.

Need To Know:
Most individuals can safely increase their physical activity without an extensive medical evaluation. But those with cardiovascular disease or other serious medical problems may need a thorough evaluation and referral to a medically supervised exercise program. Talk to your doctor about what is recommended for you before starting to exercise.

Nice To Know:
Q. If I exercise vigorously, like jogging, won't that be dangerous because my heart rate will speed up?

A. It is true that your heart rate will speed up when you exercise, causing your blood pressure to rise temporarily. But normally your body compensates by causing blood vessels to relax. With regular exercise, your heart will pump blood more efficiently. However, you should always check with your doctor before exercising. Some individuals (such as those with heart disease) may need to take special precautions, including a thorough medical evaluation, before beginning an exercise program. The hearts of some individuals are also more susceptible to increased stress associated with exercising.

How To Information:
To make sure that you are not placing too much strain on your heart, you should monitor your heart rate by checking your heart rate. To determine your heart rate, use your index and third finger to find the pulse at your wrist or neck, count for six seconds, and add a zero. Since heart rates that are generally safe for people who are exercising vary with different factors (including age and state of health), you should ask your doctor what is a safe range for you.

How To Information:
. Walking is one of the simplest, cheapest, and easiest ways to increase your physical activity level. For most people, walking is a good starting point,
. Start by buying a comfortable, well-fitted pair of walking shoes.
. Take short walks whenever you can fit them in. That might mean walking to the post office at lunch, or taking the dog for a walk in the evening.

Later, aim for longer exercise sessions:
. Start by walking for at least 15 to 20 minutes several times a week.
. Gradually build up to at least 30 minutes, five times a week.

Need To Know:
Exercise is one of the best ways to enhance your overall health and decrease blood pressure. However, exercise also puts additional strain on your heart.

Here are some safety rules to follow when exercising:
1- Do not get out of breath. If you find it hard to hold a conversation while you are exercising, slow down.
2- If you have any symptoms such as chest pain or extreme shortness of breath, stop immediately and contact your doctor.
3- If you want to try more vigorous activity, check with your doctor first. He or she may first want you to take a stress test.
4- Do not engage in muscle-building types of exercise (e.g., weight lifting) without checking with your doctor first. These types of exercise may raise your blood pressure.

Limiting Salt In Your Diet
The role that sodium plays in hypertension is somewhat controversial. Sodium, found in table salt and processed foods, appears to affect blood pressure in some people while having little effect on others.

Some people can reduce their blood pressure simply by reducing the salt in their diet. These people are considered "salt sensitive," meaning that their blood pressure goes up when they eat more salt and goes down when they eat less salt.

limit your salt and increase your Potassium

People who are most likely to be salt sensitive include:
1- Older people
2- Black people
3- People with diabetes
4- People with high blood pressure can benefit from a moderately reduced sodium intake in several other ways, as well.

Cutting back on the salt in your diet may also:

1- Reduce the need for medications to treat high blood pressure
2 - Reduce potassium loss with diuretic treatment (blood pressure treatment that reduces blood volume)
3- Protect you from osteoporosis and kidney stones
4- Possibly reverse a condition known as left ventricular hypertrophy, the thickening of the muscle in the wall of the left ventricle that can occur with uncontrolled hypertension

Need To Know:
Hypertension experts recommend that dietary sodium intake be restricted to no more than 2400 milligrams, or one teaspoon, of sodium a day. This is about two-thirds of the amount of sodium that Americans normally consume per day, the bulk of which (75%) comes from processed foods.

How To Information:
You can reduce the sodium in your diet with a few simple steps:
1- Cut down on salt used at the table.
2- Taste food before adding salt.
3- Remove the salt shaker from the table.
4- Cut down on salt used when cooking.
5- Reduce the amount of salt added to half the amount suggested.
6- Replace salt with alternative flavorings like pepper, garlic, lemon juice, herbs, and spices.
7- Eat sensibly at restaurants.
8- If you eat at fast-food restaurants, ask for a nutritional analysis of the foods, so you can check the sodium content of different items.
9- In Chinese restaurants, ask for food without monosodium glutamate (MSG).
10- Check labels on food purchased at the grocery store.
11- Use labels to compare the amount of sodium in canned, frozen, and packaged foods.
12- Look for foods or seasonings that are labeled "low sodium" or "sodium free."
13- Whenever possible, start with fresh food that you can season yourself.
14- Getting Enough Potassium And Calcium In Your Diet
15- Potassium and calcium may also help to reduce your risk of developing high blood pressure, or lower your blood pressure if it is already high.

Potassium. Studies suggest that high potassium intake may protect against the development of high blood pressure and help people with high blood pressure control their blood pressure. On the other hand, blood pressure may increase if you don't get enough potassium in your diet.

The best sources of potassium are fresh fruits and vegetables, especially bananas, prunes, grapefruits, tomatoes, and potatoes. If you eat enough of these foods, it will be easy to get the recommended 3500 milligrams of potassium daily. A banana, for example, contains about 500 milligrams potassium, while a medium-sized potato contains more than 700 milligrams potassium.

Potassium is even more important if your doctor prescribes certain types of medications, called diuretics, which cause the body to lose potassium. If potassium levels become too low, heart rhythms may be disturbed.

Need To Know:
Because some medications (such as potassium-sparing diuretics) and medical conditions (such as kidney disease) are associated with increased potassium levels, you should check with your doctor before using any potassium-containing salt substitutes or potassium supplements.

Potassium levels that are too high are extremely dangerous and can be lethal.

Calcium. Not getting enough calcium in your diet may also increase your risk for high blood pressure. Although increasing your calcium intake may also help to lower blood pressure, this effect is small, so calcium supplements are not generally recommended to lower blood pressure.

Getting enough calcium in your diet is important for other reasons. High blood pressure increases the risk of osteoporosis by causing calcium loss through the urine. Calcium regulates smooth muscle tone in blood vessels, is important for general health, and may help prevent some gastrointestinal cancers.

Limiting Alcohol Intake
Alcohol abuse causes about 10 percent of high blood pressure cases. People who drink three or more alcoholic drinks a day risk hypertension, while binge-drinkers have even higher blood pressures. Alcohol abuse also increases the risk for stroke, liver disease, and other serious conditions. It can also reduce the effectiveness of medications used to treat high blood pressure.

Yet limited alcohol intake does not raise blood pressure and has even been shown to lower risk of cardiovascular disease. Experts recommend that alcohol intake be limited to no more than 1 oz of ethanol per day. This could include two 12-oz beers, two 5-oz glasses of wine, or one 2-oz shot of 100-proof whiskey.

Women and lighter-weight individuals should restrict their alcohol intake to half this amount. This is because women absorb more ethanol than men, and lighter individuals are more susceptible to the effects of alcohol than heavier people.

Need to Know:
If you have any concerns about your alcohol intake, you should consult your doctor. Sudden stopping of heavy drinking can cause problems (including high blood pressure).

Quitting The Tobacco Habit
Avoiding tobacco in any form - including cigarettes, pipes, chewing tobacco, and cigars - can help to improve anyone's health. Those who quit smoking usually experience beneficial cardiovascular effects over the course of one year.

Each time you smoke a cigarette, your blood pressure rises for a short time. This sudden increase in blood pressure appears to be temporary, much like the short-term increase in blood pressure associated with the intake of caffeine-containing products such as coffee, tea, and colas.

However, smokers in one study had blood pressures up to 10 points higher than nonsmokers. Cigarette smoking increases the risk for other cardiovascular disease and cancer, and may also interfere with the effects of medications used to treat high blood pressure.

Your doctor can help you stop smoking, should you decide to quit. There are a number of available products (e.g., nicotine patch, gum, medication) designed to help you quit smoking.

Managing Stress
Although stress can increase blood pressure, it is not considered a major cause of high blood pressure. A number of studies have not proven that relaxation therapies or biofeedback to significantly reduce blood pressure. But these techniques do have other benefits. They can help to reduce anxiety and give you a sense of well-being. They also can help you make other important lifestyle changes, such as changes in dietary and alcohol intake, or quitting smoking.

Here are some techniques that can help you manage stress:
. Think ahead about times you may be under increased stress. Plan ways to avoid the situation, if possible.
. If you feel tense, take a walk or go for a swim. Exercise is a wonderful natural tranquilizer.
. Get a massage. A massage is a wonderful opportunity to relax mind, body, and spirit.
. Breathe. When you are under stress, concentrate on drawing air deeply into your lungs and let your abdomen expand - not just your chest.
. Explore yoga, meditation, or other techniques for stress reduction.
. Practice complete relaxation for a short time every day. Sit comfortably and relax your muscles in turn - first your legs, then your arms, then your shoulders, then your body, neck, and face.
. Imagine a soothing scene, like an empty beach on a calm, warm day. Empty everything else from your mind.
. If you feel unable to cope, ask your doctor to recommend a mental health professional who can assist you in dealing with stress.

What Medications Are Used To Treat High Blood Pressure?
Although changes in lifestyle and diet are essential steps to take in controlling high blood pressure, many people also need to use medications to keep their blood pressure in control.

Drug treatment has been shown to protect against stroke, heart failure, coronary events such as a heart attack, progression of kidney failure, and progression to severe hypertension.

Medications that lower blood pressure are often referred to as antihypertensive drugs, antihypertensive agents, or just antihypertensives. Generally these drugs are classified by how they work.

Many medications are available for effective blood pressure control. Currently, more than 100 drug preparations are available, and the list is growing. They include:

Need to Know:
Drugs that help lower high blood pressure have various side effects. If you experience severe side effects from any drug, contact your doctor immediately. Your doctor will probably be able to find another agent to control your blood pressure.

Diuretics ("Water Pills")
Diuretics, commonly called "water pills," cause the body to excrete water and salt. Diuretics are often the first-choice drug in the treatment of essential hypertension, and have been shown to reduce the occurrence of stroke by 40 percent and hypertension-related heart attacks by 16 percent.

Diuretics are often prescribed for blacks and elderly individuals, who are considered salt-sensitive. They are the preferred treatment for people with heart failure or isolated systolic hypertension. Diuretics can be used alone or in combination with other medications.

How diuretics work
Thiazide diureticsare most commonly used to treat mild hypertension. Over a short period of time, thiazide diuretics reduce blood volume by causing the kidney to excrete more sodium.

Water follows the sodium. This, in turn, means that the heart pumps less blood each minute (cardiac output), which lowers blood pressure.
Over a longer period of time, thiazide diuretics cause the smooth muscle in arterial walls to relax. The blood vessels dilate, making it easier for blood to pass through them, which lowers blood pressure.

Potassium-sparing diuretics are used in people with mild-to-moderate high blood pressure. These agents work by blocking the actions of the chemical messenger aldosterone on the kidney, which leads to the excretion of sodium but the retention of potassium.

Loop diuretics are sometime used in people with impaired kidney function. Loop diuretics cause more urine to be excreted than thiazide diuretics, but are less effective at lowering blood pressure and can cause severe electrolyte imbalances.

Nice To Know:
In general, diuretics are most effective in people with mild-to-moderate high blood pressure but normal kidney function.

What are the adverse effects of diuretics?
Although diuretics effectively reduce cardiovascular disease and death, they do have some drawbacks, including:
. Decreased (e.g., thiazides) or elevated (e.g., potassium-sparing) levels of potassium
. Elevated levels of blood sugar
. Elevated cholesterol levels of cholesterol
. Elevated levels of lipids
. Elevated levels of uric acid
. Occasional sexual dysfunction

Fortunately, when prescribed at low doses with careful electrolyte monitoring, these undesirable effects can usually be minimized.

Beta-Adrenergic Blocking Agents (Beta-Blockers)
Beta-adrenergic blocking agents, or beta-blockers, are frequently used to start treatment of hypertension. Beta-blockers lessen the heart's workload by decreasing the strength and frequency of heartbeats, slowing certain metabolic processes, and reducing blood pressure.

How do beta-blockers work?
These drugs work by blocking beta-receptors. Receptors are specialized sites at the nerve endings that are sensitive to certain chemical messengers in the body. These chemical messengers attach to the receptor sites and cause certain reactions.

Normally, the chemical messengers norepinephrine and epinephrine, commonly known as adrenaline, bind to these beta-receptors. These act to increase heart rate and make the heart pump harder, and also affect the lungs, kidneys, and blood vessels.

Beta-blockers are medications that reduce blood pressure by binding to the same site where these chemical messengers normally bind, much like someone taking your designated parking space. If the chemical messengers are unable to bind to the receptor site, they cannot exert their blood pressure-increasing effects, and so the blood pressure drops.

Beta-blockers:
. Slow the heart rate
. Reduce the strength of the heart's contractions, directly causing blood pressure to drop
. Can also indirectly lower blood pressure by slowing the kidney's production of a protein called renin. Renin normally causes the release of a powerful blood vessel constrictor called angiotensin II, which makes it harder for blood to flow through the arteries (thus raising blood pressure) and also causes secretion of hormones that cause water retention (which increases the amount of fluid in the blood).

What are the adverse effects of beta-blockers?
Beta-blockers are effective and useful drugs in the treatment of high blood pressure. However, they might not be right for everybody. Two of the hormones that beta-blockers interfere with - norepinephrine and adrenaline - also bind to beta-receptors in other regions of the body. In the lungs, these hormones cause smooth muscle in the walls of lung airways to relax, opening the airway and making it easier to breathe.

Beta-blockers interfere with this airway relaxation, instead causing the airways to narrow. This phenomenon, known as bronchoconstriction, can be particularly problematic for people with asthma or chronic obstructive pulmonary disease.

If you suffer from asthma or COPD, your doctor may prescribe a cardioselective beta-blocker. Cardioselective beta-blockers decrease blood pressure by confining their actions to the heart and kidneys, and do not block beta-receptors in lung airways.

There are also several combined alpha- and beta-blocker agents available to treat high blood pressure. These agents block alpha-receptors, which influence blood vessel constriction, as well as both types of beta-receptors.

Nice To Know:
In addition to treating high blood pressure, beta-blockers are used to treat other cardiac conditions, including angina associated with coronary heart disease and abnormalities of the heart rhythm.

Although beta-blockers are useful for controlling blood pressure in many people, they tend to be less effective than thiazide diuretics in older people and blacks. In addition, some people experience:
. Fatigue
. Depression
. Impotence
. High blood sugar level, or hyperglycemia
. Undesirable changes in blood fats
. Increased airway resistance (non-cardioselective beta-blockers)

If you are taking beta-blockers, your doctor should monitor you closely for signs of:
. Low blood pressure
. An abnormally low heart rate
. Worsening heart failure
. Increases in heart rate or blood pressure with sudden discontinuation of treatment

Need to Know:
Beta-blockers can have serious side effects. But careful monitoring and patient selection can reduce these risks. In fact, studies have shown that beta-blockers effectively reduce cardiovascular disease and death.

Like diuretics, beta-blockers are considered an appropriate initial drug choice for people with uncomplicated high blood pressure. They are also particularly useful in people who have previously suffered a heart attack.

Calcium Channel Blockers
Calcium channel blockers help lower blood pressure by relaxing blood vessels and reducing blood flow. They are effective in people with essential hypertension and have few side effects, but should not be used in people with heart failure or disturbances in the electrical conduction system of the heart.

How calcium channel blockers work
Calcium channel blockers cause blood vessels to relax, which makes it easier for blood to flow and lessens blood pressure. Some calcium channel blockers also slow the heart rate and reduce the strength of the heart's pumping action, causing blood pressure to fall.

Calcium ions are needed for muscles to contract. Calcium channel blockers inhibit the entry of calcium ions into the heart muscle and smooth muscle of blood vessels walls, reducing the force of heart muscle contraction and causing blood vessels to dilate.

There are four main types of calcium channel blockers:
1. Dihydropyridines (such as felodipine-type)
2. Phenylalkylamines (such as verapamil-type)
3. Benzothiazepines (such as diltiazem-type)
4. Tetralol (T-channel blocker)

Calcium channel blockers have different chemical structures, which means that the different types of calcium channel blockers affect the cardiovascular system differently. For example, all calcium channel blockers dilate arteries, but some dilate arteries in certain parts of the body to a greater degree than others.

Some types of calcium channel blockers slow heart rate more than others do. These differences reflect the different types of calcium channels, located in membranes of cells, that these agents block.

Long-acting dihydropyridine calcium channel blockers are particularly useful in the treatment of isolated systolic hypertension.

Adverse effects of calcium channel blockers
Calcium channel blockers can have some serious adverse effects on the cardiovascular system, including:
. Hypotension (low blood pressure)
. Disturbances in the heart rhythm
. Heart failure

Calcium channel blockers are not appropriate drug therapy for people with these heart conditions. Your physician should also obtain a record of the electrical activity of your heart (electrocardiogram or EKG) before prescribing a calcium channel blocker. The EKG is used to screen for certain heart disturbances.

These risks can be minimized with careful monitoring, patient selection, and use of long-acting medications.

Nice To Know:
Some controversy surrounded the use of one type of immediate-release (short-acting) calcium channel blocker after a study showed that the drug increased the number of deaths in people with heart disease. But this applied only to immediate-release drug formulations.

Longer-acting (sustained-release) preparations are current, popular means of treating high blood pressure as well as chest pain.

Other side effects of calcium channel blockers include:
. Flushing of the face
. Headache
. Dizziness
. Mild edema (swelling due to watery fluid outside of blood vessels)
. Constipation

The relatively low incidence of other side effects is an appealing feature. Your doctor can help you to decide whether calcium channel blockers represent a good treatment choice for you.

Angiotensin Converting-Enzyme (ACE) Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors have been used successfully in people with all types of high blood pressure. ACE inhibitors have gained popularity in recent years. In addition to being used in the treatment of mild-to-moderate high blood pressure, they are also used in the treatment of heart failure, heart attack, and kidney disease due to diabetes.
ACE inhibitors can provide safe and effective blood pressure control for many people.

Your doctor may prescribe ACE inhibitors if you have:
. Heart failure
. A history of heart attack
. Type 1 diabetes with protein in the urine

Nice To Know:
ACE inhibitors are effective when administered alone. But they are often used in combination with a thiazide diuretic or beta-blocker

How ACE inhibitors work
ACE inhibitors interfere with the renin-angiotensin aldosterone system (RAAS). The RAAS regulates blood volume, blood vessel contraction, sodium and water balance, and the development of cells in the heart.

Angiotensin-converting enzyme (ACE) is a protein that converts the inactive hormone angiotensin into the active hormone angiotensin II. Angiotensin II increases blood pressure because it:
1- Causes blood vessels to narrow
2- Stimulates the release of a hormone called aldosterone, which causes the kidneys to retain sodium
3- Stimulates the release of a hormone called antidiuretic hormone, which causes the kidneys to retain water
4- Increases blood volume and cardiac output increase the kidneys retain more sodium and water

ACE inhibitors block the conversion of the inactive angiotensin I to active angiotensin II. With less angiotensin II circulating in the body, blood pressure drops because:
. Blood vessels relax
. Blood volume and cardiac output lessen because the kidneys retain less sodium and water

ACE also slows the breakdown of a substance produced by the inner lining of blood vessels, called bradykinin. Bradykinin causes blood vessels to dilate, and causes the release of two other substances that also make blood vessels dilate: nitric oxide and prostacyclin.

Because ACE inhibitors slow the breakdown of bradykinin, they could raise the relative levels of all three of these blood-vessel-relaxing substances.

Large studies have shown that ACE inhibitors:
1- Effectively lower blood pressure in individuals with high blood pressure
2- Improve the function of the inner lining of blood vessels, or endothelium
3- Reduce the frequency of future heart attacks in people with heart disease
4- Reduce death in individuals with a history of left ventricular dysfunction, heart failure, or heart attack
5- Slow the progressive loss of kidney function in individuals with diabetic nephropathy
6- Reduce the risk of stroke and heart disease in people with high blood pressure and diabetes.

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Adverse effects of ACE inhibitors
Like any drug, ACE inhibitors can also have side effects. The most common side effect of these drugs is a dry cough, but it is not permanent. This cough, as well as occasional spasms of lung airways and an allergic skin reaction called angioedema, has been attributed partly to the activation of bradykinin that happens when ACE is blocked.

Other reported side effects of ACE inhibitors include:
. Headache
. Dizziness
. Fatigue
. High potassium levels
. Rarely, a reduction in the number of white blood cells
. 10 percent of people treated with one type of ACE inhibitor, captopril, experienced a skin rash that was not permanent

Although ACE inhibitors can help individuals with some types of kidney disease, they should not be used in those with bilateral renalartery stenosis (narrowing of the arteries that supply blood to both kidneys).

Need To Know:

Angiotensin II Receptor blockers

People who develop a nagging cough with ACE inhibitors may be better off using a different, but related, medication. Angiotensin II receptor blockers are a relatively new class of high blood pressure medication.

Like ACE inhibitors, angiotensin II receptor blockers interfere with the vasoconstricting hormone angiotensin II. However, these drugs only work at specific sites and do not affect bradykinin, which is thought to contribute to the "ACE inhibitor cough."

Results from clinical trials suggest that angiotensin II blockers are about as effective as ACE inhibitors. Side effects of angiotensin II blockers include elevated potassium levels and rarely, an allergic skin disease called angioedema. Angiotensin II blockers are generally considered safe and appropriate for the treatment of high blood pressure, and, possibly, heart failure.

Vasodilators
Vasodilators widen arteries and veins, making it easier for the blood to pass through them. Your doctor may prescribe a vasodilator in combination with a diuretic or a beta-blocker. These drugs generally should not be used in people who have angina or who have had a heart attack.

How vasodilators work
Two of the most commonly prescribed vasodilators are prazosin hydrochloride and terazosin. Both of these medications work by dilating both arteries and veins. Prazosin is often used along with a diuretic or beta-blocker, but can also be used alone. Terazosin needs to be taken less frequently than prazosin, since its effects last for a longer time.

Prazosin works by binding to receptors than control blood vessel constriction, called alpha 1 receptors. The chemicals that would normally cause blood vessels to constrict can no longer bind to these sites, and both arteries and veins dilate.

Adverse effects of vasodilators
Vasodilators can have some side effects including:
. Headache
. Drowsiness
. Palpitations (the sensation of the heart beating rapidly, slowly, irregularly, or forcefully).
. Dizziness and/or occasional fainting upon standing, due to change in blood pressure

Examples Of Antihypertensive Agents*
*Representative examples from each class but not all-inclusive listing. (G) = available in generic form.

Antihypertensive Class
How they work

Examples: trade name (drug) Diuretics , Thiazides

Short-term effects: Cause the body to excrete water and salt. Less fluid remains in the blood, and cardiac output goes down.

Long-term effects: relaxation of smooth muscle in vessel walls, causing a decrease in PR.

K+-sparing diuretics
Increased renal (kidney) sodium excretion and potassium retention

Thiazides and related
. Hydrodiuril® (hydrochlorothiazide)(G)
. Potassium-sparing:
. Aldactone® (spironolactone)(G)

Loop diuretic
. Lasix® (furosemide)(G)

Beta-adrenergic receptor antagonists
(beta-blockers)

Direct actions: Reduces heart rate and the force of heart's contractions, leading to reduced cardiac output

Indirect actions: Reduced TR and blood volume by inhibiting renin secretion, which, in turn, lowers available levels of angiotensin II

1. Lopressor® (metoprolol tartrate); G
2. Inderal® (propranolol HCL)(G)
3. Tenormin® (atenolol)(G)
4. Combined alpha-beta-blockers:
5. Coreg® (carvedilol)
6. Normodyne® (labetolol HCL)(G)

Calcium channel antagonists
(calcium channel blockers)

Causes blood vessels to relax, making it easier for blood to flow; some calcium blockers slow heart rate and reduce the force of the heart's contractions

1. Procardia SL® (nifedipine)
2. Norvasc® (amlodipine besylate)
3. Cardizem SR® (diltiazem HCL)

Angiotensin-converting enzyme (ACE) inhibitors
Prevents conversion of angiotensin I to the vasoconstrictor angiotensin II. Lower levels of angiotensin II mean that blood vessels don't constrict as much, and blood flows more easily. Also thought to decrease cardiac output by decreasing levels of hormones (aldosterone and antidiuretic hormone).

1. Capoten® (captopril)(G)
2. Vasotec® (enalapril)
3. Accupril® (quinapril HCL)
4. Monopril® (fosinopril sodium)
5. Prinivil®, Zestril® (lisinopril) lisinopril

Angiotensin II receptor blockers
Prevents the vasoconstrictor angiotensin II from binding to certain receptors. Blood vessels don't constrict as much, and blood flows more easily.
1. Cozaar® (losartan potassium)
2. Diovan® (valsartan)
3. Avapro® (irbesartan)

Alpha-adrenergic receptor antagonists
(vasodilators)

Prevents messenger chemicals from binding to certain receptors (alpha type 1), which causes blood vessels to dilate and allows blood to flow more easily.

1. Hytrin® (terazosin HCL)
2. Minipress® (prazosin HCL)(G)

What Medications Are Right For You?
You will have to work with your doctor to figure out exactly what medication or medications are right for you, and what dosages control your blood pressure best.

Olive oil is the best oil for hypertension

Fruits vegetables and legume all are good for hypertension

What Your Doctor Will Consider When Choosing Your Medication
Not every medication is right for everyone. When choosing the best medication for you to start taking, your doctor will consider:

. Your age
. Your race or ethnic background
. The severity of your high blood pressure
. If you have any other chronic diseases such as diabetes or heart failure
. If you are taking any other medications and remedies, including prescribed or over-the-counter drugs and herbal remedies

For example, diuretics and beta-blockers are often the first drugs used to treat high blood pressure. But a person with both high blood pressure and type 1 diabetes might fare better on an ACE inhibitor.

Some groups of people respond better to one type of drugs than to another. For example, older people and black people do not respond to beta-blockers as well as they do to diuretics.

Need To Know:
Other medications or remedies, including over-the-counter drugs and herbal remedies, may react with some types of blood pressure medication. In order to select the right medication for you, your doctor must know about any other medications or remedies you are taking.

How To Information:
What you should consider when choosing your medication
You should also have some input into choosing the right medication. Some things you might want to consider include:

. How often will you have to take the medication? Some drugs control blood pressure over a longer period, which means that you have to take your medication less often. These drugs may also provide smoother blood pressure control.
. How much does the medication cost? Older drugs are more likely to be available in less expensive, generic forms.
. How will the medication impact your day-to-day life? Can you live with the drug's side effects? Sometimes side effects can be decreased (or stopped) by reducing the drug dosage. In other cases, you doctor may recommend treatment with another agent.

What If The Medication Doesn't Lower Your Blood Pressure?
After selecting the medication to begin your treatment for high blood pressure, your doctor will advise you to start taking the lowest dosage possible. This is intended to avoid side effects as well as a fall in blood pressure that happens too rapidly. If your blood pressure remains uncontrolled after one or two months of therapy, your doctor will adjust the dose upwards.
If the full dose of the drug does not effectively control your blood pressure, your doctor will:

· Add another type of drug
· Switch to another type of drug

Adding a second type of drug can be useful if you are not having problems with the first drug. But if you are experiencing troublesome side effects, or if the first drug isn't lowering your blood pressure, your doctor is likely to recommend that you switch to another type of drug.

If your blood pressure is still not controlled after these changes, additional medications can be added. There are a variety of mixed-class medications that can reduce the number of pills you need to take each day.

If your blood pressure is still not adequately controlled, your doctor may refer you to a cardiologist with specific expertise in treating high blood pressure.

Nice To Know:

Q. If I take medication for my high blood pressure, and the pressure falls to normal, why do I have to keep taking the medication?

A. In some cases, high blood pressure is caused by another condition. This type of hypertension is referred to as secondary hypertension. Treating the underlying condition can sometimes cure secondary hypertension.
But 90 to 95 percent of people with high blood pressure have essential hypertension, for which there is no single identifiable cause. So if you stop taking your medication after your blood pressure falls to normal levels, it's likely that your blood pressure will increase again. As smooth, persistent control of blood pressure is a goal of treating hypertension, discontinuing your medication would be undesirable.

Also, some medications (for example, beta-blockers) can cause sudden increases in heart rate and blood pressure if you suddenly stop taking them. Therefore, you should never discontinue taking your medication on your own. This should be a decision made in consultation with your doctor.

How To Information:

How to get the most out of your medications
No matter what type of drug your doctor selects for you, there are some general rules to follow in order to get the most benefit from your medication:

. Keep taking the medication every day, even if your blood pressure begins to come down or if you feel fine.
. Make sure you know how and when you should take the medication (for example, with or without food).
. Do not adjust the amount of medication you take each day, either upwards or downwards. . Your doctor is the only person who should adjust your dosage of blood pressure medication.
. Keep track of any side effects that you experience and report them to your doctor.

. Find out what side effects are serious enough to warrant immediate medical attention.
. Make a note on your calendar to refill the prescription before it runs out.
. Make sure you have enough pills to take you when you travel.

Need To Know:
Remember that high blood pressure usually causes no symptoms, but it stays with you, inflicting damage on key organs if left uncontrolled.

Living With High Blood Pressure
It is estimated that more than 50 million Americans have high blood pressure, and most of them are unaware that they have it. Almost 75 percent of people with high blood pressure do not control their blood pressure to below the "danger zone" of 140/90 mm Hg.

But if your doctor tells you your blood pressure is high, remember that you can control it and live a normal life. In many people, high blood pressure can be eliminated with simple changes in lifestyle and diet. These changes can improve your blood pressure and enhance your overall health.

Once recognized, high blood pressure can be effectively controlled with appropriate measures. In partnership with your doctor, you can control your blood pressure. There are specific things each of you should do to help you to achieve your target blood pressure:

What you should do:
. Have your blood pressure checked regularly.
. Ask any questions you have about your blood pressure and treatment (try making a list before you next see your doctor).
. Keep all appointments and have your pressure measured as often as the doctor suggests.
. Follow your doctor's advice about changes in diet and lifestyle that can help to control your blood pressure.
. Be sure to tell your doctor about all medications (prescriptions, over-the-counter drugs, herbal remedies) you are currently taking. This information is important as it may influence the type and dose of medication your doctor prescribes.
. If the doctor prescribes medications, take them every day, on time, even if you feel fine.

. Never adjust or discontinue your medication without consulting a doctor, even if your blood pressure seems to be getting lower.
. Ask you doctor about potential side effects and which, if any, may require prompt immediate medical attention.
. Make a note of any side effects associated with your medications and report them to your doctor.
. Keep in touch with your doctor

What your doctor should do:
· Tell you the systolic and diastolic blood pressure readings and explain what they mean.
· Answer your questions and explain what is going on in simple, understandable terms.
· Tell you how often you should have your blood pressure rechecked.
· Tell you about lifestyle and dietary changes that you should try, and refer you to a nutritionist or other expert if you'd like more help.
· Ask you questions about your medical history and use of medications (prescribed and over-the-counter) or herbal remedies to determine what type of medication, if necessary, is right for you.
· Explain how any medications work and describe any side effects that may occur.
. Tell you about any conditions for which you should receive prompt medical attention, including side effects, adverse reactions of your blood pressure medications with other medications, and complications related to your blood pressure.
· Monitor you for side effects, and lower the dosage of your medication or switch you to a different type of medication if necessary.

Putting It All Together
. High blood pressure, or hypertension, refers to increased pressure or tension that the circulating blood exerts on the walls of the blood vessels
. Although blood inside the veins is under some pressure, the term hypertension is usually used to mean increased pressure in arteries.
. Blood pressure is determined by the heart rate, blood volume, how vigorously heart pumps, and resistance in blood vessels.
. Increases in heart rate, blood volume, how vigorously the heart pumps, or resistance in blood vessels may increase blood pressure.

. Hypertension occurs when the body fails to make appropriate adjustments for these changes.
. In the great majority of cases, a single specific cause of high blood pressure cannot be identified.

. High blood pressure with no known cause is called essential hypertension.
. High blood pressure rarely causes symptoms. It can only be detected with repeated blood pressure measurements obtained by a trained health care professional.
. Treatment of hypertension is based on the how high the blood pressure is, the presence or absence of other cardiovascular disease risk factors, and the presence or absence of damage to organs caused by the high blood pressure
. There are many simple lifestyle and dietary changes that can be made to help reduce blood pressure and reduce the need for medication.
. If necessary, there are a large number of safe and effective medications that can be prescribed to reduce and control high blood pressure.
. Even if your doctor prescribes medication for high blood pressure, you should also make lifestyle and dietary changes to control your blood pressure.
. Properly treated, high blood pressure should not interfere with daily living.
. Failure to control high blood pressure can lead to serious health problems, even death.

Horny Goat Weed, great Aphrodisiac herb

Horny Goat Weed leafs

Scientific names: Epimedium grandiflorum

What is Horny Goat Weed?
Horny goat weed is a rhizomatous perennial herb. It is native to Japan, Korea, and parts of China, and grows on hillsides and in cliff crevices and shady areas. The plant has light yellow, violet, red, and white flowers, and oval fruits.

What is Horny Goat Weed used for?

Traditional uses
Horny Goat weed species have has used as tonics in Chinese herbal medicine to enhance sexual performance by increasing testosterone production, sexual energy, and overall well-being. Historically, horny goat weed have aphrodisiac effects and use to:

. Improve impotence conditions

. Treating spermatorrhea (low sperm count)
. To over come premature ejaculation

It is “natural sexual stimulator. It helps very much those suffering long time from Erectile Dysfunction (ED), or male impotence

The soft green heart-shaped leaf of the horny goat weed could hold the key to a new herb for treating erectile dysfunction. Researchers say the Horny goat weed as Viagra alternative, could be as effective as the famous blue pill, but have fewer side effects.

At the University of Milan, Italy, tested the plant which is used as natural aphrodisiacs in traditional cultures to establish their potential as alternatives to Viagra.

Viagra's active compound, sildenafil, works by inhibiting an enzyme called (PDE5). Because PDE5 helps control blood flow to the penis, inhibiting PDE5 promotes male erection.

Horny goat weed had great effect to promote male pines erection. This confirmed previous studies showing that Icariin, a compound found inside the horny goat weed, is a PDE5 inhibitor.

Horny Goat weed use mainly as Aphrodisiac
According to legend, a Chinese Goat herder who noticed sexual activity in his flock after they ate the weed discovered this property. It is use as health supplement; usually in raw herb in many medicinal forms.

The "active ingredient" in Horny goat weed is icariin. This is purported to work by increasing levels of Nitric oxide, which relax smooth muscle. It has been demonstrated to relax rabbit penile tissue by nitric oxide and PDE-5 activity. Other research has demonstrated that injections of horny goat weed extract directly into the penis of the rat results in an increase in penile blood pressure. Like Sildenafil (Viagra), icariin, the active compound in Epimedium, inhibits the activity of PDE-5.

Contra-indication: Individuals; which having problems from using Viagra should Not use the herb, even the herb is far more saver than Viagra effect.
Those individuals suffering from heart problems or taking coronary dilators medicine or Digoxin (Heart failure medication) should not use the herb. Otherwise, the herb is safe to use for normal peoples.

How to use: add one cup of boiling water to one teaspoon of the herb powder; let it to brew for 10 minutes while the cup is covered. Strain and drink 2-3 times daily; keep using the herbs to build up inside your body to get maximum effect after continuing using it between one to two weeks period.

Packages: 30-gram powder in tight container.
70-gram powder in tight container.

The price: 30 gram for only 20 MR + Shipping accordingly
70 gram for only 40 MR + Shipping accordingly

Hypothyroidism causes, handling, and medication

What Is Hypothyroidism?

Hypothyroidism is a condition in which there is too little thyroid hormone in the bloodstream. The thyroid gland, which produces the thyroid hormones, is said to be "underactive," because it produces too little thyroid hormone needed for the body to function normally.

Inadequate stimulation of cells and organs in the body due to low levels of thyroid hormone causes the symptoms associated with hypothyroidism, which is generally a "slowing-down" of the body's processes. These symptoms include slowed heart rate, tiredness, inability to tolerate cold, mental fatigue, and constipation.

Hypothyroidism is a common condition, and it can be successfully treated. However, because the symptoms are often subtle, or people believe their symptoms are due to stress, depression, or "getting older," or may frequently mistake for other conditions, it is not unusual for someone with hypothyroidism to go undiagnosed, sometimes for many years. Some experts estimate that as many as 9 million people in the U.S. have undiagnosed hypothyroidism.
The condition affects both men and women, but it is far more common in women.
A different thyroid-related condition involves too much thyroid hormone in the bloodstream, producing symptoms that include rapid heart beat, extreme fatigue, weight loss, and nervousness. This condition is called hyperthyroidism, and the thyroid gland is said to be "overactive."

Nice To Know:

What is the thyroid gland?
The thyroid gland is a small, butterfly-shaped gland that lies just under the Adam's apple in the neck. There are two lobes to the gland, and they lie just in front and at either side of the windpipe (trachea). The thyroid is part of the body's endocrine system, which consists of glands that secrete hormones into the bloodstream.

The thyroid gland secretes thyroid hormones, which control the speed at which the body's chemical functions proceed (metabolism). To produce thyroid hormones, the thyroid gland needs iodine, an element contained in many foods. The thyroid gland also produces a hormone, called calcitonin, which may be involved in the metabolism of bones.

What Is Thyroid Hormone?
Hormones are chemical messengers released into the bloodstream by specialized glands called endocrine glands. A hormone circulates through the body in the bloodstream, delivering messages to other parts of the body. The "message" causes effects far from the gland that produced the hormone.

Thyroid hormone is produced in the thyroid gland, which is located in the front of the neck. It is released by the thyroid gland into the bloodstream and circulates throughout the body. Almost every cell in the body, from those in the brain to those in the feet, responds to the hormone.

There are two different forms of thyroid hormone present in the bloodstream. The two forms of thyroid hormone differ in the number of iodine units or atoms attached to the hormone. Iodine is a very important component of thyroid hormone.

. Thyroid hormone with four iodine units is abbreviated as T4.
. Thyroid hormone with three iodine units is abbreviated as T3.

Most thyroid hormone in the blood is T4.
T3 is the form that is active in the body, not T4.
Certain cells in the body convert T4 to T3.

Nice To Know:
Just about all the iodine we consume in food is used by the body for the production of thyroid hormone.
If there is too little iodine in the diet, the body cannot make the thyroid hormone, and hypothyroidism will result.
If there is too much iodine, the production of thyroid hormone may be affected and, again, hypothyroidism can result.
In developed countries, iodine is added to regular table salt to ensure that individuals get enough iodine in their diets. Salt boxes are usually labeled "iodized salt."
But in underdeveloped countries, there are nearly 200 million people with goiters (enlarged thyroids) due to insufficient iodine in their diet.

Thyroid Disease Symptoms

What Does Thyroid Hormone Do?
Cells respond to thyroid hormone with an increase in metabolic activity. Metabolic activity, or metabolism, is a term used to describe the processes in the body that produce energy and the chemical substances necessary for cells to grow, divide to form new cells, and perform other vital functions.
If you think of each cell in the body as a motor car, then thyroid hormone acts as if you were tapping on the accelerator pedal. Its message is "go."

Because thyroid hormone stimulates cells, it causes major body functions to "go" a bit faster.
. Heart rate increases.
. Breathing rate increases.
. Use of proteins, fats, and carbohydrates rises.
. Skeletal muscles work more efficiently.
. Muscle tone in the digestive system, such as those in the walls of the intestines that help to move food through the digestive system increases.
. Mental alertness and thinking skills are sharpened.

How Are The Blood Levels Of Thyroid Hormone Controlled?
Normally, the body runs like a car on cruise control - functioning at a steady rate. This steady state is known as homeostasis. The body's control system that regulates the cells to function at a steady, appropriate metabolic rate may be explained as follows:

Special "detector" cells in the brain monitor the level of thyroid hormone in the blood.
When the level of thyroid hormone drops, these cells send signals to a nearby organ in the brain known as the pituitary gland.
These signals stimulate the pituitary gland to release a substance called thyroid-stimulating hormone (TSH) into the bloodstream.
TSH signals cells in the thyroid gland to release more thyroid hormone into the bloodstream.
When the blood level of thyroid hormone has increased enough, the detector cells in the brain detect the increase in thyroid hormone level.
These detector cells send signals to the pituitary gland to stop release of TSH.

Nice To Know:
The medical specialty called endocrinology is devoted to the study and treatment of disorders of endocrine glands, that is, glands that secrete hormones. Your primary-care physician may refer you to an endocrinologist for a consultation or for ongoing care if you develop hypothyroidism or another endocrine condition.

Facts about hypothyroidism
Hypothyroidism can affect people of all ages, including children and infants.
Over five million Americans have hypothyroidism.
Hypothyroidism affects both sexes, but women are up to eight times more likely to develop it.
As many as 10% of women may have some degree of thyroid hormone deficiency.
Millions of people have hypothyroidism but do not know it.
Hypothyroidism may affect between 4% and 9% of the general population, and between 9% and 16% of people over age 60.
One out of every 4,000 infants is born with hypothyroidism.

What Are The Symptoms Of Hypothyroidism?
Symptoms of hypothyroidism usually appear gradually, particularly in people over age 50.

Mr. Habiabato sufferer of hypothyroidism for 10 years

A low level of thyroid hormone slows the body's metabolism, like running a motor car at a slow speed.
Most symptoms, such as lower heart rate, tiredness, poor memory or difficulty in thinking, even constipation, are due to inadequate stimulation of the various organs in the body due to insufficient amounts of thyroid hormone.
Other symptoms, such as inability to tolerate cold environments, are directly due to the decrease in heat generated within the body by slowed metabolic activity.

Most people with hypothyroidism will experience some of the following symptoms.
. Slow heart rate
. Tiredness
. Inability to tolerate cold
. Weight gain (usually 5 to 10 pounds)
. Emotional depression
. Drowsiness, even after sleeping through the night
. Heavy or irregular menstrual periods (in premenopausal women)
. Muscle cramps
. Constipation

Later symptoms of hypothyroidism include:
. Dry, flaky skin
. Hair loss
. Impaired memory and difficulty in thinking
. Voice becomes deeper
. A numb sensation in the arms and legs
. Puffiness in the face, especially around the eyes (a condition called myxedema, which is an indication that the disease has become serious)

Need To Know:
It's easy to dismiss symptoms such as feeling tired or being constipated as a part of aging, or as being linked to stress, which is why so many individuals with hypothyroidism remain undiagnosed.

Who Gets Hypothyroidism?
Hypothyroidism can develop at any point in the life span. It is more common in adults, but hypothyroidism in infants and children also can occur.
Women are three to eight times more likely than men to develop Hashimoto's thyroiditis, which can cause hypothyroidism.

The risk increases with age. By the time is woman reaches age 60, she has a one in five chance of having hypothyroidism.
Thyroid disease can run in families. Sometimes it skips a generation, which means a person's parents may have no sign of thyroid disease, though one of his or her grandparents may have had it.

Individuals with insulin-dependent diabetes and rheumatoid arthritis have a higher chance of hypothyroidism.
Hypothyroidism may occur in people with other autoimmune diseases such as

Addison's disease and pernicious anemia.
It may occur in people with prematurely gray hair (before the age of 30) or those who have a skin condition known as vitiligo, in which the normal pigmentation of the skin is lost and appears as white patches that do not tan normally in the sun.
Individuals with certain health conditions, who have had certain medical treatments, or who have taken certain medications also are more likely to develop hypothyroidism.

What Causes Hypothyroidism?
The vast majority of cases of hypothyroidism (roughly 95% or more) are caused by a problem within the thyroid gland. A much smaller number of cases (roughly 5% or less) are caused by a problem in the brain or pituitary gland, a small gland located beneath the brain.

The causes of hypothyroidism include:

Hashimoto's Thyroiditis

Hashimoto's thyroiditis is a condition resulting from a problem in the body's immune system.
It is the most common cause of hypothyroidism.
The immune system is a complex network that normally defends the body against "invading" organisms and other foreign substances. When the immune system detects a foreign substance in the body, it responds to this by producing antibodies against the invaders. These antibodies will recognize and attack this foreign substance when they next encounter

In Hashimoto's thyroiditis the immune system mistakenly directs an immune "attack" against its own healthy cells. Antibodies are manufactured and misdirected against the thyroid gland.
Any condition in which the body's immune system attacks its own cells is called an auto-immune disease.

Inflammation associated with the abnormal immune response causes continuing loss of thyroid cells. Eventually, this loss in function (which may take months or even years) reaches the level where there is insufficient thyroid hormone to minimally support body function, and the person develops the symptoms of hypothyroidism.

Hashimoto's thyroiditis is more common in women than in men (roughly 7 to 1), and it typically develops in women over age 40 years. It may be much more common than previously thought in older adults. Studies have indicated that up to 15 percent of women over age 60 years have evidence of mild hypothyroidism due to Hashimoto's thyroiditis.

Because genetic factors can make someone vulnerable to developing autoimmune disease, it is not uncommon for persons with Hashimoto's thyroiditis to have a history of other autoimmune disorders, including Graves' disease (another thyroid disorder that causes an overactive thyroid gland), juvenile diabetes mellitus, pernicious anemia, or the skin disorder vitiligo.

Graves' disease

In addition, the same genetic vulnerability toward disease means that more than one member of a family may develop Hashimoto's thyroiditis or another autoimmune disorder. If you are being evaluated for possible hypothyroidism, it is valuable to give your doctor any information you have on family or personal history of autoimmune disease, especially thyroid disease (namely, Hashimoto's thyroiditis or Graves' disease).

In the early stages of Hashimoto's disease, inflammation causes the thyroid to become enlarged and rubbery, and this may be enough to be noticeable. Indeed, diagnostic blood testing may be done because a doctor notices an enlarged thyroid during a physical examination.
Blood testing typically shows low levels of the thyroid hormones T3 and T4 in the blood, high levels of the hormone TSH that stimulates the thyroid to produce thyroid hormone, and the presence of antibodies directed against portions of the thyroid gland.

Treatment Of Hyperthyroidism
The treatment of hyperthyroidism - the condition in which the thyroid gland is "overactive" because there is too much thyroid hormone in the blood - can result in hypothyroidism. This can happen if:

The hyperthyroidism was treated with radioactive iodine. Nearly 50 percent of individuals who receive radioactive iodine for the treatment of hyperthyroidism from Graves' disease will develop hypothyroidism within a year, and 65 percent will develop it within five years.
Most of the thyroid gland was removed surgically in order to treat the hyperthyroidism.

Treatment Of Thyroid Tumors
Surgery for a noncancerous (benign) or cancerous (malignant) thyroid tumor is another common cause of hypothyroidism.
If the tumor is noncancerous, usually only a portion of the thyroid is removed, and hypothyroidism does not usually occur, unless most of the gland was removed.

If the tumor is cancerous, usually the entire thyroid is removed.
In either case, hypothyroidism may develop at the time of treatment or a number of years afterward.
Radiation Treatment For Head And Neck Cancers
Exposure to high doses of radiation for the treatment of head and neck cancers also can cause hypothyroidism. Hypothyroidism may occur in up to 65% of such individuals within 10 years of the radiation treatment.

Interference From Drugs
Some drugs given for non thyroid conditions have the side effect of inhibiting production of thyroid hormone within the thyroid gland. If these drugs are taken in large dosages or for a long time, hypothyroidism may result.
Use of lithium as a treatment for certain psychiatric conditions is an example of drug-induced hypothyroidism. Almost half of all people who take lithium may develop an enlarged thyroid, although less than a quarter of them will actually develop symptoms of hypothyroidism.

Another example is use of the iodine-containing drug amiodarone (Cordarone) for heart arrhythmias.
In addition, drugs used in treatment of hyperthyroidism (propylthiouracil, for instance) can also impair thyroid function and cause hypothyroidism.

Need To Know:
Numerous medications can affect the thyroid. Anyone who is at higher risk for hypothyroidism should discuss with their physician whether the medications they are taking might affect the thyroid.

Subacute Thyroiditis
Subacute thyroiditis is an inflammatory thyroid condition of unclear origin. It usually causes only temporary and mild hypothyroidism - that is, it produces a relatively less serious form of hypothyroidism that goes away on its own.
Subacute thyroiditis is an uncommon disorder that can occur in men or women of any age. The characteristic inflammation in the thyroid often follows an upper respiratory infection, and patients often come to a doctor's attention because of noticeable and painful enlargement of the thyroid gland.

Postpartum Thyroiditis

Postpartum thyroiditis means inflammation of the thyroid following pregnancy, (from post, meaning "after," and partum, meaning "birth"). It occurs in the first six months after delivery in about 5% to 9% of women. Typical symptoms relate to an initial phase of hyperthyroidism (with symptoms of rapid heart rate, increased sweating, nervousness) and a later phase of hypothyroidism (with fatigue, dry skin, feeling cold, depression).

Studies have shown that 80% to 90% or more of affected women had detectable levels before or during their pregnancies of antibodies directed against the thyroid gland.
In up to 5% of women, this can cause inflammation of the thyroid up to 12 months after the delivery.
Roughly 20% to 33% of the women who develop postpartum thyroiditis will have permanent hypothyroidism.
Almost one-third of women with hypothyroidism due to postpartum thyroiditis develop mild to moderate depression after pregnancy.

Problems In The Pituitary Gland

Hypothyroidism can also develop due to a problem in other parts of the thyroid hormone production line (namely the brain or pituitary gland). These cases of hypothyroidism, which do not originate in the thyroid gland, are much less common (perhaps 5%), and almost all of these cases are due to failure of the pituitary gland to produce or release the hormone TSH, which is responsible for stimulating the production of thyroid hormone in the thyroid gland. Diagnostic blood testing shows low levels of T3 and T4 thyroid hormones, low or absent TSH, and absence of the antithyroid antibodies characteristic of Hashimoto's thyroiditis, the commonest cause of hypothyroidism.

Is Hypothyroidism Serious?
The presence and severity of symptoms are different for different persons. Although many symptoms of hypothyroidism cause distress, most are not dangerous themselves.
Indeed, proper diagnosis may be delayed or missed in older adults because the symptoms are considered "just part of getting old." An individual may not seek help until tiredness, impaired memory, or other symptoms have affected daily living so much that a family member or friend asks them to see a doctor. Others may go to a doctor only when physical changes such as dry, flaking skin and facial puffiness have become obvious.

Rare occasions , cretinism, Sever iodine deficiency

Need To Know:
Untreated hypothyroidism can have serious consequences over the long term:
It may result in severe depression and, over a period of time, mental and behavioral impairment.

The most severe form of hypothyroidism is myxedema, which is characterized by swelling of the face, tissue around the eyes, hands, and feet. Left untreated, this may progress to even more severe symptoms of hypothermia, which is a severe drop in body temperature, seizures and ultimately coma and death.

This need never occur with proper treatment.
The good news is that treatment is simple, and the symptoms almost always resolve with treatment. Persons generally feel much better, more alert, and "back to being their old selves."
The other major factor to consider in assessing how serious hypothyroidism is in any given individual is the presence (and, if so, severity) of associated health conditions.

How Is Hypothyroidism Diagnosed?
Diagnosis of hypothyroidism is based on a person's medical history, a physical examination, and blood tests.
If a physician suspects hypothyroidism, he or she will look particularly at the cardiovascular system, the skin, hair, eyes, reflexes, and body temperature. The physical exam also may reveal an enlarged thyroid, which is called a goiter.
In Hashimoto's thyroiditis, if a goiter is present, it will not be tender and will have a rubbery feel.

If the goiter is tender, the cause may be subacute thyroiditis, an inflammation of the thyroid that often follows an upper respiratory infection.
Blood tests check the levels of the thyroid hormones T4, T3, and TSH, among other related substances.

Abnormally low levels of T4 and T3 indicate hypothyroidism is present.
The TSH (thyroid-stimulating hormone) level is especially important in determining whether the condition is due to a problem in the thyroid gland or in the part of the brain that stimulates thyroid function.
If the TSH level in the blood is high, the abnormality is within the thyroid gland. A high TSH level suggests that the thyroid gland is not responding properly to the stimulating effect of the TSH on the thyroid gland.

If the TSH level in the blood is low, the abnormality is within the brain or pituitary gland in the brain. It suggests that the pituitary is not releasing adequate amounts of TSH to stimulate the thyroid gland, despite levels of thyroid hormone low enough that it should do so.

Among adults with hypothyroidism, roughly 95% of cases represent problems in the thyroid gland. In about 5% of cases, the abnormality is found in the brain or in the pituitary gland, almost always the pituitary gland.
If blood tests suggest that the problem is in the glands in the brain, imaging tests of the brain may be necessary. These include CT scans, which are sophisticated x-rays, and MRI scans, which use magnets to create images of the inner body.
Other blood tests include an antibody test, which is a blood test to detect antithyroid antibodies. High levels of these antibodies suggest that a person may have Hashimoto's thyroiditis.

Need To Know:
Of the blood tests for hypothyroidism, the TSH is the most sensitive test. The role of TSH is to stimulate the thyroid gland to produce thyroid hormone when the level of hormone in the body drops.

If the TSH level is above 6, then a diagnosis of hypothyroidism will be made.
However, if the thyroid hormone levels are normal and the person has no symptoms, then the conditions is said to be "subclinical." This means that the hypothyroidism has been diagnosed by a blood test only, since there are no symptoms.
Most people feel best when their TSH level is between 0.5 and 2.5.

Nice To Know:
The American Thyroid Association, a national professional organization of thyroid specialists, recommends that women over age 35 should be screened every five years for hypothyroidism.

How Is Hypothyroidism Treated?
Treatment of hypothyroidism is simple. It involves taking daily thyroid hormone replacement medication. This supplies the body with thyroid hormone to replace what isn't being produced by the thyroid gland.

The replacement thyroid hormone is artificially manufactured and is structurally identical to the thyroid hormone produced naturally in the body. It is a synthetic derivative of the thyroid hormone T4 and is called levothyroxine. Brand names include Synthroid, Levothroid, Levoxyl, Levo-T, as well as numerous generic preparations.

Synthetic thyroid hormone (T4) is made in a wide range of strengths so that dosage can be individually tailored to each person's needs.
An adult typically starts with 0.1-0.15 milligrams per day, and the dosage is adjusted over time to reach normal blood levels, reflected by normal blood levels of TSH. It is important that older adults, especially those with heart disease, start at a low dose and increase it slowly. This minimizes the risk that the increase in metabolic activity due to thyroid hormone replacement therapy will stress the heart.

Because T4 is converted into T3 (the other very important thyroid hormone) within the body, physicians are comfortable using T4 therapy alone. However, one recent study has suggested some persons may benefit from combined T3 and T4 therapy.

Need To Know:
People differ in how quickly they respond to the medication.
It is important to take the medication regularly as prescribed. Some hypothyroidism sufferers feel a marked improvement after only a couple weeks on medication. They find that their heart rate increases to normal range, they lose the weight they gained, and their skin and hair will return to normal. Some feel much improved in themselves only after a couple of weeks of treatment. It takes a little longer for the enlarged thyroid to decrease in size and for the "bad cholesterol" to return to normal levels.

But others may find they still have various symptoms at six months or longer after beginning medication. If it's taking that long, it's usually because the dose is inadequate to bring the thyroid hormone levels into the normal range. The doctor may need to increase the dose, or perhaps try a combination of drugs with T4 and T3. A person who frequently forgets to take their medication will also not benefit from improvement in their symptoms.If the symptoms persist even though the blood tests of thyroid function are normal, it is likely that the symptoms are not due to thyroid hormone deficiency.

Even cats can develop hypothyroidism

It may be useful for an individual with newly diagnosed hypothyroidism to list their most distressing symptoms and to track changes in them over time after hormone therapy is begun.

Some people find that their physician will increase the dosage of their thyroid medication every year or two, in order to keep their blood levels of thyroid hormone within the normal range. This is because the inflammation of the thyroid gland may continue affecting more thyroid hormone producing cells, thus causing the thyroid to produce even less thyroid hormone than before.
Need To Know:

It is important not to take too much thyroid hormone, since this can cause symptoms of hyperthyroidism. These symptoms include a fast heart rate, tremor (shaking), excessive sweating, inability to tolerate heat, and abnormal heart rhythms.

Nice To Know:
Individuals diagnosed with subclinical hypothyroidism - when their TSH levels are high but thyroid hormone levels are normal, and they are not feeling any symptoms - are not always treated with replacement thyroid hormone. The decision is an individual one, made by the person and the physician. But up to half of such individuals will feel better after taking thyroid medication, and others will have improved cholesterol levels in the blood.
What Other Health Problems May Be Associated With Hypothyroidism?
Several potentially significant health conditions are common in persons with hypothyroidism.

They include:

Goiter
Goiter is a general term for an enlarged thyroid gland that has the appearance of a swelling or fullness in the neck. Many persons with Hashimoto's thyroiditis have a goiter. Although the thyroid gland is usually painless, there can be some discomfort. At the extreme, large goiters can interfere with swallowing, breathing, or both. In many cases, goiters decrease in size, often considerably, after thyroid hormone replacement therapy is begun. Surgery is rarely required.

Nice To Know:
Before the connection of iodine and thyroid function was made, people realized that goiters (large thyroid gland seen as a swelling in the neck) were more common in certain areas-areas we recognize as low in iodine in the average diet. Indeed, the area around the Great Lakes was called the "Goiter Belt." The goiters in many people living there were not due to a problem within the thyroid such as Hashimoto's thyroiditis. Instead, the goiter developed because of the lack of iodine needed for the production of thyroid hormone.

The cells of the thyroid gland increased in size and number in response to long-term high levels of TSH, the hormone that stimulates the thyroid to produce thyroid hormone, working overtime in an effort to get the thyroid gland to produce adequate amounts of thyroid hormone, despite the low level of available iodine. This ability of the cells to adapt to chronically low levels of dietary iodine by enlargement and increase in function meant that many people retained low normal levels of thyroid hormone because their thyroid cells could take up and use virtually all of the iodine they consumed.

Heart Disease
One of the major organs affected by thyroid hormone is the heart. Increased heart rate and palpitations are common in persons with untreated hyperthyroidism, and a slowed heart rate is common in persons with hypothyroidism.

Need To Know:
Persons who have hypothyroidism and heart disease should discuss their cardiac symptoms with their doctors before beginning thyroid hormone treatment.
Individuals having frequent attacks of angina, the heavy pain typically felt in the chest, jaw, or left arm, have symptoms indicating that their hearts are not receiving enough blood during the periods when angina is felt.
These individuals should plan the early phase of thyroid hormone therapy so that minimal stress is placed on the heart due to increased metabolic activity. This may be done by starting at a low dose of thyroid hormone, limiting exertion, or both.

If angina or other symptoms persist or worsen even on a low dose of thyroid hormone, other treatments may be required for the heart condition.
High Cholesterol

The decreased metabolic activity associated with hypothyroidism leads to increased blood levels of cholesterol. Individuals whose blood cholesterol levels are found to be high, particularly if they do not have a previous history of high cholesterol, may be advised to have thyroid hormone levels checked. If the high cholesterol is due (at least in part) to hypothyroidism, improvement will come after hormone treatment is begun. A low-fat, low-cholesterol diet will also help; if cholesterol levels remain high, appropriate drug therapy may be needed to lower them.

Anemia
Anemia is the general term for any condition marked by a low red blood cell count. Because red blood cells carry oxygen between the lungs and the rest of the body, persons with anemia often feel tired with little exertion. This fatigue is in addition to the fatigue felt due to untreated hypothyroidism. Persons who have hypothyroidism, heart disease, and anemia become particularly tired and may develop angina or worsening of their angina.

Individuals with hypothyroidism may become anemic due to inadequate stimulation of red blood cell development in the bone marrow; this type of anemia (as well as persistent feelings of fatigue) usually goes away after thyroid hormone treatment is begun. Over-the-counter iron supplements and other preparations are not helpful.

However, if a premenopausal woman with untreated hypothyroidism has had heavy menstrual periods, she may have iron deficiency contributing to her anemic condition. These women will find iron supplementation useful in combination with their thyroid hormone treatment.

Hypothyroid persons with anemia, particularly elderly persons, should also be checked for possible pernicious anemia, an autoimmune form of anemia characterized by vitamin B12 deficiency. The same genes that cause a vulnerability to development of Hashimoto's thyroiditis can cause vulnerability to pernicious anemia, so it is particularly important to look for in anemic individuals who have a history of Hashimoto's thyroiditis.

Infertility
Infertility is common in women whose thyroid hormone levels are low, and some women are diagnosed with hypothyroidism as part of a medical exam for infertility. After thyroid hormone treatment is begun, it is usually easier to conceive.

Because thyroid hormone crosses the placenta in small amounts, the thyroid hormone taken by the expectant mother may have important effects on the developing fetus.

Because the dose of thyroid hormone may need to be increased after a woman has conceived, it is valuable to get baseline (pre-pregnancy) thyroid tests (including TSH) and to periodically recheck during the pregnancy.
After delivery, the mother's thyroid hormone needs typically return to pre-pregnancy levels.

If You Are Having Surgery
It is generally better to schedule elective surgery for one to two months after beginning thyroid hormone treatment, because thyroid hormone levels will have come toward or into the normal range. The daily dose of thyroid hormone can be continued up to the time of surgery, although skipping a dose on the morning of surgery will not lead to problems.
On the other hand, if there is a pressing need for surgery it usually can be performed safely in an untreated or partially treated person with hypothyroidism.

Hypothyroidism And Pregnancy
Hypothyroidism can develop during or after pregnancy. It also can affect a woman's ability to become pregnant.

A woman has a 25% higher risk for developing hypothyroidism after pregnancy if she has diabetes or another autoimmune disorder. A miscarriage may be an indication that antithyroid antibodies were present before pregnancy. These antibodies do not cause the miscarriage, but seem to be a marker for other immune system problems that can lead to pregnancy loss.

How Hypothyroidism Can Affect Pregnancy
Hypothyroidism can affect pregnancy in several ways:
It can cause infertility in women because it can prevent the production of eggs.
A pregnant woman with hypothyroidism is at higher risk for miscarriage.
Women with untreated hypothyroidism near the time of delivery are in danger of developing high blood pressure and premature delivery.
Babies born to women with untreated hypothyroidism may not achieve their full intellectual potential.

Untreated hypothyroidism can cause serious problems for an unborn child, so many experts recommend that all pregnant women be tested for thyroid function during the pregnancy.

Every woman treated with thyroid hormone who anticipates becoming pregnant or is found to be pregnant should have her thyroid hormone levels monitored more closely. Some woman may need to have their dosage of medication increased by as much as 50% during pregnancy. Thyroid medication is safe to take during pregnancy.

A collaboration between a woman's endocrinologist and obstetrician will maximize the chances for a successful pregnancy and delivery and make the mother's postpartum adjustments as easy as possible.

Hypothyroidism Resulting From Pregnancy
One in every 20 women will develop hypothyroidism after pregnancy. This happens because they developed antibodies to their own thyroid prior to the pregnancy, and this caused an inflammation of the thyroid after delivery. This condition most often develops between four months to a year after delivery and usually resolves on its own. If it is long lasting or permanent, it is easily treated with medication.

Nice To Know:
Q: We tried to conceive for several years, and now I'm finally pregnant. My obstetrician did some blood work when I went to see her, and she says I'm at risk for thyroid trouble after the baby comes. I don't recall any doctor talking about my thyroid before. What does she mean?

A: Postpartum thyroiditis (an inflammatory condition of the thyroid that develops after delivery) affects about 5% to 9% of mothers. About 80% to 90% of women who develop postpartum thyroiditis had antibodies directed against their thyroid gland in their blood before their pregnancies. Ask your doctor what she found in your blood test results - do you have antithyroid antibodies in your blood? A consultation with an endocrinologist may be helpful.

Living With Hypothyroidism
Hypothyroidism can be treated easily and inexpensively with daily thyroid hormone (T4). This treatment supplies the hormone missing in the body and allows organs to return to a proper level of stimulation. Symptoms that had been distressing improve or disappear after hormone therapy has been begun.

Persons with hypothyroidism should remain aware of the symptoms of both hypothyroidism and hyperthyroidism so that they can alert their doctors if symptoms appear.

Symptoms of hyperthyroidism occur when the body's need for thyroid hormone decreases, and the previously correct dose becomes excessive. Changes that the individual might notice include a feeling of nervousness, a rapid heartbeat, intolerance of hot environments, and diarrhea.

Symptoms of hypothyroidism occur when the body's need for thyroid hormone increases, and the previously correct dose becomes inadequate. Changes that the individual might notice include feelings of physical and mental fatigue, a slowed heartbeat, intolerance of cold, and constipation.

Because thyroid hormone is simply a replacement for hormone no longer produced in the body, treatment does not require an individual to change lifestyle, give up alcohol, or make other changes. However, all individuals, regardless of gender or age, who take medications in addition to their thyroid hormone, should discuss the possibility of drug interactions with their doctors.

Some medications interfere with absorption of thyroid hormone from the digestive tract into the blood; such interference can keep the blood level of thyroid hormone low enough that symptoms of hypothyroidism continue or reappear.

Two commonly used drugs that can interfere with thyroid hormone absorption are
. Cholestyramine, used for reduction of blood cholesterol
. Sucralfate, used in peptic ulcer disorders

If these drugs are required, they can be taken several hours apart from the thyroid hormone tablet. Also, iron and calcium supplements may interfere with thyroid hormone absorption. These too may be taken several hours apart from the thyroid hormone medication.

Nice To Know:
Exercise is important to maintain health, but many people with hypothyroidism lack the energy to exercise. One expert suggests splitting exercise into several short sessions.

Putting It All Together
. Here is a summary of the important facts and information related to hypothyroidism.
. Hypothyroidism is the condition marked by too little thyroid hormone in the blood.
. Symptoms of hypothyroidism include slowed heartbeat, tiredness, difficulty thinking and remembering, dry and flaky skin, constipation, and inability to tolerate the cold.
. Hypothyroidism can occur at any age, from birth well into the senior years.
. Diagnosis of often delayed or missed because symptoms are subtle and can be attributed to other causes, such as aging or stress.
. Hypothyroidism is diagnosed with a medical exam and blood testing.
. The condition can be easily and successfully treated with medication that replaces the thyroid hormone that is lacking in the body.
. Regular monitoring via blood testing provides the means for ensuring appropriate hormone replacement therapy for the rest of one's life.
. Hypothyroidism can affect a woman's ability to become pregnant and also the health of her unborn child. Pregnant women can safely take thyroid medication, as it does not affect a developing fetus adversely.
. Most of the symptoms of hypothyroidism improve greatly or disappear after thyroid hormone treatment is begun.
. Thyroid hormone treatment may be needed for life, but fortunately treatment is simple, inexpensive, and easily monitored.

Enlarged thyroid gland and Hyperthyroidism

What Is Hyperthyroidism?

Hyperthyroidism is a condition in which there is overproduction of thyroid hormone by the thyroid gland, causing the levels of thyroid hormone in the blood to be too high. People who have it are often said to have an "overactive thyroid".

Miss Manaf''illa hyperthyroidism patient for 20 years

The thyroid gland is a small, butterfly-shaped organ located in the neck below and in front of the Adam's apple.

Thyroid hormone is a chemical substance produced by the thyroid gland and released into the bloodstream. It interacts with almost all body cells, causing them to increase their metabolic activity.
This abnormally high level of thyroid hormone typically speeds up the body's metabolism. Metabolism is the chemical and physical processes that create the substances and generate the energy needed for cell function, growth, and division.

Symptoms of hyperthyroidism may include a rapid heartbeat, tremor of the fingers and hands, weight loss, and the inability to tolerate heat.
About the thyroid gland

The thyroid lies just under the Adam's apple in the neck. There are two lobes to the gland, and they lie just in front and at either side of the windpipe (trachea).
The thyroid is part of the body's endocrine system, which consists of glands that secrete hormones into the bloodstream.
The thyroid gland secretes thyroid hormones, which control the speed at which the body's chemical functions proceed (metabolism). To produce thyroid hormones, the thyroid gland needs iodine, an element contained in food and water.

The para-thyroid gland also produces a hormone, called calcitonin, which is involved in the metabolism of our bones.

Thyroid and par-thyroid glands

What Is Thyroid Hormone?
Hormones are chemical messengers released into the bloodstream by specialized glands called endocrine glands.

The hormone circulates through the body in the bloodstream delivering a message to other parts of the body. The "message" causes effects far from the gland that produced the hormone.

Thyroid hormone is produced in the thyroid gland, which is located in the front of the neck. It is released by the thyroid gland into the bloodstream and circulates throughout the body. Almost every cell in the body, from those in the brain to those in the feet, responds to the hormone.

There are two different forms of thyroid hormone present in the bloodstream. The two forms of thyroid hormone differ in the number of iodine units or molecules attached to the hormone. Iodine is a very important component of thyroid hormone.
. Thyroid hormone with four iodine units is abbreviated as T4.
. Thyroid hormone with three iodine units is abbreviated as T3.
Most thyroid hormone in the blood is T4.
. T3 is the form that is active in the body, not T4.
Certain cells in the body convert T4 to T3.

Nice To Know:
Just about all the iodine we consume in food is used for the production of thyroid hormone. Iodine is added to regular table salt to ensure that individuals get enough iodine in their diets. Salt boxes are usually labeled "iodized salt." People with deficiency in iodine will develop hypothyroidism, a condition in which the circulating levels of thyroid hormone are too low..

What Does Thyroid Hormone Do?
Cells respond to thyroid hormone with an increase in metabolic activity. Metabolic activity, or metabolism, is a term used to describe the processes in the body that produce energy and the chemical substances necessary for cells to grow, divide to form new cells, and perform other vital functions.

If you think of each cell in the body as a car, then thyroid hormone acts as if you were tapping on the accelerator pedal. Its message is "go."

Because thyroid hormone stimulates cells, it causes major body functions to "go" a bit faster.
. Heart rate increases.
. Breathing rate increases.
. Use of proteins, fats, and carbohydrates increases.
. Skeletal muscles work more efficiently.
. Muscle tone in the digestive system, such as those in the walls of the intestines that help to move food through the digestive system increases.
. Mental alertness and thinking skills are sharpened.

How Are Blood Levels Of Thyroid Hormone Controlled?
Normally, the body runs like a car on cruise control-functioning at a steady rate. This steady state is known as homeostasis. The body's control system that regulates the cells to function at a steady, appropriate metabolic rate may be explained as follows:

. Special "detector" cells in the brain monitor the level of thyroid hormone in the blood.
. When the level of thyroid hormone drops, these cells send signals to a nearby organ in the brain known as the pituitary gland.
. These signals stimulate the pituitary gland to release a substance called thyroid-stimulating hormone (TSH) into the bloodstream.
. TSH signals cells in the thyroid gland to release more thyroid hormone into the bloodstream.
. When the blood level of thyroid hormone has increased enough, the detector cells in the brain detect the increase in thyroid hormone level.
. These detector cells send signals to the pituitary gland to stop release of TSH.

Nice To Know:
The medical specialty called endocrinology is devoted to the study and treatment of disorders of endocrine glands, including hyperthyroidism. Primary care physicians refer individuals to an endocrinologist for a consultation and ongoing care for hyperthyroidism or other endocrine conditions.

Facts about hyperthyroidism
Hyperthyroidism is a medical condition characterized by an abnormally high level of thyroid hormone in the bloodstream.
Hyperthyroidism is commonly referred to as "overactive thyroid."
Hyperthyroidism is also known as thyrotoxicosis from the prefix "thyro-" meaning thyroid, the term "toxic" meaning poisonous, and the suffix "-osis" meaning condition.

Thyroid literally means "shaped like a shield." The thyroid gland lies in front of the voice box. The gland and it associated support tissues are shaped like a shield.
Symptoms of hyperthyroidism may include a rapid heartbeat, muscle weakness, tremor, weight loss, and the inability to tolerate heat.

About one or two in every 100 Americans develop hyperthyroidism. Most of them are women or girls.
Each year, about 500,000 Americans are diagnosed with hyperthyroidism.
The most common form of hyperthyroidism is Graves' disease. About 95 percent of affected individuals have this form of the disease.

Barbara Bush; Graves' disease sufferer

Nodular thyroid disease is much less common than Graves' disease as a cause of hyperthyroidism.
The three major treatment options-medication, radioactive iodine, and surgery-work by decreasing the amount of thyroid hormone produced. The goal of treatment is to bring the body into a healthy, balanced condition.

About 30 percent of people with Graves' disease have associated eye disease. Hyperthyroid eye disease may cause significant changes in vision along with eyes that bulge or protrude from the face. Other problems with the eyes vary greatly and may include discomfort, pain, or excessive tearing to blurry vision or even double vision.

What Causes Hyperthyroidism?
These are two major causes of hyperthyroidism.
About 95 percent of persons diagnosed with hyperthyroidism are found to have a condition called Grave's disease

Most of the remaining persons have a condition called nodular thyroid disease
A less frequent cause is inflammation of the thyroid gland, called thyroiditis
Uncommon causes include hormone producing tumors of the pituitary gland or ovary and iodine-induced hyperthyroidism from iodine-containing drugs

What Is Graves' disease?
Graves' disease is a condition resulting from a problem in the body's immune system.

The immune system is a complex network that normally defends the body against "invading" organisms and other foreign substances. When the immune system detects a foreign substance in the body, it responds to this by producing antibodies against the invaders. These antibodies will recognize and attack this foreign substance when they next encounter it.

In Graves' disease the immune system mistakenly directs an immune "attack" against its own healthy cells. Antibodies are manufactured and misdirected against the thyroid gland, mimicking the action of the hormone from the brain (thyroid stimulating hormone) that normally controls the thyroid function. These antibodies act like a switch put into a permanent "on" position. Thyroid cells are continually stimulated to produce and release thyroid hormone, even after blood levels are already high.

Any condition in which the body's immune system attacks its own cells is called an autoimmune disease.

Graves' disease is more frequent in women than in men. The symptoms of Graves' disease may begin at any age but those between the ages of 20 and 40 are more likely to develop this condition.

What Happens With Graves' Disease?
With time, the over stimulated thyroid becomes generally enlarged and may eventually become noticeable to the affected person or others as a swelling in the front of the neck. In addition, in some people Graves' disease may be associated with particular eye and skin changes.

The eye changes are called hyperthyroid eye disease and occur in about 30 percent of people with Graves' disease. These changes are visible as protruding eyes. There is no relationship between the appearance of eye changes and the severity of the hyperthyroidism. There is increased risk for infection and visual problems in persons with severe hyperthyroid eye disease.

Eye disease is most likely to progress in people who fit a certain profile.

This includes those:
. Whose hyperthyroidism is not promptly corrected and controlled
. Whose thyroid hormone level is not within normal limits
. Who smoke cigarettes

The autoimmune process that causes hyperthyroid eye disease is poorly understood. Doctors do understand what causes the swelling of tissues behind the eyeball, decreased range of motion of the muscles around the eyeball, and retraction (a pulling back) of the eyelids.

Common symptoms include pain, excessive tearing, increased sensitivity to light, blurred vision, double vision, or protrusion of the eyes from the face.

The most common skin problem associated with Graves' disease is called pretibial myxedema, which is characterized by swollen patches of skin on the front of the lower legs. This skin change is found in about five percent of persons with Graves' disease. These patches itch and become bothersome; usually no other symptoms or problems are associated with them. Doctors evaluating a patient with possible hyperthyroidism check for pretibial myxedema because it is almost never found in persons who do not have Graves' disease.

What Is Nodular Thyroid Disease?
Nodular thyroid disease is unlike Graves' disease in five important ways:

Nodular disease is much less common.
. The cause is not known.
. It tends to develop in persons older than those who develop Graves' disease.
. The disease process is not found throughout the thyroid gland.
. No particular problems outside the thyroid, such as eye or skin disease, are seen with nodular thyroid disease.

When a physical exam is done, the thyroid is usually enlarged and painless. As untreated disease progresses, distinct nodules (lumps) may be felt with the fingertips. Within the thyroid gland, nodules of abnormal thyroid cells are visible among areas of normal cells. This patter of nodular disease is seen as spots of over activity on radioactive iodine uptake scanning.

Is Hyperthyroidism Genetic?
Certain genetic factors may make someone more likely to develop an autoimmune disorder. It is not uncommon for individuals with Graves' disease to develop other autoimmune conditions including:
.. Hashimoto's thyroiditis, a thyroid condition that results in an unusually low thyroid hormone level

.. Pernicious anemia

Nice To Know:
The fact that there is a genetic basis for Graves' disease means that more than one member of a family may develop it. When one person is diagnosed with Graves' disease, other family members should have their thyroid function checked by their doctors

What Are The Symptoms Of Hyperthyroidism?
If you think of the body as a motor car, the most common symptoms of hyperthyroidism imitate a vehicle that is running too fast, for too long.

These symptoms include the following:
. Rapid heartbeat, sometimes with palpitations
. Extreme tiredness
. Inability to tolerate heat
. Excessive sweating
. Weight loss, with a normal or increased appetite
. Nervousness and irritability
. Inability to sleep
. Shakiness and muscle weakness, often with trembling in the hands
. Diarrhea
. Menstrual problems in women, especially lighter periods or absence of periods
Some symptoms, such as excessive sweating and the inability to tolerate a hot environment are directly due to heat generated within the body by increased metabolic activity.

Weight loss reflects use of body stores of fats, proteins, and carbohydrates, as normal food intake cannot keep up with demand.
The presence and severity of symptoms varies from person to person. For reasons not understood, older individuals with hyperthyroidism often have far few symptoms compared to younger people. Although many symptoms of hyperthyroidism cause distress, most are not dangerous.

An exception occurs in some people who have heart disease. In these cases, untreated hyperthyroidism places additional stress on the heart, causing problems such as heart failure, irregular heartbeat (atrial fibrillation), or abnormal heart rhythm (arrythmia).

How Is Hyperthyroidism Diagnosed?
Individuals with hyperthyroidism usually tell their doctors about symptoms such as rapid heart rate, intense fatigue, inability to tolerate a hot environment, and constant nervousness, jitteriness, or irritability. In addition, doctors look for physical signs such as weight loss, rapid heartbeat, slight tremors of the hands, or excessive sweating. The presence of such symptoms and signs strongly suggests the need for diagnostic testing for hyperthyroidism.

Hyperthyroidism is diagnosed from blood tests:
. Abnormally high levels of T3 and T4. This indicates that hyperthyroidism is present.
. An unusually low level of circulating thyroid stimulating hormone (TSH). This is normally due to an abnormality within the thyroid gland.

In some cases of hyperthyroidism, a special diagnostic scan of the thyroid gland using radioactive iodine called radioactive iodine uptake (RAIU) testing may be particularly useful. This test is often done on an outpatient basis in the nuclear medicine department of a hospital.

RAIU testing shows whether:
The entire thyroid gland is overactive, in which case, a large amount of radioactive iodine is "taken up" by the thyroid.
Only portions of the thyroid are overactive. Significant amounts of radioactive iodine are "taken up" by portions of the thyroid, not the entire gland.

Nice To Know:
Typically, Graves' disease produces increased iodine uptake throughout the thyroid gland. Nodular thyroid disease produces a scan that shows patches of increased iodine uptake surrounded by areas with normal uptake.

How Is Graves' Disease Diagnosed?
Most people with hyperthyroidism, or about 95 percent, are eventually diagnosed with Graves' disease.

The diagnosis is confirmed through laboratory testing.
In people with Graves' disease, blood tests usually demonstrate:
. Increased levels of T3
. Increased levels of T4
. Low levels of TSH
. Presence of thyroid stimulating antibodies

A radioactive scan, such as RAIU testing, is usually not necessary to confirm the diagnosis of Graves' disease. If a scan is performed, it typically shows increased uptake of radioactive iodine throughout an enlarged thyroid gland. Areas of iodine uptake represent those areas in the gland producing thyroid hormone.

How Is Nodular Thyroid Disease Diagnosed?
When a physical exam is performed, the thyroid is usually larger than normal; however, there is usually no pain associated with an enlarged thyroid. As untreated disease progresses, individual lumps or nodules may be felt with the fingertips.

RAIU testing may be used to diagnose nodular thyroid disease. In individuals with this form of hyperthyroidism, this test shows clusters or nodules of abnormal thyroid cells among areas of normal cells. After this test, doctors see "spots" of overactivity on radioactive iodine uptake scanning film.

Is Hyperthyroidism Serious?
How serious hyperthyroidism is depends on the severity of the condition causing it. In people whose thyroid hormone levels are only slightly elevated, the symptoms will be fewer and less severe than for those with very high levels of circulating thyroid hormone.

HAIR Falling

The seriousness of hyperthyroidism also depends on how well the body can compensate for the changes brought on by excess thyroid hormones. For example, a heart that is already stressed by heart disease may deteriorate and develop heart failure as the heart rate rises in response to the increased level of thyroid hormone. In addition, serious eye complications are fortunately rare, but need to be properly cared for.

How Is Hyperthyroidism Treated?
There is no known cure for Graves' disease. Three forms of therapy are available for the treatment of hyperthyroidism.
These therapies work by decreasing the amount of thyroid hormone made by the thyroid gland; therefore, an excess amount of hormone does not get into the bloodstream.

The treatments available are:
. Anti-thyroid drugs
. Radioactive iodine, also known as radioiodine or 131I

How-To Information:
When working with a doctor to decide the correct treatment for an individual, consider the following:
. Is there anything in the personal or family medical history that makes one form of treatment better for that individual?
. Will affected individuals be able to take their medications on time, every day, and stick closely to the dosing plan for an anti-thyroid drug over a long period of time?
. Would a permanent treatment choice, such as radioiodine, be better?
. What About Surgery As A Treatment For Hyperthyroidism?
Surgical treatment for hyperthyroidism involves removal of almost all of the thyroid gland. The remaining part of the gland is not able to produce excessive amounts of thyroid hormone. This surgical procedure is known as a near total thyroidectomy. Surgical treatment is less common than in the past.

There are important points to know about surgery for hyperthyroidism:
It brings rapid, permanent control of hyperthyroidism. Preparation before surgery with anti-thyroid drugs is advised; this may require several months.
Almost all patients develop hypothyroidism following surgery.
As with other surgical procedures, there are the usual risks of:
General anesthesia
. Bleeding
. Nerve damage
. Wound infection
. Other type of infection

. Other complications

Need To Know:
If any of the following factors are present, surgery is more likely to be recommended:

. A very large thyroid.
. A nodular thyroid of any size that does not demonstrate much iodine uptake on RAIU scanning. This finding eliminates radioiodine as a choice for therapy.
. A thyroid nodule that may be cancerous.
. Moderate to severe hyperthyroidism in a child or a pregnant woman.

Need To Know:
It is extremely important that people with hyperthyroid eye disease make sure that their thyroid levels remain normal after treatment for hyperthyroidism. Smokers must make every effort to quit. A smoking-essation program involving nicotine replacement therapy or a support group is usually helpful.

Hyperthyroid Eye Disease
Graves' disease may be associated with particular eye changes.

The eye changes are called hyperthyroid eye disease and occur in about 30 percent of people with Graves' disease. These changes are visible as protruding eyes. There is no relationship between the appearance of eye changes and the severity of the hyperthyroidism. There is increased risk for infection and visual problems in persons with severe hyperthyroid eye disease.
Eye disease is most likely to progress in people who fit a certain profile.

This includes those:
. Whose hyperthyroidism is not promptly corrected and controlled
. Whose thyroid hormone level is not within normal limits
. Who smoke cigarettes

The autoimmune process that causes hyperthyroid eye disease is poorly understood. Doctors do understand that there is swelling of tissues behind the eyeball, decreased range of motion of the muscles around the eyeball, and retraction (a pulling back) of the eyelids.

Common symptoms include pain, excessive tearing, increased sensitivity to light, blurred vision, double vision, or protrusion of the eyes from the face.

Most people with hyperthyroid eye disease do not need any treatment beyond special eye drops. When more extensive care is required, treatments may be needed to decrease the pressure on the eyeball. This increase in pressure is the result of tissue swelling in the eye sockets. Additional treatment may be required to increase the range of motion (ROM) of the eyes or to improve the cosmetic appearance of bulging eyes.

These may include:
. Treatment with certain drugs such as steroids or immunosuppressive drugs to decrease the swelling behind the eyes.
. External radiation therapy to decrease swelling behind the eyes.
.l Surgery to remove a small portion of bone from the eye socket.
. Treatment with certain medications such as steroids or immunosuppressive drugs to help improve eye muscle function and increase range of eye muscle movements.
. Plastic surgery to improve the appearance of eyes or eyelids

How-To Information:
When discussing treatment options, it is important to discuss several issues with your ophthalmologist including:
. Your chief concern about your eyes
. How will this concern be treated
. The chief medical concern from the eye doctor's perspective
. How will treatment address his or her concerns
. The presence of additional, significant medical conditions
. How the proposed treatment plan affects these pre-existing conditions
. The timing of treatment steps and the particular order of these possible treatments. For instance, it may be advisable to correct abnormally high or low levels of thyroid hormone before beginning additional treatment.

Looking After Yourself
People with hyperthyroidism may experience many uncomfortable and sometimes distressing symptoms.

These may include:
. Weight loss
. Heart palpitations
. Anxiety
. Irritability

Before and during treatment for hyperthyroidism, make sure your doctor knows which symptoms or problem are most bothersome to you.

How-To Information:
If anxiety or heart palpitations are troublesome, treatment with anti-adrenergic drugs, also known as beta-blockers, may calm these symptoms. If you already have heart disease, drug treatment with beta blockers may not be advisable.

Be sure that your endocrinologist and other treating physicians are aware of your other medical conditions, if any.

During treatment for hyperthyroidism, there may be some restrictions imposed on your day-to-day activities, including those related to your:
. Work
. Leisure time
. Recreational time
. Travel plans

This is particularly true for people who choose radioiodine therapy or surgery.

Need To Know:
If antithyroid drugs or radioactive iodine is used, thyroid hormone levels are monitored to ensure that they are maintained within normal limits. The treating doctor will schedule laboratory testing and regular visits to complete these tests.
When treatment is complete, most people feel much better than before their treatment. They are able to do more and to enjoy the activities of their daily lives. Most find that, after appropriate treatment, there are essentially no treatment-related limitations on their activities of daily living.

The chance of developing hypothyroidism, or low levels of thyroid hormone, depends on the cause of the hyperthyroidism and its treatment. It is likely, in many cases, that hypothyroidism may persist and become a permanent condition. Fortunately, hypothyroidism is usually treated successfully with thyroid hormone supplementation. This is taken in the form of a daily pill.

Oprah Winfrey diagnosed with hypothyroidism.

Need To Know:
The possibility of lifetime hypothyroidism as a result of treatment for hyperthyroidism is real. Therefore, it is important to make a commitment to regular, lifetime follow-up care. This follow-up ensures that thyroid hormone levels remain normal. After thyroid hormone levels are normal and stable, it is possible that hormone levels may need to be checked only once a year.

Hyperthyroidism And Pregnancy
About 1 in 500 women have hyperthyroidism during pregnancy. In some, it is a preexisting condition; in others, the condition will develop during the course of the pregnancy. It can be difficult to diagnose because the pregnancy often "masks" it; that is, some of the symptoms may be attributed to the pregnancy itself rather than to hyperthyroidism.

Hyperthyroidism may affect a woman's ability to become pregnant.
The most common cause of hyperthyroidism in pregnancy is Graves' disease.
Symptoms generally will be worse in the first half of the pregnancy, will lessen during the second half, and most likely will recur after the baby is born.
You should continue with your normal anti-thyroid medication during your pregnancy as prescribed by your doctor.

Most pregnant women and their babies will not experience significant problems if the hyperthyroidism is mild to moderate. If properly treated the pregnancy can be expected to progress normally.

Women with severe or uncontrolled hyperthyroidism have an increase risk of infection, iron deficiency (anemia), and high blood pressure accompanied by too much protein in the urine (a potentially dangerous condition called pre-eclampsia).

If a woman has severe hyperthyroidism, her baby has a chance of having hyperthyroidism as well. There is a risk to the outcome of the pregnancy, having a small baby or a premature birth.

Fortunately, most women who have hyperthyroidism in pregnancy can be successfully treated with medication.

The anti-thyroid drug
. Propylthiouracil or methimazole is commonly prescribed and can be safely used during pregnancy. It may take up to a month on medication for the symptoms to resolve.
. Radioactive iodine cannot be used during pregnancy. Rarely, if the symptoms and thyroid hormone levels cannot be controlled, surgery needs to be considered to remove the thyroid gland.

Hyperthyroidism does not affect labor and delivery. However, thyroid storm can develop which can be life threatening. The symptoms are an exaggeration of the normal hyperthyroid symptoms with a very fast heart rate, tremors, nervousness, altered consciousness, nausea, vomiting, diarrhea, and an extremely high fever. This will require intensive care treatment to try normalizing the very high thyroid hormone levels and keeping the patient cool.

Following delivery, anti-thyroid treatment must continue. Although both the anti-thyroid drugs Propylthiouracil and methimazole do pass into the breast milk, both can be used safely in breast-feeding women. You should discuss this with your physician.

Your baby will be thoroughly checked to be sure he or she is well with no evidence of thyroid problems. Most babies born to hyperthyroid mothers whose hyperthyroidism has been well controlled during pregnancy are normal healthy babies.

Putting It All Together
Here is a summary of the important facts and information related to hyperthyroidism:

. Hyperthyroidism is a condition in which there is overproduction of thyroid hormone by the thyroid gland.
. Symptoms of hyperthyroidism may include a rapid heartbeat, tremor of the fingers and hands, weight loss, and the inability to tolerate heat.
. The most common form of hyperthyroidism is Graves disease, a condition resulting from a problem with the body immune system.

. Some families have a tendency toward developing Graves disease.

. About 95 percent of individuals with hyperthyroidism have this form of the disease.
. About 30 percent of people with Graves disease have associated eye disease, which may cause significant changes in vision along with eyes that bulge or protrude from the face.
. The three major treatment options for hyperthyroidism-medication, radioactive iodine, and surgery-work by decreasing the amount of thyroid hormone produced.
. The effect of antithyroid drugs stops when treatment is discontinued, allowing the individual to switch to another treatment plan if necessary.
. Therapy with radioactive iodine permanently destroys thyroid tissue, meaning that too much thyroid will no longer be produced. The main disadvantage to this type of treatment is that hypothyroidism (low levels of thyroid hormone) may result. However, hypothyroidism is treatable.
. Surgery to remove almost all of the thyroid gland is called thyroidectomy and brings rapid permanent control of hyperthyroidism.
. Most people feel much better after treatment for hyperthyroidism is complete, but thyroid hormone levels still need to be checked periodically throughout a person lifetime.
. Most pregnant women and their babies will not experience significant problems if the disease is mild to moderate.

AWAS .. Pirates are on the Road to Kuala Pilah.

Today I feel urge to write on social issue instead of writing about medical one!! Aiming to help other peoples not to go through things I already suffered from it. My point from writing this article is to protect the principle issues, and never be about the material ones

There is saying said:

اذا أكرمت الكريم ملكته ،، وإذا أكرمت اللئيم تمرد

If you are generous to the genuine people, you can enjoy them …
If you are generous to sinister people they get revolt against you.

&

الساكت عن الحق شيطان أخرس

The One who is making quiet on the truth is a dumb devil.

"The measurement of a man have nothing to do if he is short or tall, big or small, only the measurement is about what he says, facts or false, lies or true, fulfill his prom

ises or deny what he says. No matter if he have a faith or with no faith, only his word will judge his legitimately or falsification".

I came to Malaysia as a Retired Medical Doctor after practicing medicine for almost 38 years in different location around the world. This time, I like to enjoy seeing Malaysia in depth; at the same time, my commitment is to help peoples and community around as medical advisory free of charges. My new mission is to educate peoples, how to protect themselves from different kind of aliments, diseases and infection, and stay in good health.

Beside I am medical carrier oriented doctor; I am also practicing applied herbal alternative medicine for 18 years with great successes starting in Canada. My desire is to introduce those medicinal herbs to peoples, and let them understand their potentials and health benefits.

While I am staying in Malaysia, I have to know very good Malaysian peoples; they are outstanding peoples full of manners and characters, they are genuine people no question about that, and the bottom line they are just good like the best apple fruits.

At the same time, I have to meet Some bad peoples, this nature of life!!

While the good peoples like good bright apple fruits in a box. The bad peoples on the other hand look like; and smell like; Rotten egg plant, staying in the same box with apple fruits, and I am trying hard to avoid get my hand dirty on approaching them, but whatever you try to be careful, my hand already get dirty; on knowing and dealing with such peoples before and today.

Last April 2008, we are looking to find some new plant to add to my collection here in Malaysia, working them in unused land at my house back yard. Therefore, my brother In-law suggests driving us to the road of Kuala Pilah. While we standing at one of those stalls on the road buying plant seedling, we meet a couple refer to them (Mr. & Miss Rubber).

They engaged with us by talking in English. I get to understand they are looking for help and advice, since they have a big area of farming land, and they need to know if it possible to utilize this land for good? Since they meet with some other peoples before us, and those peoples apparently simply turn there backs on any advice or action to them for a reason, and we get to know Why later!!

However, for me UNFOURTIONTLY I felt like I would like to help those people to find there way for good.

While we standing there on the corner of their land, I just suggest that I can help them to cultivate medicinal herbs for new concept. We invited them to our house; they came with their eldest daughter, which is already graduate form agriculture institute and having a diploma; and do nothing more than watching TV and staying at home no work, no nothing. (they all admitted this with no any denial).

I am very practical person, I always live up to any given word to any one. We start to talk business unconditionally, I never ask for advice fee, or asking any benefits from them. We start to draw a scheme of starting nursery area around there house to be easily handled by any family member around. For the big farming land area, it would be a future expansion to after developing the start nursery, Then we can talk business more seriously.

I offered to help them in doing plantation on my house back yard nursery, all medicinal herbs on my own expenses; and I start plant them by hundreds, and offering them different Varity of seeds of exotic herbs; none exist in Malaysia before. My plants and small growing trees inside my own herbal nursery where Hijacked continuously, and intentionally, on a frequent times through (Nine months), since we get to know (Mr. & Miss Rubber).

Some of my stoolen Herbs taken by Hundreds each; to Hijackeers place

I thought they would respect our VERBAL agreement of doing business together on foundation of 50/50 calculation. To be partners on the side of my effort; and working with them on developing there land; by thoughts, MONEY, and ideas; and by offering those new herbs; which they already taken it to there land; and planted there.

On the other hand, literally, they hijacked my herbs from my place to there place in Kuala Pilah.I count my plants; and I do have inventory of them, they are OVER 2000 seedling and cutting in plastic poly-bags or just loose. I do prepared them with my own hands; with lots of tiredness, and extra sweat, and money spending - plus 200 small trees (Ten month old) already hijacked from my herbal nursery, moving them by there truck Ta-Ta, with NO payment or return back, or apology from Hijackers.

What a shame when this can happen from Moslem or non-Moslem peoples.

قال تعالى : يا أيها الذين آمنوا أوفوا بالعهود- سورة المائدة /1

"And fulfilled the Covenant; the Covenant was responsible"

Those peoples can deceive you easily, by showing you there rituals as if they are doing every things just right. They use to complain from surrounding neighbors that they make fun of them, and look inferior to them. At that time of early involvement with those Hijackers, we have another impression, which they are good enough to us; but the dirty stuff is already hiding there, not surface yet.

The rest of the story already long extended to 9 months ago. Where this Mr. & Miss Rubber asks for sharing them in doing a project together; as a joint venture; and take them from zero information about medicinal herbs values, and there potential in the market value. We start with them and took them on high-level stand, to leap forward towards the market, and expand ourselves with them by sharing together incoming profits. this is our agreement on doing so.

But they never fulfill their promises in any given time.

After hard work and lot of effort to teach them the value of the project, now they have there own herbal nursery, and there own Blog site; on their own name. Using my blog site, and use most of my herbs to trade them in open market, freely, solely for themselves; also using my reputation as a medical consultant to give people more confidence about what they are promoting in their blog site, with no consideration for us as a joint partners; and suppliers of the herbs and knowledges, as we agree VERBALY before.

Even though; and by time they were asking for Money capital from our side to do a side project – Planting three ( 3 ) Acers of Corn on there land – and as they says: "They guarantee within 3 month - they will retune back the capital plus our share of the profit from planting this corn." We pay the money 8,000 RM; and wait 3 months, then four months; then 5 months up to 8 months and our money not yet to come back!!

Guess what happened! They hijacked my money for eight months, no planting corn or nothing like that, but doing and improving on our Hijacked herbal plants for themselves. Listed those herbs in there blog, clam they are the owner of those plants, selling them to the public after they learn how it works; and I already suffered hard time during teaching them HOW to do it and how it works!

علمته الرماية فلما اشتد ساعده رماني

"I taught him how to shoot; when his shooting intensified, he shoots me."

Not only they betrayed me, but also they go up higher level aiming to betrayed the governmental agriculture department and get a loan from the bank on reputation of my stolen plant. they succeeded to hijack the government department money too; to pay back my Hijacked money after 8 wasting months.

Not only that, I use to be generous unconditionally even with there kids, I offer to loan there eldest daughter -21 tears old- She Just finished her Diploma in KPM Beranang, and she is in charge for running this swindle operation. I looked to the girl as mature adult; and responsible person and willing to start her carrier life with honesty and credibility.

In addition, in the presence of her parents, I give her 500 Saudi Riyal money, to assist her to buy the necessity materials, and help her to lunch the herbal project operation.

The girl took my money and kept the them in her folder as a souvenir!! She never spends a penny from my 500 Saudi Riyal money in any items, and she liked to foul me too, marching on the same road her parents did to me and grip on my money like bloody sucker leech.

After they already stand on a solid ground, betrayed other peoples on the road the same way they did to me, and after calling them 10 times and sending e-mails to retune my own money back; I admit they succeeded to tortuous me for eight months utile they paid my money back in installment.Yes, I get the eight thousands RM back, but there girl refuse to return the other 500 Saudi Riyals money back "She also likes to bite the hand that helped her" in there hard time.

How Many Chances Do You Give a Cheater?

In conclusion: comparing some human behaviors with animal behaviors you can find in many occasion, the animal behaviors can win as better-quality behavior.

Warning: My aim of writing this short story is to advise other good peoples; they might like to go to that destination; or may be are already there waiting for there turne "on the road to Kuala Pilah" To be watchful; and try to avoid things like that might happen to them too.

The bottom line is that: Those folks declare their identity, and label themselves as rude, anemic -in the since of the mutual respect- opportunistic, penny-pinching, stingy, greedy, very selfish, very calculative, dishonest, break there promises always. No wonder when they says, they are not loved by there close neighbors, relatives, or friends, mainly because their bad attitude; and intentionally misleading honest peoples in non-honorable way.

That is enough for time being; I would continue later.

Full story available on request

Female libido; problem and solution

Understanding Female Libido

The word libido commonly refers to the desire to have sex or one's sex drive, but the word is much more complex.
Libido for both men and women are virtually the same, although they can be affected in very different ways. The Libido is affected by both physical and emotional or psychological factors.

While testosterone drives the libido, it can also be affected by psychological and physiological aspects. Depression, fatigue and even one's self image can affect your libido. These would be examples of how the psyche can affect the level of Libido.

Hormonal changes in the body seem to be one of the greatest threats against libido for woman. The lack of testosterone in the body causes a drop in libido. Women may notice a slight to extreme change in their desire to engage in sexual acts when their hormones are fluctuating like during pregnancy or even menopause. There are remedies for the latter through hormone replacement, while with a pregnancy you need to take the route of patience. As the hormones level out and get back to normal the libido can return.

A woman's libido can affect much more than just her desire to have children. It can also affect her over all mental and physical health. The lack or over drive of a woman's libido can be a signal of other underlying problems. Women should feel free and comfortable to discuss changes in their libido with their doctor as female libido is an internal message board from your body. It can point doctor's to the right path when it comes to your health care.

Daily factors that cause a low, unsatisfactory female libido
Though the term ‘libido’ has been around for hundreds of years, it is only within the last decade that female libido has reached the medical community. With all the male sexual enhancers out there, it’s about time science caught up with the ladies! There are many reasons behind a low libido these days. Women are working more and have more pressures on them. Lifestyle choices, including smoking and alcohol consumption, as well as medical conditions like diabetes, all play a factor in low female libido.

Both men and women experience a drop in their sex drive from time to time, and this is normal. There are many reasons for these temporary decreases in libido. Aside from life’s daily stresses, there could be a number of reasons a woman shows little or no interest in sex, whether it’s emotional issues or physical problems.

Medical origins of a low female libido
Sexual dysfunction is a problem with the act of having sex during any point during the encounter. It can start with lack of desire, but extend all the way to failure to reach orgasm. Sometimes problems reaching orgasm can turn around and affect desire because if a woman knows there is no resolution to the sex act, there’s no point in having intercourse.

Sexual Arousal Disorder refers to a problem in either achieving or maintaining sexual desire. Long before medical science started looking into female libido, they used to call this medical problem frigidity. We now know that there are a number of reasons for not having an active libido, not the least of which is vaginal moisture.

Achieving your full sexual satisfaction potential
While it’s true the answer to low female libido may lie in an undiscovered medical problem, it can be as simple as your own personal lubrication. Even a normal female libido can be accentuated by a sexual enhancement product designed specifically for women for precisely this issue.

What if through nothing more than a proper mixture of natural ingredients could boost your sex drive, or improve a dull sex life?

Loss of Libido
Perhaps the most frustrating change in your sexual life is the loss of libido, of "those urges." You've lost your hair, your breast is altered or gone, you've put on weight, you have no energy, you're tired, you're nauseated, and you hurt in new places. No wonder you're not feeling sexy.

Your sex life may be altered by vaginal pain resulting from breast cancer treatment, especially after bone marrow transplantation. Certain chemotherapies can cause short-term ulcers in the body's mucous membranes (mouth, throat, vagina, rectum). Physical changes may result from hormone replacement therapy. Add the psychological stress, and pleasure from sex may seem like ancient history.

Advice from your doctors, or from friends who've been down the same road, may help, but some impairment of sexual function is generally unavoidable. Over time, however, things do get better.

Depression and libido
Depression is a common result of both the diagnosis and the treatment of breast cancer, and it directly affects your interest in sex. If you're depressed, sex may be the last thing you want to deal with. (You may even develop a real aversion to sex.) A sensitive partner picks up on this and holds back. But then, when you've recovered, your partner may continue to show no interest in sex, and you may assume it's because you're no longer desirable.

If you are depressed and unable to turn the corner, you need help. Try to consider therapists or group support. You've undoubtedly heard of the success of new medications, but you'll have to be careful. Some therapies for depression may cause loss of libido, including Prozac (chemical name: fluoxetine) and Zoloft (chemical name: sertraline). Medications must be carefully administered and monitored by a qualified medical professional (usually a psychiatrist). Effective dose levels are important and not always appropriately prescribed, and for many medications it takes three weeks or more for you to feel the benefit.

Depression, however, is too debilitating a condition to ignore, so be sure to seek help. There are some things that time alone doesn't heal.

Hormones and libido
You may find that it has become harder to get aroused, and even harder to experience orgasm. "It takes so long to make it happen," said one woman. This dullness of response—if you can call it a response—is a consistent complaint. You must be open with your doctor, so that he or she can suggest appropriate medical solutions. Loss of desire and drive may be directly related to your lower estrogen, progesterone, or testosterone levels, brought on by your breast cancer treatment.

If you're having problems with sex, you might want to try downplaying the importance of orgasm, at least for a while. While you're recovering, try concentrating on pleasure from touching, kissing, and imagery, rather than penis-in-vagina orgasm. De-emphasizing vaginal orgasm may actually allow it to happen again sooner than you expected.

For some women who've had minimal interest in or opportunity for sex before all this happened, loss of libido may not be much of a problem. But if it is for you, talk to your doctor about the possibility of a hormone evaluation. A woman's sex drive is somewhat dependent on the hormone testosterone (the primary hormone in men), produced in the ovaries and the adrenal glands. A little goes a long way, and an adjustment may help restore sexual interest.

But if your testosterone level is within normal range (20 to 60 nanograms per deciliter in a blood test), more testosterone probably won't help. In fact, too much testosterone can produce acne, irritability, and male characteristics such as facial hair or a deepened voice. In addition, it's not known if "testosterone replacement therapy" is safe for women with a personal history of breast cancer.

Pain, nausea, and libido
Painful intercourse can destroy your interest in sex faster than anything else. Vaginal ulcers that arise during certain chemotherapies (such as 5-fluorouracil) are a major source of such pain. The ulcers may be particularly severe in women who have had bone marrow transplantation, but they do go away when treatment ends. Women with genital herpes may have an outbreak of the disease brought on by stress and a weakened immune system.

Steroids and antibiotics can cause yeast infections in the mouth and vagina. Pain medications, narcotics in particular, can also reduce libido.

Menopause, whether natural or treatment-induced, can cause thinning and shortening of the vaginal walls. Vaginal dryness (lack of natural lubrication) is another menopausal side effect. These conditions can contribute to pain during sex.
Nausea, a side effect of chemotherapy, can kill your interest in anything, particularly sex. And some anti-nausea medications depress libido.

Female Libido - How To Increase It Naturally
Some natural herbal aphrodisiacs can be potent in terms of increasing female libido
The natural herbs listed below can increase the pleasure of sex naturally and work on the physiological state of the body making it more active and energized making sex a more enjoyable experience.

The most popular natural herbs for increasing female libido and desire are listed below

Gingko

Gingko for sexual function was first investigated after an older man who decided to take ginkgo to improve his memory. His sexual function improved so dramatically that it caught the attention of researchers. Subsequent investigation found that it also has a positive effect on female libido

A test using Ginkgo biloba extract with 63 patients was found to be effective in 84% of patients with antidepressant-related sexual dysfunction.
In the study, all areas of sexual libido saw improvement, including desire, excitement, and orgasm.

Arginine
Arginine is an amino acid, also referred to as L-arginine.
It is one of the more popular supplements for sexual dysfunction for both men and women and is referred to us natures Viagra.
Arginine is needed by the body to make nitric oxide, a compound that works to relax blood vessels and allow more blood to flow through arteries and this of course includes to the sexual organs.
In a clinical study 77 women with decreased libido were given either a combination product or placebo.
Women taking arginine showed greater improvement such as increased reported sexual desire in 71% compared to 42%
They also reported other improvements such as they were happier with their sex lives, improved the frequency of orgasms, and experienced better clitoral sensation.

DHEA
DHEA is a hormone produced naturally by the adrenal glands.
It is converted in the body to both the female hormone estrogen and the male hormone testosterone. Levels of DHEA decline naturally with age and this can lead to decreased libido
Because older people with a natural decline in sex drive, several studies have examined whether supplemental DHEA can improve libido in these groups.
Research so far suggests that it can help improve sexual function in both men and women.
Physician supervision is strongly advised when using DHEA.
You need to consult an experienced professional before using it and make sure you have the correct dosage and are in good health.

Ginseng

Ginseng may improve sexual dysfunction in both men and women and has been used for thousands of years in China for this purpose.

The active ingredients, ginsenosides, are again believed to facilitate the release of nitric oxide in blood vessels which increases blood flow to the clitoris resulting better orgasms.
Ginseng is known to possess phytoestrogen activity and is believed to help the body adapt to stress, which again helps female libido

Dong Quai

Dong quai is an aromatic herb that grows in China, Korea, and Japan and is used by herbalists as a treatment for a variety of gynecological complaints from regulating the menstrual cycle to treating menopausal problems and is known as:“The women’s herb”
It is used as a general blood tonic and contains vitamins E, A and B12 and rich in tannins.
Researchers have identified six coumarin derivatives that exert antispasmodic and vasodilator effects.
The essential oil in dong quai contains Ligustilide, butylphthalide, Ferulic acid and various polysaccharides are also present.
These elements can help reduce blood clotting and relax peripheral blood vessels.
Although not used specifically to increase libido its affect on the overall body can help women feel more virile as again it has an effect on blood vessels which carry blood to the sexual organs

Female Libido is complex and may result from both medical and psychological conditions.
For female libido women a combination of all the herbs above can help women feel better and increase desire by improving mood, reducing stress, increasing nitric acid and improving blood flow generally.
As with any herbs only use under the supervision of a experienced physician.

Our herbal preparation to correct and help to solve all female genital organs problems is ... Intimacy Cream plus

Intimacy Cream plus has been traditionally used for women after childbirth. Usage of Intimacy Cream plus will restore vagina suppleness, tightens vagina tissue, significantly reduce vagina discharge, reduce excessive mucus of the vagina and increases intimacy between husband and wife.

How does Intimacy Cream plus work?

Intimacy Cream plus contains Oak Gall, also known as a natural astringent that contains antiseptic materials and antioxidants. The Oak Gall extract, helps smooth the texture of skin and restore suppleness. It also contains protein, carbohydrate, calcium, iron, vitamin A and B. correct ugliness appearance associated with a BIG vagina, Fights against local infection and diseases, Strengthen vagina to fight against Leucorrhoea (white water), Protect your vagina against Vaginits, Fights against Sexually Transmitted Diseases (STD)

How long does it take to feel the tightening of vagina and for how many days?
It varies from individual to individual. Intimacy Cream plus usually works 20 minutes after application but it is advisable wait for 60 minutes.

How often can I use Intimacy Cream plus?
You can use it once in 15 days. There is completely no risk of side effects as it is 100% natural.

Are there any side effects?
There are no side effects. Intimacy Cream plus is 100% herb-based. The main contents are Oak Gall and extra virgin Olive Oil+ many other medicinal herbs.

Can I use it immediately after childbirth?

Yes, you can. In fact, Intimacy Cream plus speeds up the internal healing process after childbirth. Women in Asia have traditionally been using Oak Gall (the main content of Intimacy Cream plus) after giving birth, to tighten their vagina tissue and strengthen the womb.

How much is Intimacy Cream plus?

We sale extra amount for less price at 20 USA dollars ONLY outside Malayasia, inside Malaysia is only MR 60+Shipping accordingly.

Preparation: 30 gram cream container

Do you ship worldwide?
Yes, we ship internationally.

How long does it take before I receive Intimacy Cream plus?

We will process and ship your order within 24 hours via first class registered mail.

Can virgins use Intimacy Cream plus ?

No, they cannot.

Want to Improve Your Sex Life & Relationship?"
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· It totally eliminates the need for vagina tightening surgery which is the fastest growing (and one of the most expensive) medical procedures being asked for by women today!
· It tightens the vagina and the muscles in the surrounding area!
· It increases a woman's sexual desire!
· It slows the menopausal process!
· It dramatically increases the intensity, frequency and quality of a woman's orgasms!
· It restores the natural elasticity of the vagina!
· It acts as a lubricant with a fresh, clean scent!
· It maintains natural color and a "teenage" appearance!

Facts of Life

It is common knowledge that men prefer a tight vagina for extra sexual pleasures. Generally, the vagina can lose some elasticity due to ageing, menopause, overstretching from childbirth or sexual activities.

You Need To Know:

. There are a few options you may choose to achieve a tighter vagina and restore your precious inner beauty. However, it is important to ask yourself these questions when you explore the various options:
. Are you prepared to spend thousands of dollars to go through painful and dangerous Laser .

. Vaginal Rejuvenation? Not only is it costly, you will also need time to heal before you can start to enjoy sex again .
. Are you willing to spend countless hours trying ineffective exercises and be disappointed with the results?

Feel great again. Experience the joys of lovemaking like never before the fast, easy, affordable and natural way - the Intimacy Plus Way!

Usage Instructions
1. Wash/cleanse vagina your fingers and vagina.

2. Wipe and dry vagina.

3. Apply cream evenly into vagina and wait for 20 minutes.

4. For full results, wait for 60 minutes before sexual intercourse.

5. After sexual intercourse, clean off any remains.

Caution:
This cream is not suitable for:

1. pregnant women

2. use during menstruation period

3. women with skin allergies or vaginal infection

4. women who are diagnosed or infected with sexually transmitted diseases

Women Genital Hygiene

Women Genital hygiene

Genital hygiene is very important for preventing infections from developing and spreading.
Many women take the issue of genital hygiene very seriously even to the extreme of becoming obsessed in cleanliness and aroma. Over cleaning of the vagina can in fact be harmful.


The inside of the vagina rarely needs cleaning with the use of soap. It has a natural balance of substances that can become disturbed by washing causing any bacteria that enter to have the potential of developing into an infection.
The external part of the vagina, the labia, should only need cleaning after toilet release using a mild soap and water. The area should also be cleaned following sexual intercourse.


Washing should be performed using a singular front to back motion to avoid bacteria around the anus from coming into contact with the vagina or urethra (the external opening to the bladder).

The anus should be the last part to be cleaned so the bath water or flannel does not become contaminated with bacteria that would be spread to other parts of the body.

Wash cloths and towels should be individual and washed after use.
Particular attention should be paid in the incidence of thrush and cystitis. All items should be single use and washed immediately, not left in the laundry basket.

There is no need to increase washing frequency whilst menstruating, as long as appropriate sanitary wear is being used. The use of stockings instead of tights and cotton underwear with good coverage rather than thongs, can help reduce the likelihood of perspiration and the transfer of bacteria from the anal region being introduced to the genital area. Perfumes and deodorants should not be directly applied to the genital region.

Once seen as a taboo subject, menstrual hygiene is now a multi-billion dollar industry with many products available giving women choices as to how they manage their personal menstrual hygiene.

Cleanliness
It is essential to maintain strict hand-washing practices before and after changing sanitary products. Any bacteria on the hands and fingers prior to fitting a sanitary product can be transferred to the vaginal canal and cause infection. Likewise, any bacteria on the fingers following the changing of a product can be transferred to other items.

Many women feel uncomfortable and unclean during their menstrual cycle and may wish to bathe more often. There are no rights and wrongs for washing and bathing and each individual will adopt practices that are acceptable to them. It should be noted though, that there is no need to clean inside the vagina during your period as this can disturb the normal body flora and increases the risk of infection. It is fine to gently cleanse around the external labia of the vagina and pat dry.

There are many feminine wipes and fresheners available for use during the menstrual cycle, though they are usually unnecessary and are used as much for their reassuring qualities than any other. They should not be used inside of the vagina as they may cause irritation.

Types of Products Available

Tampons

These are tubes of tightly packed cotton that are inserted into the vagina by either the fingers or with the use of an applicator. They are very discreet and once the correct technique of insertion has been established, they are extremely comfortable. They have the benefit of being wearable during any activities that the user wishes and are normally very reliable. The maximum time that they should be worn is eight hours, with the ideal duration between changing being four to six hours, or more frequently if necessary.

If you are likely to have a long sleep, it is not advised that they are worn overnight as the risks of developing toxic shock syndrome are higher. Toxic shock syndrome (TSS) is a potentially life-threatening condition that can arise from the prolonged use of tampons.

It is recommended that the lowest absorbency is used for each individual’s period so as to lower the risk of TSS. It is perhaps advisable to alternate the use of tampons with sanitary towels. Tampons should be avoided in the presence of a vaginal infection as the tampon provides an excellent breeding ground for bacteria and can spread the infection further.

Sanitary Towels

These are worn externally and are attached within the user’s underwear. They are less invasive than tampons, though can be more uncomfortable top the buttocks and upper thighs due to chaffing, especially in the summer months. They can be noticeable as pads designed for heavy flow tend to be bulky in some brands, so they are not ideal for use with some summer clothes.
Again these should be changed when needed and prolonged use should be avoided as they can develop noticeable odours. It is safest to use sanitary towels at night to avoid TSS.

Menstrual Cups

Menstrual cups can be either disposable or reusable and are worn internally. They collect and retain the flow, and can be emptied, cleaned and reused.
They are the best option for protecting the environment and are very cost-effective. They are discreet and the disposable variety are reported to be extremely comfortable.
All women manage their hygiene needs individually. There are no ‘correct’ practices and many of the issues surrounding menstrual hygiene are dependent of finances and cultures.

Sexually Transmitted Disease

The subject of STDs is a very important topic of discussion in modern society. With children in primary schools being taught about sexually transmitted diseases and the importance of protected sex, this subject cannot go without mention.

Types of STD
There are a multitude of diseases that can be spread from unprotected sex, some causing life threatening illnesses, others causing minor but highly irritating and embarrassing problems.
Sexually transmitted diseases can range from the extremely frightening HIV to the less problematic cystitis.

Preventing a Sexually Transmitted Disease
The most common ways of reducing the chance of transmitting an infection is by abstinence from sexual intercourse or by using condoms.

Condoms can be worn by either the male or female (Femidom), and are available in a wide range of colours, flavours, sizes and can even come with added features such as being ribbed.

Many people enjoy full sex lives without the need for having full sex by using methods of massage, touching and foreplay to enrich their lives; indeed this is particularly useful with a new partner until trust or the subject of being tested has been discussed.

There is nothing to be lost by asking a new partner for a full screen to be undertaken at your nearest clinic, but it is only fair to offer this test to be done on yourself also.
STDs can also be spread through oral sex and the use of condoms or cling film is useful to prevent this occurring.

Common Types of Illnesses

Herpes
Herpes can be found around the mouth or the genitals and can be spread easily from person to person by having unprotected sex and oral sex. Herpes results in painful sores and blisters and is a virus that once treated will continue to remain in the system through-out life.

Medications can be bought over the counter, though if these are not effective, a prescription from your GP or local GUM clinic may be necessary.
Avoid having sex whilst suffering from an outbreak and use condoms at all other times; though if sores have spread to areas outside the coverage of a condom, it can still be spread.

Gonorrhoeae
Gonorrhoeaeis a bacterial infection that can be passed by vaginal, oral or anal sex. The main consequence of Gonorrhoeae is infertility, and as it has no symptoms in its initial development it can be spread very quickly and very easily from person to person.

If left untreated for a long period of time, other parts of the anatomy may be affected and can have serious consequences. The best protection from Gonorrhoeae is the use of condoms and not having multiple partners.

Chlamydia
Chlamydia is a bacterial infection passed through intercourse and oral sex. It has no obvious symptoms and can cause urinary tract infections and infertility if left untreated.
Usually the only symptom of Chlamydia is from the urinary tract infection which can cause burning and increased frequency of urination.

Typical Symptoms of an STD
Below is a list of many of the symptoms that accompany STDs; it is worth remembering that these symptoms often occur a long while after the infection has developed so your treating doctor or nurse will want you to remember all sexual partners so that each infected person can be traced and treated.

. Discharge from the vagina or penis, often with itching.
. Pain during intercourse or when passing urine.
. Sore throat.
. Pelvic Pain.
. Sores or blisters developing that do not respond to other treatments.
. Swollen glands, fever, night sweats.

It is important to remember that by using condoms and by reducing the amount of sexual partners you have is the easiest and most effective way of protecting yourself from diseases.

It is impossible to tell from appearance who has an infection and who hasn’t. Do not be embarrassed to go and seek medical help; all appointments are confidential and you will gain respect for taking the responsibility seriously.

Thrush

is a yeast infection that occurs mainly in the mouth, vagina or with nappy rash. It is caused by a fungus that thrives in a warm, dark and moist environment, it is very common is women and is more likely to occur when pregnant, as a side-effect of certain medications, when run down or when immuno-suppressed, such as with HIV or when receiving chemotherapy. The fungal particles are usually harmlessly present in humans, but when unwell or under stress, it can multiply and become problematic.

Signs and Symptoms

Oral thrush is first seen with a redness of the tongue with the occurrence of a few small white spots. It can develop to a full coverage of the tongue with a thick whitish carpet-like appearance.
Vaginal thrush is distinguished by having a thick creamy discharge that can be odorous and itchy. The area may be red and tender with a small chance of pain when passing water.

Treatments
There a many creams and pessaries available for the treatment of vaginal thrush, and a selection of oral preparations to help eliminate oral thrush, many available as a single dose; the pharmacist at your local chemist can help select an appropriate treatment.

Prevention of Thrush

Avoid tight fitting clothes and underwear, especially in hot weather as this can increase the chances of developing thrush. If you know you are prone to thrush, try wearing stockings instead of tights and always wear cotton underwear, which should be changed at least once daily. Ensure the correct methods of sterilization of baby equipment is followed to help reduce the incidence of thrush in infants; if you are unsure, speak to your health visitor who will give advice on types of sterilization equipment available and demonstrate how to use it.

If using an inhaler of any type, always rinse the mouth after using the inhaler to prevent bacterial and fungal build-up.

Use separate towels for bathing and ensure strict hand washing techniques are employed to avoid the spread of thrush and the transfer of fungal infection from hand to mouth, especially after using the toilet or tending to menstrual hygiene. Avoid the unnecessary use of anti-biotics as this can increase the use of thrush developing.

Avoid unprotected sex, even with a long-term partner if thrush has developed as the infection can spread to partners. If thrush is a persistent problem, speak to your GP who may want to do blood and urine tests to rule out the incidence of diabetes.

If you are caring for someone with thrush, particularly the very dependent such as the elderly or mentally incapacitated ensure they have a frequent supply of clean fresh fluids and ensure teeth/dentures are cleaned thoroughly to help alleviate the symptoms.

Thrush is a very common problem and should not be confused with a sexually transmitted infection. It is a fungal infection that can develop in people of any age at any time.

Urinary tract infection or UTI

A urinary tract infection or UTI occurs when bacterial cells are found in the urine. Normally sterile before being passed from the body, urine is produced to excrete waste products from the body via the kidneys and out through the urethra. The urinary tract consists of the kidney, the ureters (tubes that connect the kidney to the bladder), the bladder, muscles and the urethra (the tube that connects the bladder to the external orifice.

If an infection is limited to the urethra, it is called urethritis, if it concerns the bladder, it is called cystitis; involving the kidneys is named pyelonephritis.
Causes of a Urinary Tract Infection
The bacteria that causes a UTI is normally found in the digestive tract, and is found to be abnormal to the bladder. As it is more common in women than men, experts believe that the reason for this is due to the shorter length and location of the urethra; it is a lot closer to the anus than in men, and it is thought that bacteria from the digestive tract migrates to the frontal area.

It can be transmitted through sexual intercourse, either from the transmission of germs from the anus, or passed on from the partner if they are suffering from a UTI themselves.

Signs and Symptoms
The most common symptom of a UTI is finding the urge to pass urine is a lot more frequent than normal. Often sufferers want to go to the toilet often, but when trying, cannot pass anything.
When able to pass water, it is often accompanied by a burning sensation that can be very uncomfortable for some. Urine may appear cloudy or even blood stained, and may cause pelvic pain. Any pain felt in the kidney area indicates the infection has reached the kidneys and needs immediate treatment, as untreated kidney infections can cause permanent damage.

Risk Factors

Being female seems to be the greatest risk factor as the incidence is much higher in women than men. There is also further increased risk if pregnant.
Those who are diabetic are more probable to develop a UTI, as are those who wear a catheter or use an intermittent catheter. Any foreign body of the urinary tract raises the chances of developing an infection; factors such as tumours or stones all increase the likelihood of an infection.
Children whom suffer from these types of infections are often found to have some degree of anatomical abnormality which will need treating.

Treatments
Increasing oral intake of fluids is useful for helping to flush toxins away and out of the bladder.

Drinking cranberry juice has been proven to help prevent the bacteria from adhering to the tissues of the urinary tract, so a daily drink of cranberry coupled with a generous intake of water will help to clear the infection.
Anti-biotics are frequently prescribed for the treatment of this infection, and the full course should be taken or symptoms may return.
Anatomical abnormalities, tumours or stones will need to be removed, often by a surgical procedure in order for the condition to be eliminated.
If pregnant, see your GP immediately who will prescribe anti-biotics, as a urine infection can complicate the pregnancy. Scientists are currently exploring the benefits of acupuncture in the treatment of a UTI.

Prevention

. Drinking plenty of fluids, including cranberry juice will help to stave off infections.

. If you are prone to infections, it may be worth considering a change in sexual practices as this may be the cause.
. When passing water make sure the bladder is fully emptied.
. When using toilet roll, always clean the area from front to back to avoid spreading the bacteria from anus to urethra.
. A diet rich in zinc and vitamin C increase the body’s immunity to infections.
. Urinary tract infections are a very common and often recurrent problem that affects more women than men. By employing some preventative measures the risk of developing a UTI may be lowered, some however will still be at significant risk of developing an infection.

Herbal medication for all women Genital Hygiene

Vagaclean powder is our herbal line of diseases and health problem prevention; it maintains healthy vagina, female organs, urinary tract, and in general good health and high female hygiene at one time.
It eradicates most resistant bacteria, virus, or fungus infection before it does any harm to your organs and your body.

Vagaclean powder is 100% organic herbs, no additives no chemical inside the formula.
It is very gentle and soft for all sensitive parts in your body. It is stringent, and would stop most of the vaginal discharges from happing, protect the urinary tract from infection, and keep your healthy organs maintained.

Package: 50 grams powder in tight container

Uses direction: use one small teaspoon in 3 cups of boiling water. Let it boil for 5 minutes, then let it to cool down or use it as little warm. Put the prepared liquid in a douche container, and start to clean the vagina and area around until the liquid is finished.
Repeat every day in the same time if you feel there is still dissatisfaction or abnormal discharge continues.

Price: 10 USA dollars or 30 RM inside Malaysia + shipping accordingly.

Insomnia, Difficulty falling asleep

What Is Insomnia?

Insomnia is a sleep disorder in which a person experiences poor sleep or has trouble sleeping. Insomnia can involve:

. Difficulty falling asleep
. Difficulty staying asleep (that is, waking up many times during the night), without necessarily having had any difficulty falling asleep
. Waking up too early in the morning
. Not feeling refreshed after a night's sleep

In any of these cases, the person feels tired the next day, or feels as if he or she did not have enough sleep.
Poor sleep for any length of time can lead to mood disturbances, lack of motivation, decreased attention span, trouble with concentration, low levels of energy, and increased fatigue.
About one-third of the average person's life is spent sleeping. Healthy sleep is vital to the human body and important for the optimal functioning of the brain and other organs.

There are three types of insomnia:

. Transient, or mild, insomnia - sleep difficulties that last for a few days; there is little or no evidence of impairment of functioning during the day
. Short-term, or moderate, insomnia - sleep difficulties that last for less than a month, that mildly affect functioning during the day, together with feelings of irritability and fatigue
. Chronic, or severe, insomnia - sleep difficulties that last for more than a month, that severely impair functioning during the day, and cause strong feelings of restlessness, irritability, anxiety, and fatigue

Need To Know:

Q: What is the right amount of sleep I should get?

A: Since everyone has different sleep needs, there is no "correct" amount of sleep. On average, most people need between seven and nine hours of good quality sleep each night in order to feel alert the next day. But some function perfectly well with only four or five hours a night. The key to healthy sleeping seems to be a consistent pattern, rather than the number of hours one sleeps.

Is Insomnia Serious?
Insomnia can have physical and psychological effects. The consequences of insomnia include:

. Impaired mental functioning. Insomnia can affect concentration and memory, and can affect one's ability to perform daily tasks.
. Accidents. Insomnia endangers public safety by contributing to traffic and industrial accidents. Various studies have shown that fatigue plays a major role in automobile and machinery accidents. As many as 100,000 automobile accidents, accounting for 1,500 deaths, are caused by sleepiness.
. Stress and depression. Insomnia increases the activity of the hormones and pathways in the brain that cause stress, and changes in sleeping patterns have been shown to have significant affects on mood. Ongoing insomnia may be a sign of anxiety and depression.
. Heart disease. One study reported that people with chronic insomnia had signs of heart and nervous system activity that might put them at risk for heart disease.
. Headaches. Headaches that occur during the night or early in the morning may be related to a sleep disorder.
. Economic effects. Insomnia costs the U.S. an estimated $100 billion each year in medical costs and decreased productivity.

Normal Sleep
Sleep is not a simple process. Many different parts of the brain control and influence sleep at different stages. There are two natural daily peak times for sleeping: at night and at mid-day, which in parts of the world is traditional "siesta" time.

Here is how the body initiates sleep:

. As light fades, cells in the retina of the eye send a signal to a cluster of nerve cells located in the hypothalamus, in the center of the brain.
. These cells in turn send a message to the pineal gland in the brain to produce the hormone melatonin, which causes a drop in body temperature and sleepiness.
. At the same time, another cluster of nerve cells in the brain is believed to deactivate three major chemical messengers in the body, that keep us alert: histamine, norephinephrine, and serotonin.

There are two distinct phases of sleep:

. Non-rapid eye movement (Non REM) sleep - The quiet or restful phase of sleep, also referred to as "slow wave sleep"; it is divided into four stages of progressively deepening sleep
. Rapid eye movement (REM) sleep - The phase of sleep in which the brain is active and dreaming occurs; it is also known as "dream sleep"

When we first go to sleep, the "brain waves" (the electrical activity normally produced in the brain) slow from a frequency of 10 cycles per second that usually occurs while we're awake, to about 6 cycles per second as our alertness decreases and we fall asleep. Then after about an hour, there is a sudden increase in brain wave activity for a few minutes when the electrical activity in the brain speeds up, similar to normal waking. This is REM sleep. During this time if the person is woken up, he will say he was dreaming.

Then the electrical activity of the brain slows down again. This cycle may be repeated several times during one night's sleep. Total REM sleep for the night is about 20% of the total sleep time. So we spend about a fifth of our sleeping time dreaming.

The phases of sleep occur in a repeated cycle of Non REM followed by REM sleep, with each cycle lasting about 90 minutes. The sleep cycle is repeated four to six times a night. It is possible to identify which stage of sleep a person is in by measuring different activities of the brain and body.
Each phase of sleep is important. Research suggests that Non REM sleep may play a role in bolstering the immune system and may also be tied to the rhythms of the digestive system. Experts believe that REM sleep is necessary for long-term emotional well-being and may help bolster memory.

Need To Know:
If your insomnia lasts longer than a few weeks and is affecting your mood, relationships, and ability to function well, it is a good idea to see a doctor, therapist, or sleep specialist.

What Are Sleep Disorders?
An estimated 40 million Americans experience some type of sleep disorder, but 95 percent of them go undiagnosed and untreated, simply because they do not realize they have a problem or because they think that nothing can be done for them.

Common sleep disorders include:

Insomnia, an inability to sleep or to remain asleep throughout the night
Obstructive sleep apnea, in which a person's breathing passages become temporarily blocked during the night; this condition is often marked by excessive snoring
. Chronic sleep apnea, a neurological condition in which the brain "forgets" to instruct the body to breathe

. Restless leg syndrome, in which a person has occasional movement and/or uncomfortable sensations in his or her legs, feet, or toes just before they fall asleep

. Hypersomnia, an increase in sleep by about one-fourth of a person's regular sleep patterns
. Narcolepsy, in which a person gets sudden attacks throughout the day and night of drowsiness and sleep that cannot be controlled
. Parasomnias, which are vivid dreams and physical activities that occur during sleep, such as sleepwalking (somnambulism) and episodes of screaming and flailing about (night terrors).

Nice To Know:
Chronic sleep deprivation - in which a person sleeps soundly, but just doesn't get enough sleep - is not classified as a sleep disorder, but it contributes greatly to our sleepy society. Experts say most of us need at least one more hour of sleep per night than we get.

Facts about insomnia:
. Studies estimate that about one-third of the adult population in the world experiences some insomnia each year.
. Experts estimate that only about 5 percent of people with insomnia seek medical help, and 69 percent never even mention the problem to their doctor.
. More than 35 million Americans suffer from long-lasting insomnia, with 20 to 30 million others experiencing shorter-term sleeplessness.
. Insomnia costs the U.S. approximately $100 billion each year in medical costs and decreased productivity.
. In the U.S., as many as 100,000 automobile accidents and 1,500 deaths from these accidents are caused by sleepiness.
. In one study, 40 percent of people with insomnia also had a psychiatric disorder.
. At least 70 percent of people with depression also experience insomnia.
. As many as 25 percent of people with anxiety disorders also experience insomnia.
. Substance abuse - especially alcohol, cocaine, and sedatives - plays a role in an estimated 10 to 15 percent of cases of chronic insomnia.

How Is Insomnia Diagnosed?
Insomnia is almost always the result of some other problem and is not an 'illness' in its own right. Discovering its cause is the most important step in relieving it. Your doctor will ask questions such as:

. How would you describe your sleep problem (for example, do you have trouble falling asleep, or is the problem waking up too early)?
. How long have you been experiencing the problem?
. Does it occur every night?
. Does it affect your daytime functioning?
. Do you snore?
. Do you have any medical conditions?
. Are you taking any medication?

Nice To Know:
Keeping a sleep diary can help your doctor make a diagnosis. You should record all sleep-related information such as how long it took you to fall asleep, how restful the sleep was, what you ate or drank before bed, how often you woke during the night, etc. Your bed partner can also help by adding observations about whether you snored, moved in your sleep, etc.

Most of the time, a physician can make a diagnosis of insomnia from the information provided by the person. But if unexplained insomnia persists, or if there is evidence that the sleep disorder is caused by a breathing problem, a doctor may suggest a sleep study at a sleep lab to identify the root of the problem.

Getting Help At A Sleep Lab
There are many excellent sleep labs throughout the U.S. that are designed to diagnose sleep disorders through a sleep study. Most require spending one or more nights in the lab. The American Sleep Disorders Association has a list of the accredited sleep labs in the United States.

Most sleep labs require a referral from your doctor. However, you may want to call and find out if you can have an evaluation done independently. Once you have made an appointment, you will receive complete instructions as to what tests will be done and what is required of you.

How-To Information:

How is a sleep study done?

A sleep study is conducted overnight. The individual arrives in the early evening and plans to spend the night in a bed in the sleep lab. Although a sleep study may look high-tech, it is pain-free and individuals are usually quite comfortable.
Electrodes will be attached with soft tape to various parts of the body, including the head, chest and legs. A belt may be placed around the abdomen and chest. These devices are linked to computerized equipment that record the body's sleep patterns through the night.

Recordings are made of brain wave activity, respiration (breathing), heart rhythm, eye movements, chest movements, arm and leg movements, and pulse oximetry, which measures the level of oxygen in the blood. In the morning, there is a wealth of data that can be analyzed.

Nice To Know:
Q: Will my insurance pay for a sleep study?

A: Most authorized sleep studies are considered medical procedures and are covered by most insurance companies, including Medicare. Check with your insurance provider to determine if your policy covers a sleep study.

How Is Insomnia Treated?
Sleep research has led to major advances in the treatment of insomnia. Many experts now consider sleeping pills to be overused, as well as dangerous because they can become addictive. They suggest that medication be used a last option, after other treatments have been tried.

Non-medicine treatment options include:
Physical Relaxation

If you are anxious about falling asleep, certain muscles in your body become tense and sometimes painful, interfering with sleep. Physical relaxation techniques can help.

. Find a quiet, peaceful place in which to practice the following technique about 30 minutes a day:
. Lie perfectly still until you find the most comfortable position for yourself. Now deliberately tense up the muscles in your arms and legs as tightly as you can. Try to hold this tension for about a minute and then let the muscles relax gradually-first your legs, and then your arms.
. Now let your whole body feel as relaxed as it possibly can. Take a rest for five minutes and then repeat the procedure twice more.
. At the end of the session, try to concentrate on the feeling of your muscles and let them go as limp and relaxed as possible for the rest of the period. Try to make your breathing slow and steady as you relax.

.This technique is designed to teach individuals how their body relaxes and how to control relaxation and tension.

Mental Relaxation

Since stress and worry, including the worry about not being able to fall asleep, are often at the core of insomnia, many people have found that mental relaxation techniques can help them to feel less anxious and therefore sleep better.

This method also requires finding a peaceful, quiet place to practice this technique for about 30 minutes a day:

. Try to relax your body first, by finding the most comfortable position for yourself. Then empty your mind of all thoughts by concentrating on one particular object in the room or a particular part of the room.
. After a minute, sit up, and then walk around for a bit. Then return to your position and repeat the exercise.
. Now think of a particularly happy time in your life that you really enjoyed. If you cannot immediately think of something, find a poster of some exotic place or beautiful scenery. Concentrate on imagining yourself in this place for about five minutes.
. Try to feel the sensations first in your neck muscles, and then in your arm and leg muscles, as they gradually become relaxed. After another few minutes, get up and walk around the room a bit. Then repeat the process.
This exercise differs from the physical technique in that it emphasizes controlling the psychological components of anxiety before attempting to relax your body.

Other Techniques
Other relaxation techniques to try include:

. Yoga or meditation
. Exercise (shown in studies to be an effective way to achieve a healthy sleep)
. Mind-body therapies such as guided imagery or hypnotherapy
. Reading while lying in a relaxed position
. Listening to music while lying in a relaxed position
. Having a soothing bath or shower before bed
. Massage, especially of the neck, shoulder, and leg muscles

Need To Know:
Some people find psychotherapy (the treatment of mental and emotional disorders with professional counseling) very helpful in relieving anxiety or depression that could be contributing to insomnia.

Can Medication Help Insomnia?

Sleep medications should not be taken lightly. Low-dose sleep medication can help short-term insomnia but is rarely helpful for long-term sleep problems. Many experts today recommend only trying medications as a last resort, after other treatments for insomnia have failed, because they can be addictive and can have serious side effects.

Hypnotics (sedatives, minor tranquilizers, and antianxiety drugs) are among the most commonly used medications for insomnia.
. Most hypnotics require a doctor's prescription because they may be habit-forming or addictive, and overdose is possible.
. Many hypnotics can lose their effectiveness once a person has become accustomed to them.
. Hypnotics also may produce withdrawal symptoms, and this can make the insomnia return. For this reason, doctor's recommend reducing the dose slowly; complete withdrawal can take several weeks.

Sleep medications are available as:

Over-The-Counter Medications
Two inexpensive medications available without a prescription that can relieve mild or occasional sleeping problems are diphenhydramine and dimenhydrinate.

. These medications can leave you drowsy the next day, but they are not addictive.
. Side effects include dizziness, blurred vision, and dry mouth.
. They should not be used be used by people with angina, heart arrhythmias, glaucoma, prostate problems, or urinary problems.

Over-the-counter medications for insomnia are purchased more than any other type of drug.

Commonly used over-the-counter sleep medications include Nytol, Sleep-Eez, and Sominex.
When sleeplessness is caused by minor pain, over-the-counter pain relievers such as acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Advil, Motrin) can be very helpful.

Some newer medicines (such as Anacin P.M., Excedrin P.M., and Tylenol P.M.) contain both a sleeping medication and a pain reliever.
Antihistamines have a sedating effect and may be used as mild sleep inducers. They include chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl).

Need To Know:
About melatonin supplements

You may have heard about the treatment of insomnia with melatonin supplements. Despite its widespread use, little is actually known about the long-term safety of melatonin supplements. The U.S. Food and Drug Administration does not monitor melatonin, and many of the melatonin products sold in health food and supplement stores contain unknown substances.

Prescription Medications
Prescription medications for insomnia should be taken at the lowest dose possible. Various types of prescription medication include:

. Benzodiazepines. These are the most common and safest hypnotics. They include lorazepam (Ativan), alprazolam (Xanax), triazolam (Halcion), and temazepam (Restoril), among others. Side effects include respiratory symptoms, daytime drowsiness, memory loss, and odd mood states. Benzodiazepines are potentially dangerous when combined with alcohol and should not be taken by people who use the ulcer medication cimetidine (Tagamet).

. Non-benzodiazephines. These hypnotics may pose less of a risk of dependence. They include zolpidem (Ambien), zopiclone, and zaleplon. Side effects include nausea, dizziness, nightmares, agitation, and headache.

. Antidepressants. These can relieve insomnia associated with depression or early morning awakening. Newer antidepressants include trazodone (Desyrel), nefazodone (Serzone), and paroxetine (Paxil). These medications have far fewer side effects, and much less danger for overdose, than other anti-insomnia drugs.

Need To Know:

What are the ground rules for being prescribed sleeping medication for insomnia?
Simply put, the focus should be on what's causing the insomnia and not simply on giving treatment to help someone sleep. For example, is the insomnia due to a brief short-lasting worry, or is it a symptom of an underlying disorder such as depression? Sleeping pills do not relieve such an underlying disorder, whereas antidepressants usually do.

Many experts suggest the following ground rules:
. Try to avoid benzodiazepine sleeping pills and use a nonaddictive one instead.
. Try to take them only occasionally and not make a habit of it.
. Accept that the course of treatment will be short (no more than two weeks) and the prescription will not be repeated.

Nice To Know:
For women who have reached menopause, hormone replacement therapy (HRT) helps prevent insomnia caused by hot flashes, a common symptom of menopause. Studies have shown that women who take HRT seem to fall asleep faster, have fewer wakeful periods, and sleep longer than those not taking estrogen.

How Can I Avoid Insomnia?
Prevention of sleeplessness is very much dependent on your ability to relax and learn techniques for sleeping well.

How-To Information:

Here are some tips to help improve your sleep:
. Learn to use physical and mental relaxation techniques.
. Establish a regular sleep schedule. This involves setting a regular bedtime and wake-up time and making every attempt to stick to it, including on the weekends. This will help to set the body's clock in a way that will make nighttime sleep deeper and more consistent.
. Avoid taking naps, especially in the afternoon.
. Exercise regularly during the day.
. Use the bed only for sleep and sex, not reading or watching television.
. If you do not fall asleep fairly quickly, get out of bed. Do not return until you are feeling drowsy.
. Try to reduce stress in your life, or find better ways to cope with stress. .
. If it is noisy in your bedroom, introduce some form of "white noise" such as a rotating fan.
. Do not over-focus on falling asleep by watching the clock.
. Create a bedroom environment that is quiet, relaxing and peaceful.
. Set up a regular bedtime routine that revolves around an activity that helps you unwind.
. Avoid caffeine, and other stimulants, especially late in the day.
. Eliminate smoking. It has a detrimental effect on the lungs, heart, sinuses, and circulation, and it also interferes significantly with sleep, as nicotine is a stimulant that prevents the brain from resting. Cutting back on cigarette smoking may lead to nicotine withdrawal in the middle of the night, which can awaken you, so it is important to stop smoking completely.
. Avoid alcohol. Even if it helps you fall asleep quicker, it actually worsens insomnia by causing shallow, unrefreshing sleep.

Frequently Asked Questions

Here are some frequently asked questions related to insomnia.

Q: What is the right amount of sleep I should get?

A: Since everyone has different sleep needs, there is no "correct" amount of sleep. On average, most people need between seven and nine hours of good quality sleep each night in order to feel alert the next day. But some function perfectly well with only four or five hours a night. The key to healthy sleeping seems to be a consistent pattern, rather than the number of hours one sleeps.

Q: How can I tell if I am getting enough sleep?

A: Here are some simple questions to ask yourself to test for sleepiness:
Do I need to set an alarm clock in order to wake up in the morning?
If so, do I usually press the snooze button?
Do I feel like I need a nap during the day?
Do I fall asleep while watching TV?
Does reading a book make me feel sleepy?
If you answer yes to more than one of these questions, you are not getting enough quality sleep to meet your needs.

Q: What can I do to avoid insomnia?

A: Here are some rules to abide by:
Don't exercise just before going to bed.
Don't read or watch television in bed.
Don't use alcohol to help you sleep.
Don't take another person's sleeping pills.
Don't participate in stimulating activities just before bed.
Avoid all foods and drinks containing caffeine close to bedtime.
Don't lie in bed fretting. If you can't sleep, get up and do some quiet activity. Only return to bed when you are sleepy. Do this as many times in a night as necessary.

Q: Does insomnia ever go away on its own?

A: Sometimes insomnia does go away on its own. Usually this happens with short-term insomnia that is due to some temporary stress in your life. When it persists, however, it may be a sign of another illness, such as anxiety or depression, and you should seek treatment.

Q: What is REM sleep and why is it important?

A: REM sleep stands for rapid eye movement sleep. For most of the night, our eyes are still. However, every so often the eyeballs of a sleeping person will make rapid side-to-side movements under the lids. People woken up during these times report that they have been dreaming. During REM sleep the muscles of the body are very relaxed and movements are difficult. Some believe this semi-paralysis of the muscles stops us from walking around or otherwise acting out the scenes being played out in our dreams. Although adults spend only a fifth of the night in REM sleep, a newborn baby may spend half of its sleep in this stage. Some studies suggest that REM sleep is particularly useful for growth and repair of the brain itself, while the other type of deep, or slow-wave, sleep is useful for repair of the rest of the body.

Q: Why is alcohol detrimental to sleep?

A: After we have had a few drinks, alcohol often causes drowsiness and lets us get off to sleep quite easily. Later in the night, however, when the alcohol level in our blood decreases, our body's arousal mechanism is stimulated and our normal sleep pattern is impaired. In addition, one of the effects of alcohol is to stimulate the pouring of adrenalin into the bloodstream, causing arousal, sweating and palpitations. This can result in waking up half-way through the night, or earlier than normal, with the heart pounding, making it quite difficult to get to sleep again.

Q: Will my insurance pay for a sleep study?

A: Most authorized sleep studies are considered medical procedures and are covered by most insurance companies, including Medicare. Check with your insurance provider to determine if your policy covers a sleep study.

Putting It All Together

Here is a summary of the important facts and information related to insomnia.
Insomnia is a sleep disorder in which individuals experience poor sleep or have trouble sleeping.

. Poor sleep for any length of time can lead to mood disturbances, lack of motivation, decreased attention span, trouble with concentration, low levels of energy, and increased fatigue.
. Factors that increase a person's chances of developing insomnia include being female, being elderly, having certain medical conditions, taking certain medications, having had childhood fears, and having a lifestyle that includes frequent travel, smoking, or overuse of alcohol or caffeine.
. Insomnia has psychological causes (such as anxiety or depression), physical causes (such as illness or pain), and other causes (such as jet lag or environmental noise).
. The consequences of insomnia include impaired mental functioning, a higher risk for accidents, stress and depression, heart disease, and headaches.
. Treatment options for insomnia include physical and mental relaxation techniques, other techniques (such as yoga, massage, or meditation), and medications (over-the-counter or prescription).
. Prevention of sleeplessness is very much dependent on your ability to relax and learn techniques for sleeping well.

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Bronchial Asthma in General, Children and Adult

Asthma is a condition that affects the air passages of the lungs. It is a two-step problem:

· When a person has asthma, the air passages are inflamed, which means that the airways are red and swollen.
· Inflammation of the air passages makes them over extra-sensitive to a number of different things that can "trigger," or bring on, asthma symptoms.

During breathing, air is normally brought in through the nose where it is warmed, filtered, and humidified. It then passes through the throat and into the windpipe, called the trachea (TRAY-kee-a). The trachea divides into two large tubes called the right bronchus (BRONG-kus) and left bronchus. These then split up into much smaller tubes, which in turn branch into thousands of very small airways called bronchioles (BRONG-kee-olz). It is the large and small bronchi that are generally affected in asthma.

When a person is exposed to one of these irritants, or triggers, the oversensitive air passages react by becoming narrower, swollen, and even more inflamed. This obstructs airflow to and from the lungs and makes it very difficult for the person to breathe.

Is All Asthma The Same?
Asthma is a chronic condition. This means that while it often looks like it goes away for awhile, the inflammation of the air passages remains present all the time. However, in some instances, this inflammation may go unnoticed for long periods of time. As long as the air passages are inflamed, asthma can flare up at any time. This is one of the reasons that an awareness of the triggers that cause the flare-ups is so important in preventing asthma episodes.

Allergic asthma - Allergic asthma is most common in children and adolescents. Usually, but not always, the allergies that cause the asthma appear before the age of 35. An asthma attack or episode occurs when a person comes into contact with something to which he or she has developed an allergy.

· Nonallergic asthma - This type of asthma is most common in middle-aged adults. Asthma attacks may occur in response to triggers such as exercise, cold air, or respiratory infections. The allergic mechanism is not responsible for the asthmatic reaction.

What Is An Asthma Episode (Asthma Attack)?

Asthma symptoms can vary from very mild to very severe. Some adults with asthma have only seasonal bouts of symptoms. Some have symptoms only after exercise or after exposure to something to which they are allergic, such as a dog or cat. Others have a chronic form of the disease and experience asthma symptoms almost daily.

In an "asthma episode," also known as an "asthma attack," the symptoms develop because the oversensitive airways of the lung react by becoming more inflamed and narrows, thus obstructing the normal flow of air through the air passages.

The reduced size of the air passages occurs because:
· The muscles around the airways tighten
· The linings of the airways become swollen
· The normal secretion of the airways (called mucus) becomes "trapped," thus clogging the airways

As the airways become narrower and more obstructed, it takes extra effort to breathe and force air through them. The air may make a whistling or wheezing sound as it goes past the narrowed parts of the air passages. A person having an asthma attack may also cough a lot and spit up a lot of very sticky mucus.

SO one or more of the following symptoms may occur once the airways have narrowed in response to a trigger:

· Coughing. Coughing is often a sign of asthma, but is easily overlooked. As a general rule, healthy people don't cough unless they have something in their throats or have a cold.
· Wheezing. Wheezing is a whistling noise heard during breathing, as if something is "caught" in one of the breathing passages.
· Tightness of the chest. Many adults with asthma describe a tightness of the chest, an uncomfortable feeling caused by over-inflation of the lungs due to difficulty in pushing air out through the narrowed airways.
· Shortness of breath. Shortness of breath is the feeling that a breath is barely finished before another is needed. It has been described as "air hunger" by some people.
· Mucus production. Many people with asthma produce excessive, thick mucus that obstructs the airways, which can lead to coughing.

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For many people, asthma symptoms are worse at night and in the early morning or after exercise. Furthermore, an asthma episode often gives early warning signs, thus giving the person time to act.

Q. What makes my breathing passages so sensitive to triggers?

A. The underlying cause of the sensitivity in the airways is inflammation. Inflamed airways are highly reactive to triggers. In other words, they are easily irritated and respond by contracting, swelling, and filling with thick mucus. Some of the breathing passages don't have much supporting cartilage in their walls the way the windpipe does. As a result, they are not very "stiff" and are easily squeezed closed. Think of them as tiny tubes with thin muscle fibers wrapped around them like "rubber bands." If the "rubber bands" (airway muscle) tighten, the thin-walled passages are more easily choked off, making you short of breath.

Are Asthma Episodes Dangerous?

Most of the time asthma episodes are mild, and the airways will open up in a few minutes to a few hours in response to medication. But some attacks can be severe, lasting for a long time and not responding to the regular medication. And they can be very dangerous. A very severe, prolonged attack can threaten a person's life. Such an episode requires immediate emergency attention in a hospital.

Learning to recognize signals and take action to prevent asthma symptoms from becoming worse is an important step in the long-term control of asthma. So is managing an episode if it does occur.
Learning all about asthma will ultimately help a person have fewer and milder episodes and reduce the risk of a more serious attack.

This includes understanding about:
· The way your lungs work
· The things that cause asthma episodes
· The ways you can avoid those things
· The medicines that help prevent and control symptoms

What Does "Good Asthma Control" Mean?
The long-term goal in asthma management is "good asthma control." In fact, because of a better understanding of the disease and the development of newer drugs, drug treatments are so effective that many adults with asthma can go for long periods of time without symptoms.

Good asthma control includes the following goals:
· There is no wheezing, coughing, or shortness of breath.
· Nighttime sleep is not interrupted by asthma symptoms.
· Exercise and daily activities can be carried out normally.
· Reliever medication is used less than three times per week.

Facts About Asthma
· The process of moving air into and out of the lungs is something most people take for granted. But for as many as 15 million Americans living with asthma, this simple activity requires significant effort.
· Asthma cannot be cured, but with proper treatment it can be effectively controlled. Good asthma control allows most adults to live full, active, trouble-free lives.
· Without satisfactory control of asthma, long-term damage can occur in the respiratory system. Poorly controlled asthma can lead to reduced physical activities, missed work, and extra visits to the emergency department.
· For most adults with asthma, a reduced quality of life doesn't have to happen. Arming yourself with information is an important step in maintaining a healthy life.

What Causes Asthma?
We don't know what causes asthma. But we do know that:
· Asthma and allergies are likely to run in families and may be inherited.
· Children who have allergies at a young age may be at greater risk for developing asthma as adults.
· Some adults with asthma also had asthma as teenagers and as children. In some individuals, the condition may become less severe over time, but in others, the reappearance of symptoms in adulthood occurs. A respiratory infection sometimes sets it off, but often there is no apparent reason for the reoccurrence or increase in symptoms.

Certain conditions seem to make asthma worse. And for some it seems to be worse on certain days and at different times of the year. Asthma symptoms occur when sensitive lungs overreact to certain factors called triggers. These irritating factors are part of the environment in which we live and are different for different people.
· Allergies are a common asthma trigger.
· Other asthma triggers range from dust to air pollution, from exercise to weather changes.

Because everyone with asthma responds to different triggers, an important step in gaining control of asthma is to identify the factors that trigger asthma episodes in your lungs. Once you have discovered your own personal triggers, you will be able to work better with your doctor to prevent and control asthma attacks.

Asthma Caused By Allergies

In some people, an asthma episode is brought on by an allergy to something in the environment. Allergies occur when the body reacts to common harmless substances that normally don't trigger a response in another person. These substances are called allergens.
In the person with allergic asthma, a flare-up of the airways can occur when the allergen is introduced to the body. At first, reactions may be very minor, barely noticeable. But repeated exposure gradually increases sensitivity.
In an allergic reaction, certain body cells release various chemicals. In an asthma attack brought on by an allergen, these chemicals irritate the already inflamed air passages and cause the reactions that make the airways narrow and breathing difficult.

Common things that can trigger allergic asthma include tiny particles in the air derived from:

House Dust Mites

House dust mites are extremely small organisms that live in dust and feed on skin cells that have been shed by people. Products of dust mites are a common cause of allergies. They look like very tiny insects but are actually distant cousins of spiders. House dust mites thrive in warm, damp climates and are commonly found in mattresses, pillows, bedding, carpets, and upholstered furniture.

Ways to reduce exposure to dust mites:

Dust mites cannot be entirely avoided. But you should aim to lessen your exposure to them, particularly in the bedroom:
· Put plastic zippered covers on mattresses and pillows.
· In the bedroom, move out anything that collects dust (including the carpet if possible) and avoid upholstered furniture and clutter.
· Wash all bedding each week in hot water (at least 130º F).
· Linoleum, tile, and hardwood floors are best for minimizing both dust and dust mites.
· If possible, try to have someone who does not have allergic asthma do the vacuuming when you are not in the bedroom.
· Vacuuming will not get rid of mites, and in fact spreads them up into the air for several minutes before they settle again. Try to use a vacuum cleaner with a HEPA air filter (which stands for "high efficiency particle arresting") or a double-layer collecting bag.
· Keep the humidity in the room low, around 35% if possible (never over 50%), because high humidity encourages dust mite growth.
· Curtains should be laundered often; it is better to avoid heavy curtains and use window coverings such as easy-to-clean blinds.

Cockroaches

The dried-up body parts of dead cockroaches are a very potent stimulator of asthma in those allergic to them. Regular cockroach control is essential to good control of asthma for people allergic and exposed to them. This can be a particular problem in big cities.

Mold

Mold is the greenish, gray, or black material that grows in damp places. Molds or fungi release microscopic particles called spores for their reproduction. These spores can float through open windows into the house, especially on cool nights in the spring and fall. Asthma attacks may also be triggered by the type of mold that grows in the house.

Ways to reduce exposure to molds include:
· The use of air conditioners and dehumidifiers to reduce humidity. (They must be cleaned often to prevent mold growth.)
· Regular ventilation of the kitchen, bathroom, basement, and other damp areas of the house. (Exhaust fans in the kitchen and bathrooms work well.)
· Cleaning out mold from damp places in the house such as shower stalls, and clearing out moldy objects from closets. Use a spray cleaner with a fungicide in it.
· Keeping bedroom windows closed to keep out mold spores and pollen.
· Keeping drainage from rain water away from the house, in order to decrease humidity in the basement.

Pollen

Pollen are microscopic particles released by plants for their reproduction. Pollen is more a cause of hay fever than asthma. But there are some people with allergic asthma who clearly have problems with ragweed and other typical plant pollens that can cause a flare-up in their asthma.
Make note of whether your episodes of asthma are worse when the pollen count is high.

To prevent allergic reactions due to pollens:
· Pay attention to the pollen count in your area. Whenever necessary, keep the windows shut.
· Air conditioning can be very helpful in minimizing pollen entry into the house and in keeping the humidity down. But check with your doctor before purchasing expensive equipment.
· On days of high mold and pollen counts, if you have been outside for a prolonged period, take a shower and wash your hair before bedtime (to get the pollen and mold out). Also, leave your outdoor clothes out of the bedroom.
· Change pillowcases every two to three days.

Animal Hair and Dander

Many people are allergic to a substance in the saliva and on the skin of furry animals. This substance, called dander, is a powerful allergen. It gets on a dog's or cat's coat and is spread into the air and onto surfaces.

Dander can float through the air for hours. Cat allergen particles, for example, are only about one-tenth the size of dust mite allergen particles and can escape the filtration system on most vacuums. Cat dander can still be found in the dust of a house even months after a pet has left.

Hamsters, gerbils, mice, and rats can produce the same problem. In some individuals, fine particles on feathers may also set off an allergic reaction. Animal allergens are a potent stimulator of asthma. It is very likely that frequent asthma symptoms in someone living with a furry pet are caused by the pet.

To prevent allergic reactions due to exposure to animals:
· The best way to deal with pet allergy is to find the pet another home.
· If this is out of the question, the pet should be kept outdoors as much as possible and never allowed into the bedroom.
· Frequent washing (twice weekly at least) of the pet may also reduce the presence of animal dander in the home. Dog washing does not present any major problems when animal shampoo and lukewarm water are used. Cats present a greater challenge but can be slowly accustomed to the ritual by associating a positive experience such as feeding with the bath. Shampoo is not needed nor is it necessary to immerse the cat in water. A gentle wiping with a damp cloth will help remove some of the cat dander.
· Deciding what to do about a pet is not easy, but if its presence really worsens the asthma condition, making the hard decision is the right thing to do.

Do some foods cause asthma?
Foods are rarely implicated as a cause of regular asthma. Asthma in some people can be triggered by an allergy to certain foods, but the asthmatic symptoms are usually part of a serious reaction called anaphylaxis.

Other Asthma Triggers
A host of other things can bring on an asthma attack in susceptible people. These include:

Respiratory Infections
Asthma can be made worse by common colds, sinusitis, and influenza (the flu). Viral infections are known triggers of asthma attacks. Antibiotics don't work against viral infections, but medication to open up the air passages can help.

To prevent asthma episodes triggered by respiratory infections:
· Ask your doctor for flu and pneumonia shots for yourself and your family.
· Stay healthy with daily exercise, nourishing foods, and enough sleep.
· Avoid contact with people who have upper respiratory infections.
· Wash your hands frequently.
If you notice one of the following changes, suspect a respiratory infection:
· Fever or chills, sore throat, muscle aches, runny nose, cough

If you have a respiratory infection and experience signs that indicate you are losing control of your asthma, call your doctor as soon as possible. These signs include:
· Shortness of breath or wheezing
· Cough that is getting worse
· Production of a large amount of mucus, or mucus that is thicker than usual or is changed in color
· Awakening at night with asthma
· Increased need for your rescue inhaler

Follow your doctor's instructions and your asthma should quickly be brought under control again:
· Take whatever medicine your doctor prescribes, exactly as directed.
· Don't stop taking the medicine unless your doctor tells you to, even if you feel better.
· Follow directions for clearing your lungs of mucus.
· Keep your doctor informed of any change in your condition.

Irritants

Common products in the home can trigger an asthma episode. For example, inhaled fumes from a variety of common household products can irritate the sensitive airways of people with asthma and trigger episodes.

These products include:
· Cleaning solvents
· Paints, thinners, stains, varnish, and shellac
· Liquid chlorine bleach
· Sprays such as furniture polish and oven cleaners
· Personal products with strong smells such as hair sprays, perfumes, spray deodorants, and cosmetics
To prevent asthma episodes triggered by irritants:
· Keep strong-smelling chemicals out of the house, or try to stay out of areas where household cleaners and other substances with strong odors are being used.
· Rooms where hobbies are performed that produce strong smells should be aired thoroughly and often.

Industrial Fumes And Dusts At Work

Reactions to industrial irritants may occur suddenly or take years to develop. Substances known to trigger asthma episodes in susceptible people do so through either an immune response or through irritation of air passages.

Industrial substances causing an immune response include:
· Wood products (western red cedar)
· Dusts (flour, cereal)
· Metals (platinum, chromium, soldering fumes)
· Mold (decaying hay)

Industrial substances causing an asthma response because of irritation include:
· Dusts (cotton)
· Gases (sulfur dioxide, chlorine gas)

Because of the nature of many industrial jobs that bring workers into contact with these known asthma triggers, avoidance is usually not possible. The best protection is the use of approved personal protection and safety equipment associated with your job:

· Protective eyewear (glasses, goggles, hoods)
· Masks and respirators with approved filtration devices
· Proper ventilation and filtration of air in the work area

Air Pollution
There are certainly some "bad days" when it comes to air quality in some of the larger cities. Fine particles, gases, vapors, and smoke are added to the air near industrial areas. These substances can serve as powerful irritants of the sensitive and inflamed airways of some people with asthma. Inhaled pollutants that can act as asthma triggers include:

· Oxides of nitrogen
· Ozone
· Fine particles
· Sulfur dioxide

Cigarette smoke is a common indoor pollutant that can aggravate inflamed air passages.

To prevent asthma episodes triggered by substances in the air:

· Avoid breathing secondhand smoke from cigarettes, pipes, and cigars.
· Make sure no one smokes in your house or car.
· Always look for non-smoking sections in public areas.
· Insist on your right to clean air. No one has a right to create a health hazard for you.
· If possible, avoid places with dirty, congested air such as smoke-filled rooms, parking garages, dusty work areas, and traffic jams.
· Avoid smoke from barbecues and outdoor fires.
· Check the ventilation in your home. Modern, airtight homes often trap indoor pollution.
· Make sure that all fuel-burning appliances such as wood stoves and gas fireplaces are properly adjusted and vented.
· During days of heavy air pollution, check the news for air quality and pollution alerts.
· On really bad days, stay indoors and use the air conditioning if you have it.
· Avoid strenuous outdoor activities on days of poor air quality if air pollution is identified as one of your asthma triggers.

Exercise

Exercise can bring on an asthma episode in some people. Symptoms of asthma may begin after several minutes of exercise or after the exercise is over. They may last for a few minutes to an hour and usually get better by just stopping the exercise, but can continue even with resting.
These symptoms may limit play and interfere with performance. The severity of the asthma episode will depend on how intense and for how long the person has exercised. The symptoms are not caused by the physical effort itself, but by the loss of heat and moisture from the air passages that occurs when dry, cold air is inhaled rapidly.

Q: Can I still play the same sports I used to?
Most A. adults with asthma under good control can play sports if a good treatment plan has been worked out. Swimming is particularly encouraged by many physicians, but stick with the sports you most enjoy. Exercise and sport is most definitely encouraged for people with asthma.
Remember that one of the goals of asthma control is to allow normal activities to be enjoyed. Exercise is important for both general health and for the health of the lungs. Therefore, if the exercise you enjoy seems to be acting as an asthma trigger for you, ask your doctor about taking medicine before exercise so that the episode can be prevented.

To prevent asthma episodes triggered by exercise:
· Work out a plan with your doctor. This may mean taking medication 10 to 15 minutes before exercising to prevent symptoms while exercising or playing sports.
· Appropriate warm-up is important in reducing symptoms and can be very important for competitive athletes.
· Drink lots of fluids and adjust your activities accordingly on hot, humid days.
· If asthma symptoms occur during sports, take a short rest and then continue if possible. Medication may need to be taken when symptoms occur.

Nighttime

Asthma symptoms that occur at night are part of nighttime asthma, or nocturnal asthma, a very common condition for many people with asthma. Sleep is not the actual trigger, but while we sleep the airways tend to narrow and mucus tends to build up in the airways, often triggering a bout of coughing. There are many causes of nocturnal asthma, including:
· At night there are changes in body chemicals, which allow airway inflammation to increase.
· The drop in body temperature at night causes airway cooling and narrowing.
· Allergens encountered in the daytime may produce a delayed response three to eight hours later, just in time for nighttime sleep.
· Increased drainage from the sinuses while lying down may trigger a reaction in sensitive airways.
· Lying horizontally may allow some of the stomach contents to rise up into the esophagus. This is called reflux and may trigger an asthma episode in sensitive individuals.
To help prevent nighttime asthma symptoms:
· Check with your doctor if you have symptoms of nighttime asthma. Nocturnal asthma often responds to asthma medicines taken before bedtime.
· If reflux of stomach contents is the cause of your nighttime asthma symptoms, they may be minimized by antacids taken before bedtime, raising the head of the bed, or avoiding meals and alcohol just before bedtime.
Weather

The onset of asthma may be seasonal. Weather affects different people in different ways. For example:
· Heat, humidity, air pollution, and pollen counts in the summer can trigger an asthma episode in some people.
· In others, the wet conditions of the spring and fall may encourage the growth of certain molds that can trigger an attack.
· For others, the buildup of smoke, animal dander, and mites in a sealed house in the winter can aggravate asthma. Or, the cold temperature outside may serve as a trigger during physical activity.
To prevent asthma episodes triggered by weather:
· When the air quality is poor, try to limit outdoor activity.
· Try to eliminate sources of dampness in the home that may encourage mold growth.
· Replace furnace and air conditioner filters.
· Clean humidifiers and dehumidifiers to limit mold growth.
· Breathe through the nose when outside in cold weather. Cover the nose and mouth with a scarf on extremely cold days.
· Moving to a different climate with different weather won't cure asthma. Different triggers are found in different places, but asthma is quite common in all parts of the country. Remember that it is the sensitivity of the airways that is responsible for asthma episodes. The environmental trigger is simply the irritant that starts the process.
Emotions

Emotions do not cause asthma, but sometimes laughing, crying, and yelling stimulates nerves that cause the tiny muscles in the walls of airways to tighten in sensitive lungs.
People with asthma can become angry or frustrated with their condition and may refuse to take the medicines that will help them. Thus, in an indirect way, emotions such as anger may contribute to asthma symptoms.

To help minimize asthma symptoms due to emotions:
· Ask your doctor about taking extra medication if you are under severe stress. Do not change your dose on your own.
· When you start to feel excited, try to concentrate and relax your breathing.
· Always follow your doctor's instructions so that you can gain control of your asthma. With control of the situation, frustration and fear will be reduced.
Hormonal Changes
In some women, asthma symptoms increase at a particular time of their menstrual cycle, usually just before their periods. Asthma symptoms may become better or worse during pregnancy, because they may be influenced by hormonal changes.

Health Problems
Asthma symptoms can be triggered by a variety of health-related factors such as:
· Respiratory infections such as the common cold and flu
· Sinusitis (inflammation of the linings of the sinus cavities). Excess mucus production from the nose and sinuses ("postnasal drip") may drain into the throat and airways. This drainage combined with the release of body chemicals from inflamed sinus linings may act as trigger to irritate the linings of the airways, especially at night.

· Allergies (pollen, mold, dander)
· Gastro esophageal reflux disease (GERD) is a disorder in which the acid contents of the stomach enter the lower part of esophagus. In sensitive individuals, this may cause the asthma to worsen. Heartburn and nighttime asthma symptoms may indicate GERD disease. Inform your doctor of your nighttime difficulty with breathing and your heartburn symptoms. The doctor will prescribe medication that will reduce the symptoms of GERD and provide you with greater asthma control.

Medications Used To Treat Asthma
There are two completely different types of asthma medications, and they are used for completely different purposes:
· Medications to prevent asthma symptoms from developing
· Medications to relieve asthma symptoms once they've started
Asthma medications come in many forms - liquids, tablets, injections, powders, vapors and herbs too - so that it can always be taken in the most appropriate way.

Asthma medicines are tailored to a persons individual needs. Some adults with asthma only need an occasional dose of medication, while others need asthma medication on a regular basis.

Medications To Prevent Asthma Attacks
Knowing how airway inflammation prompts asthma symptoms, researchers have developed powerful "preventer medicines" for asthma that halt inflammation in a number of ways, including:

Stopping the production of chemicals in the body that cause inflammation
Blocking the release of these harmful chemicals from the cells that make them
Competing with these harmful chemicals so as to prevent them narrowing of the airway

Anti-Inflammatory Medicines

These medications prevent asthma attacks by:

. Reducing the swelling of the lining of the airway
. Reducing the narrowing of airways due to tightening by the surrounding muscle
. Reducing mucus formation in the airways

Anti-inflammatory medications are taken on a regular basis every day to prevent symptoms, even when you feel well.

. They are slow-acting (They take hours or weeks before they become effective).
. They do not provide immediate relief of symptoms

Regular use should decrease the need for your reliever medication.
Contact your doctor if you still have symptoms after two weeks

The main anti-inflammatory preventer drugs are inhaled corticosteroids. Examples of inhaled corticosteroids are:

1- AeroBid; Bronalide (flunisolide)
2 -Advair (fluticasone + salmeterol)
3 -Azmacort (triamcinolone) (has a built-in spacer device)
4 -Beclovent; Vanceril (beclomethasone)
5 -Flovent (fluticasone)
6 -Pulmicort (budesonide)

Corticosteroids are the most effective anti-inflammatory drugs for the prevention of asthma symptoms.

The corticosteroids used in asthma treatment are not the same as the anabolic steroids used by some athletes to build muscle mass and "bulk up."

Using a spacer with inhaled steroids reduces the risk for mouth and throat irritation. Gargling and rinsing the mouth with water after using the inhaler also is recommended.

At the usual doses inhaled steroids are well absorbed in the lung and produce few side effects. At higher doses, side effects may include:

. Hoarseness
. Cough
. Thrush (yeast infection in the mouth)

Other Preventer Medications

Sometimes the long-term control and prevention of asthma symptoms requires the use of other medicines in addition to, or in place of, inhaled corticosteroids. Your doctor will tell you exactly what to do if a dose adjustment in your inhaled steroid is required or if other asthma medicines are to be added.

Other preventer drugs that can help control asthma symptoms include:

Long-Acting Beta2-Bronchodilators
These medications include Foradil (formoterol) and Serevent (salmeterol). These are inhaled medications that are used in addition to inhaled anti-inflammatory steroids. They should not be used alone.

The amount of other preventer medicines you take may be adjusted by your doctor after you start taking long-acting bronchodilators. Do not change dosages of any asthma medicines on your own.

Long-acting beta2-bronchodilators are much more potent than short-acting beta2-bronchodilators such as albuterol. Do not take more than your doctor ordered.

These very potent and long-acting drugs relieve airway constriction for a long period of time (about 12 hours) but are not indicated for the relief of symptoms during an acute asthma attack.

If your action plan instructs you to take a short-acting reliever drug such as albuterol during an asthma attack, continue using your long-acting medication as directed.

Theophylline Bronchodilators
These include Theo-Dur, Theolair (theophylline). They are oral bronchodilator drugs (tablet or syrup) that work in a different way than the beta2-bronchodilators to relieve muscle spasm of the airways.

Long acting and useful for nighttime asthma symptoms.

Effectiveness in controlling asthma symptoms is related to the amount of drug in
Regular blood tests to determine the blood level of theophylline are required.
The blood level of theophylline can be increased by many different drugs such as erythromycin (an antibiotic) and conditions such as cirrhosis of the liver. The blood level of theophylline can be decreased by other drugs such as benzodiazepine (a tranquilizer) and factors such as cigarette smoking.

At higher doses, side effects may include nausea and vomiting, headache and dizziness, nervousness and irritability, and insomnia.

When theophylline is used properly and monitored under a doctor's care, it is a safe and useful drug in the management of asthma symptoms.

1 - Oral Corticosteroids

These include:

. Delta-Cortef (prednisolone)
. Deltasone (prednisone)
. Medrol; Solu-Medrol (methylprednisolone)

These steroids are related to cortisone produced in our bodies. They are sometimes required to control more severe episodes of asthma.

If used for more than a few weeks, the dose must be gradually reduced if the drugs need to be withdrawn

Long-term use of oral steroids can produce significant side effects such as high blood sugar, weight gain, fluid retention, high blood pressure, muscle weakness, and slow wound healing.

Your doctor may try to minimize these side effects by prescribing a very low dose of oral steroids, having you take the medicine every other day, or some combination of instructions.

2 - Nonsteroidal Antiallergics

These include Intal (cromolyn) and Tilade (nedocromil). Cromolyn and nedocromil are not related to the corticosteroids.
These drugs work by blocking the release of inflammatory chemicals from certain cells in the body.

They are useful in protecting the airways from exposure to allergens or to the irritating effect of exercise or cold air.

They may reduce the need for inhaled corticosteroids and bronchodilators.
The nonsteroidal antiallergics must be taken continually for maximum protection.

3 - Leukotriene Modifiers

These include:

. Accolate (zafirlukast)
. Singulair (montelukast)
. Zyflo (zileuton)

Leukotriene modifiers (or antileukotrienes) are the first new class of prescription asthma medication to be introduced in 20 years. The drugs control leukotrienes, which are inflammatory chemicals released by cells in the lung during an attack.
Leukotrienes cause lung tissue to become inflamed, mucus to be secreted, and smooth muscle around the airways to contract. These changes lead to asthma symptoms such as wheezing and shortness of breath.

Zafirlukast and montelukast control asthma symptoms by blocking the action of leukotrienes on the airways. Zileuton blocks the actual production of leukotrienes.

When used in combination with inhaled corticosteroids, the leukotriene modifiers may be helpful in preventing more attacks.
All of the leukotriene modifier drugs are oral medications, making them easier to take than most other asthma medicines that are taken into the lungs by inhaler.
Side effects may include headache and nausea.

Q: Can I cure or treat my asthma with a special diet?

A: There is no cure for asthma. And there is no diet treatment that can serve as an alternative to taking asthma medications and following the asthma control plan worked out with your doctor. A wholesome, nourishing diet helps promote general health, which is essential in the overall control of asthma.

Medications To Relieve An Asthma Attack

Asthma medications that relieve the muscle spasms responsible for narrowing of the airways are called reliever medicines. The medications that best accomplish this are the bronchodilators. ("Bronchodilate" means to open up the airway, and that's exactly what these medications do.)

Points to keep in mind concerning the bronchodilator drugs include:

They relax the airway spasms to provide immediate relief.
Bronchodilators are used before exercise or before exposure to triggers such as cold air.

They are to be kept with you at all times.
You should contact your doctor if you are not getting immediate relief from your symptoms.

Bronchodilators should not be used every day unless prescribed by your doctor.
A number of different inhaled drugs are available that relieve asthma symptoms.

They include:

. Short-Acting Beta2-Bronchodilators
. Anticholinergic Bronchodilators

Bronchodilators are commonly used medications that immediately relax the muscle of airways that are in spasm during an asthma episode and generally provide prompt relief. Side effects can include:

. Tremors
. Fast or pounding heartbeat
. Nervousness
. Dizziness

When taken as directed by your doctor, these reliever medications do not cause long-term side effects.

4 - Short-Acting Beta2-Bronchodilators

This group of inhaled short-acting reliever drugs includes:

. Brethaire; Bricanyl (terbutaline)
. Maxair (pirbuterol)
. Tornalate (bitolterol)
. Ventolin; Proventil (albuterol in the U.S.; salbutamol in the U.K. and Canada)

If you need to use these medications too frequently, or they don't appear to be as effective as they used to be, this can be a signal that your asthma is not being controlled effectively and may be an early warning signal of an asthma episode. These drugs are not recommended for long-term daily treatment of asthma. Always carry a short-acting beta2-bronchodilator for fast relief during an asthma episode.

5 - Anticholinergic Bronchodilators

One example of an anticholinergic bronchodilator is Atrovent (ipratropium).
It relaxes airway muscle by blocking the nerves that cause constriction of the airways.

It is sometimes used in combination with a short-acting beta2-bronchodilator.
It should be used with caution if you have glaucoma. Accidental spraying of the mist in the eyes can worsen the eye problem.
It is not fast-acting enough to be used as "front-line" reliever medicines during an asthma attack.

Common side effects include dry mouth, dry throat, dry nose, and headache.

Your Asthma Medication Checklist

Currently there are eight classes of drugs available to treat asthma:

Trade names and Generic names

Preventer drugs and drugs to control persistent asthma symptoms

1. Inhaled corticosteroids - These medications block the production or release of inflammatory chemicals in the body. Few side effects are produced by the inhaled drugs because of their local action in the lung.

- AeroBid; Bronalide flunisolide
- Advair fluticasone + salmeterol
- Azmacort triamcinolone
- Beclovent; Vanceril beclomethasone
- Flovent fluticasone
- Pulmicort budesonide

2. Long-acting beta2-bronchodilators - These cause relaxation of the muscle fibers surrounding the airways, thus opening up the narrowed passageways. These drugs are slowly cleared from the body; therefore, their bronchodilating effects last for a long time (about 12 hours).
- Serevent salmeterol
- Foradil formoterol

3. Theophylline bronchodilators - These cause relaxation of constricted airways by blocking the action of chemicals that cause contraction of muscles surrounding the airways. Oral, slow-release theophylline drugs are commonly used in asthma maintenance therapy. (A fast-acting intravenous form of theophylline is also available for emergency room treatment of severe asthma episodes.)
- Theo-Dur; Theolaire theophylline

4. Oral corticosteroids - These medications block the production or release of inflammatory chemicals in the body. Oral administration of corticosteroids for a prolonged time can produce several undesirable side effects.
- Delta-Cortef prednisolone
- Deltasone prednisone
- Medrol; Solu-Medrol methylprednisone

5. Nonsteroidal antiallergics - These medications block the release or action of inflammatory chemicals in the body, thus reducing the symptoms of inflammation, including relief of airway constriction.
- Intal cromolyn
- Tilade nedocromil

6. Leukotriene modifiers - These block the production or action of inflammatory chemicals called leukotrienes, thus reducing inflammation, relaxing the airways, and reducing mucus production.
Accolate zafirlukast
Singulair montelukast
Zyflo zileuton

Rescue medication for use during an asthma attack.

7. Short-acting beta2-bronchodilators - These medications cause the muscle fibers surrounding the airways to relax, thus opening up the narrowed passageways. These drugs are rapidly cleared from the body, therefore, their effects last for a relatively short time (about 3 to 4 hours).

Brethaire; Bricanyl terbutaline
Maxair pirbuterol
Tornalate bitolterol
Ventolin; Proventil albuterol

8. Anticholinergic bronchodilators - These medications block the nerve responses that normally cause narrowing of airways. They are commonly used in combination with a beta2-bronchodilator such as albuterol
Atrovent ipratropium

Using Inhalers
Many of the drugs given to prevent and treat asthma are inhaled. Inhaled medications do not have to be processed in any way by digestive organs in order to start working. Instead, they travel directly to the lungs, produce their effects quickly, and cause relatively few side effects.

Several different inhaler devices are available to suit the needs of different people with different kinds of asthma. All of them have their own advantages and disadvantages. Your doctor will decide which ones are best for you.

Our Herbal medication for asthma

1 - Verbascum thapsus (Bullock's Lungwort)

2 - Coltsfoot (Tussilago farfara)

3 - Thyme (Thymus vulgaris)

4 - Oroxylum seeds (Indian trumpetflower)

5 – Lobelia inflata (Indian Tobacco)

200 gram packages of drayed herbs ready to use as herbal tea to alleviate asthma symptoms and keep it in the bay.
Our herbs are gentle in action, safe to use for all ages, easy to use all the times.

The Asthma Action Plan
An asthma action plan is a written plan developed by your doctor to help in the management of asthma episodes. It is a customized plan that tells you what to do based on changes in your symptoms and peak flow numbers. It is also called a crisis intervention plan, asthma self-management instructions, or written guidelines for asthma.

Asthma action plans can be organized in any number of ways, but the important thing is that your individualized action plan gives you and your family information that can be invaluable in an asthma emergency. Action plans may include:

· A list of the triggers responsible for your asthma and how to avoid them.
· A list of peak flow meter readings and zones based on your personal best.
· A list of routine symptoms such as coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production, and what you should do if these symptoms occur.

· What you should do if nighttime asthma symptoms awaken you.
· A list of more serious asthma symptoms such as decreased effectiveness of your reliever medicine and breathlessness, and what you should do if these symptoms occur.
· The name and dose of the preventer medication that needs to be taken, even when there are no symptoms, and the name and dose of the reliever medication that needs to be taken when you are having an asthma attack.
· Emergency telephone numbers and locations of emergency care.
· Instructions about when to contact your doctor, whom to call if your doctor is unavailable, and a list of where to get emergency treatment.
· Information about asthma organizations and support groups.

Keep your action plan handy and keep it current. Action plans should be reviewed with your doctor at least once a year. Changes in the plan may be needed because of changes in your peak flow numbers or the medications you are taking.

Warning Signs Of An Asthma Attack

Asthma is an unwelcome intruder in a person's life. It is a chronic lung disease and it can't be cured. But there are several unique features of the disease that are not found with most other respiratory diseases.

· Asthma is reversible. With good treatment, the damage to the lung can be reversed or minimized.
· It can be controlled by avoiding asthma triggers and taking the right medicines.
· Asthma attacks usually can be predicted. Asthma episodes normally do not occur suddenly, without warning (although it may seem that way at times). They develop over a period of time, providing a chance to start countermeasures to ward off an attack.

What Conditions May Bring On An Asthma Attack

Changes in the external environment may signal an increase in the irritating effect of certain triggers for some people with asthma:
· Decrease in the environmental air quality (increasing pollution index)
· Increase in the pollen count
· Windy, dusty conditions
· High humidity and high temperature
· Low humidity and low temperature

The best course of action on such days is to avoid them if at all possible by staying indoors where the environment can be better controlled.

If Symptoms Get Worse

Early warning signs of an asthma episode may include symptoms such as:
· Runny, stuffy nose
· Sneezing
· Chin or throat itchiness
· Headache
· Feeling or looking tired
· Reliever drug being used more often than usual
· Difficulty sleeping because of symptoms such as coughing
· Physical activity brings shortness of breath

What to do: Follow your action plan and take your medications as per the plan.

Signs that your asthma is becoming severe:

· Awakening at night, unable to sleep
· Reliever drug is bringing little relief
· Breathlessness is getting worse

What to do: Contact your doctor immediately.

Signs that you asthma has become dangerous:
· Reliever drug brings no relief
· Peak flow stays in the red zone after using rescue medication
· Difficulty speaking
· Walking is difficult
· Feeling of fright
· Faint-headed

What to do: Go to the closest hospital emergency department immediately.

What To Expect At The Emergency Department

· Fast-acting beta2-bronchodilators that open the airways will probably first be given to you with a small-volume nebulizer. Nebulizers produce a fine mist of medication that can be inhaled through a facemask or mouthpiece and require no "coordination" between breathing in and the delivery of drug to the lungs.
· You will also probably receive additional asthma medications, possibly through an intravenous (IV) line that delivers drug directly to the bloodstream.
· Steroid medication may be necessary to quickly reduce the inflammation in the air passages.
· Oxygen will probably be delivered through a facemask or through small tubes that fit under your nose.
· In more serious cases of asthma, intubation may be required. In this procedure a breathing tube is placed into the throat so that oxygen can be delivered directly to the lungs.

What Should I Do During An Asthma Attack?

Ideally, your early warning signs such as a feeling of tightness in your chest, wheezing, coughing, and restlessness while trying to sleep will have given you the extra time you need to take the steps outlined in your personal action plan.

If the episode is just beginning:
1. Follow the instructions in your action plan. Take the medicines your doctor has prescribed to keep the episode from getting worse.
2. Pay close attention to the type of medication being taken. Because of the feeling of urgency and distress during an asthma attack, people sometimes mistakenly use their preventer medicine. This will not help the symptoms of an asthma attack. The reliever drug at the dose prescribed is what is needed. Make note of the color of the two different kinds of inhalers and make sure you use the one containing the reliever medicine.
3. Relax your breathing.
4. Use pursed-lip breathing.
5. Cough to loosen mucus in the airways and cough again to bring it up. Spit out the mucus into tissues.
6. Call your doctor if the attack is getting worse and you have taken the proper medicine and done everything else you can think of. This is not a time to feel embarrassed or ashamed. If you have followed the action plan and you are still having an asthma episode, it's time to seek medical attention. Don't wait too long to get a doctor's help when needed.

Need To Know:
Your preventer medication will not be of help in a severe asthma attack. Be sure you are using the reliever medication, not the preventer medication.

Relaxing in order to breathe more easily is not easy in a situation where fear, anxiety, and anger are natural feelings. But it can be done with practice:

· Start by sitting comfortably in a chair. Do not lie down.
· Relax your shoulders and neck. Concentrate on not gasping for air as you drop your shoulders.
· Breathe in slowly through your nose. Concentrate.
· Purse your lips together tightly the way a trumpet player does, and blow out slowly through your mouth. Take as much time as possible to exhale in this way.
· Relax. Keep using the pursed-lip breathing until the breathless feeling goes away. Rest between breaths if you feel dizzy.

Pregnancy And Asthma

If you are pregnant and have asthma, you should try to learn all you can about the drugs you are taking to control your asthma. Good asthma control is essential to provide the oxygen your body and the fetus needs. Your doctor will work out the asthma plan best suited to your needs while you are pregnant.

You must also communicate with everyone involved. Make sure your obstetrician knows that you have asthma and what you are doing about it. Also, you must keep the doctor who looks after your asthma informed about your pregnancy and the medications you may be taking. Your doctors will usually be well informed and experienced in treating asthma in pregnant women.

· As a general rule, your doctor will try to determine the lowest amount of medication required to control your asthma. It is important to keep your asthma well controlled during pregnancy so that you and your baby will be in the best possible condition for the birth.
· The drugs used for control and relief of asthma symptoms are not tested on pregnant women because of ethical reasons. (In fact, proof of safety during pregnancy is not established for most drugs.) However, limited studies of asthma medications in pregnant animals, and the routine use of such drugs in pregnant women with asthma, suggest the drugs are safe. There is little to suggest an increased risk to the fetus. Therefore, there is wide acceptance by experts that the usual asthma drugs should be used to control asthma symptoms in pregnant women. Maintaining adequate oxygen supply to the fetus is essential. Because some drugs have not been tested in pregnant women does not mean that they are harmful. It means that a medical decision must be made regarding their use during pregnancy, and that the dosage and effects be closely monitored by your doctors.
· Always ask your doctor about the use of over-the-counter (OTC) medicines during pregnancy and never change the dosage of your asthma medicines without directions from your doctor. Follow your action plan.
Nice To Know:
Interestingly, the fetus protects itself against low oxygen levels by producing a special type of hemoglobin in its red blood cells. (Hemoglobin molecules carry oxygen in the bloodstream.) This special hemoglobin makes the baby's red blood cells very efficient in receiving oxygen from the mother. In fact, even in women who have moderate to severe chronic asthma, the fetus usually receives enough oxygen for its needs.

Frequently Asked Questions

Here are some frequently asked questions related to asthma in adults.
Q: What breathing exercises can help me during an asthma attack?

A: Pursed-lip breathing involves closing the lips tightly and blowing air out past them the way you would when blowing out a candle. This action helps keep the airways open during exhalation by keeping the pressure in them a little higher. Pursed-lip breathing acts like a "splint" to keep the airways open a little longer and allow stale air to be blown out of the lungs. Remember that fresh air can't be drawn into the lungs if stale air is still there. Practicing relaxed breathing and the pursed-lip technique will give you the confidence to handle almost any emergency situation. Of course, the best time to practice such exercises is when you are not having an attack. That way, you can strengthen the respiratory muscles without the panic of being short of breath. Strong respiratory muscles will help you if another attack should come.

Q: What are the biggest "mistakes" that people with asthma make?

A: During the panic and agitation of an asthma attack it is easy to make mistakes:
· Taking tranquilizers or sedatives. Drugs such as Valium should never be taken to control the anxiety associated with shortness of breath during an attack. These drugs depress breathing.
· Taking the wrong medicine during an attack. Remember, it is only the short-acting beta2-bronchodilators that produce immediate relaxation of your airways. Know which of your asthma medicines are your reliever medications, carry them with you, and know the dose your doctor wants you to take during an attack. On their own, the preventer inhalers and oral drugs will not help an attack. Always follow your personalized asthma action plan. Seek emergency treatment when you are instructed to do so by your personalized plan.
· Overmedication. Taking more than the prescribed dose of a reliever medication will not help relieve the attack. The side effects will only be made worse. Follow the emergency plan worked out with your doctor. If he or she has instructed you to take additional beta2-bronchodilators during an attack, follow those instructions but do not exceed the dosage.
· Undermedication. Some people with asthma make the mistake of waiting too long to follow their action plan. Know and be sure of the correct dose of your asthma medicines and take them faithfully. Don't try to take the least possible dose and don't try to "tough it out" if an asthma attack starts. Follow your action plan and seek emergency help when it is wise to do so.
· Failure to avoid triggers. With more effective drug control of asthma symptoms, some people with asthma may take fewer precautions when it comes to avoiding their known triggers. Don't fall into this habit. Identify and remove or avoid situations and conditions that you know may cause your asthma to flare up. Elimination of known triggers is an important step in the long-term management of asthma.

Q: I know that my breathing passages are constricted during an asthma attack. Can I use any bronchodilator drug as a reliever to relax the airways?

A: Although relaxation of airways is needed in a severe asthma episode, some bronchodilators work too slowly to be of any immediate benefit. Short-acting beta2-bronchodilators such as albuterol, terbutaline, pirbuterol, and bitolterol work quickly to relax airway muscle that is in spasm and are, therefore, called "rescue" medications. Other bronchodilators such as long-acting beta2-bronchodilators, anticholinergic bronchodilators (ipratropium), and theophylline may be useful in the treatment of an asthma episode, but should not be used in place of short-acting beta2-bronchodilators for treatment of acute symptoms.

Q: I love to cross-country ski but I'm worried about a flare-up in my asthma. Should I stop exercising?

A: First of all, check with your doctor to make sure this type of exercise is suitable for your asthma condition. You may have two triggers involved here: cold weather and physical exertion. Drying of the linings of the airways due to cold air, exercise, or both, may trigger an episode. For many people, pretreatment with a beta2-bronchodilator 10 to 15 minutes before activity allows them to exercise without experiencing asthma symptoms. Ask your doctor if pretreatment medicine would help you stay active. Some of the preventer medicines used to control persistent asthma symptoms are also useful in controlling exercise-induced and cold air-induced asthma. The benefits of exercise in persons with asthma cannot be overemphasized.

Q: Why is my chest so tight during an asthma attack when I try to breathe out?

A: Because the airways are swollen and narrowed they close earlier in expiration. This "traps" air in the lungs that would normally be exhaled. Therefore, breathing occurs at a higher lung volume than normal, causing a feeling of "tightness" of the chest due to over-distended lungs.

Q: What is the link between triggers, inflammation, and asthma?

A: Triggers are irritating factors that make asthma worse, and they are usually different for different people. Because the airways of people with asthma are chronically inflamed, the airways are sensitive or reactive to triggers. Know what your triggers are and how best to avoid them.

Q: I'm allergic to ragweed, which makes my eyes and nose runny and itchy for most of the summer. My doctor calls it "seasonal rhinitis." Will it give me asthma?

A: Not necessarily. Not all people with asthma have allergies, and not all people with allergies develop asthma. It depends. There are complex factors at work here, such as your genetic make-up, the reactivity of your airways, and the success you have in controlling your "hay fever" condition. Pollens and other things can trigger asthma in susceptible people, and there's nothing you can do about your genetic background. Therefore, the best approach is to work with your doctor to control your seasonal allergy.

Q: What's the difference between corticosteroids and anabolic steroids? I don't want to "pump up," I just want to control my asthma.

A: Although the term "steroids" is used widely, there are many types of steroids with many different effects. In fact, our bodies actually produce steroids for beneficial effects of various kinds. The types of steroids that body-builders may abuse are called anabolic steroids. The types of steroids used to control asthma symptoms are called corticosteroids, and they do not have the same effects as the anabolic steroids. Corticosteroids are taken because they help control inflammation in the body. They have virtually no muscle-building or performance-enhancing effects like those produced by the anabolic steroids.

Q: My wife really wants a pet. She doesn't seem allergic to pets and skin tests show she's not allergic to dogs or cats. How about it?

A: As you've stated, your wife is not allergic to dogs or cats. Having a pet in the house is only a problem if the person is allergic to that animal. However, the problem here is that she may become allergic over time with regular exposure to the animal. If that occurs, the airways remain slightly irritated. This may set her up for asthma attacks triggered by other factors.

Q: I forgot to refill the prescription for the inhaler that gets rid of my wheezing on bad days. Can I just use my other inhaler - the one with the steroid I normally use every day for asthma control?

A: No. You really need to get your prescription filled as soon as possible. The medications in the two inhalers are quite different and are not interchangeable. The inhaled steroid is the "preventer" drug. It normally does a great job of preventing the symptoms of asthma by controlling the inflammation that triggers it. The "rescue" inhaler contains the drug you may need to counter the tightness and wheeze that can occur if the "preventer" drug isn't able to block your symptoms.

Q: Should we consider moving to a different climate?

A: Moving to a different climate will probably not help in cases of allergic asthma. Asthma is quite common in all parts of the country. Generally, families that move to a new area find that asthma symptoms continue to occur, usually because of different triggers in the new environment. Nonallergic asthma may improve with a move to a different climate having less pollution or warmer temperatures if triggers such as industrial pollution or cold air temperatures were responsible for the asthma episodes. Check with your doctor.

Q: Can "allergy shots" help if I have allergic asthma?



A: Once your personal "troublemakers" have been identified, your doctor may try some different approaches to control inflammation and your response to these triggers, including:
• Avoidance. This is the simplest approach, but not always easy to carry out. If strong chemical odors are suspected as a trigger, avoid such irritating substances. But if your personal trigger is the pollen released from a particular tree or weed, not much can be done to avoid it.
• Injections. These injections, commonly called "allergy shots," may make you less sensitive to the trigger substance. In this treatment, very small amounts of the trigger substance are injected in doses that are slowly increased over time to increase your tolerance. (The treatment works best for allergies to pollen, dust mites, and cat dander.)
• Drugs to prevent asthma episodes. Certain preventer drugs are used to control inflammation and asthma symptoms even though allergies are still present.

Q: What are the most important things I can do to help improve my asthma?

A: Three actions are most important: check the environment, keep lines of communication open with your doctor, and understand your treatment plan. Removing a trigger from the environment can often do wonders. For example, if you are allergic to cat dander, you can survive the presence of a cat by inhaling corticosteroids to control asthma, but you would probably be far better off if the cat went to another home. Generally speaking, the more triggers you can remove, and the less medicine you have to take as a result, the better off you will be in the long run. Good communication between you and your doctor is essential in identifying and minimizing triggers and developing your personal asthma action plan.

Putting It All Together
Here is a summary of the important facts and information related to asthma in adults.

• Asthma is a condition in which extra-sensitive lungs overreact to certain irritating conditions called "triggers."
• In asthma, the air passages of the lung are chronically inflamed, meaning they are red and swollen. When an asthma attack occurs, the muscle in the walls of the air passages may contract, causing the airways to narrow.
• The signs of an asthma attack or episode include difficulty in breathing because of narrowed airways caused by tightened muscles around the airways, swelling of the inner linings of the airways, and mucus that is clogging the airways.
• Symptoms of asthma may include coughing, wheezing, tightness in the chest, shortness of breath, and excess mucus production.
• "Good asthma control" means that one does not experience wheezing, coughing, shortness of breath, and interruption of sleep, that exercise and daily activities are carried out normally, and that reliever medicines are used less than three times per week.
• We don't know why some adults get asthma, but many have a history of childhood allergies, asthma, or both.
• Asthma is a chronic condition that cannot be cured but can be successfully treated.
• Both allergic and non-allergic types of asthma exist.
• Asthma symptoms usually develop over a period of time and may be triggered by changes in the external environment such as very hot or cold weather, and by changes in the pollution and pollen levels in the air.
• Managing asthma episodes includes taking the correct medications, using breathing relaxation and pursed-lip breathing exercises, and coughing and mucus removal.
• Medications to manage asthma come in various forms, such as tablets and inhaled forms.
• Using a peak flow meter as the doctor recommends can help you determine if an asthma attack is coming, even if you feel fine at the time.

Please watch the following video sites.
http://www.youtube.com/watch?v=82gn_rDRpHk&feature=related
http://www.youtube.com/watch?v=aGDi5tI5vTk&feature=channel

Stroke ... Brain attack

Stroke or Brain attack

A stroke is a "brain attack" that happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die.