Alzheimer's Disease

Source: Alzheimer's Association, 225 N Michigan Ave., 17th Fl., Chicago, IL 60601-7633; phone: (800) 272-3900; www.alz.org

Alzheimer's disease, the most common form of dementia, is a progressive, degenerative disease of the brain in which nerve cells deteriorate and die for unknown reasons. Its first symptoms usually involve impaired memory and confusion about recent events. As the disease advances, it results in greater impairment of memory, thinking, behavior, and physical health.

The rate of progression of Alzheimer's varies, ranging from 3 to 20 years; the average length of time from onset of symptoms until death is 8 years. Eventually, affected individuals lose their ability to care for themselves and become susceptible to infections of the lungs, urinary tract, or other organs as they grow progressively debilitated.

Alzheimer's disease affects an estimated 4.5 million Americans, striking men and women of all ethnic groups. Although most people diagnosed with Alzheimer's are older than age 60, some cases occur in people in their 40s and 50s. An estimated 10% of the population over age 65 have Alzheimer's, and the disease affects almost half of those over 85. In the United States, annual costs of diagnosis, treatment, and long-term care are estimated at $100 billion.

Diagnosis involves a comprehensive evaluation that may include a complete health history, a physical examination, neurological and mental status assessments, and other testing as needed. Skilled health care professionals can generally diagnose Alzheimer's with about 90% accuracy. Other conditions that can cause similar symptoms include depression, drug interactions, nutritional imbalances, infections such as AIDS, meningitis, and syphilis, and other forms of dementia, such as those associated with stroke, Huntington's disease, Parkinson's disease, frontotemporal dementia, and vascular disease. Absolute confirmation of diagnosis requires a brain biopsy or autopsy.

Treatments for cognitive and behavioral symptoms are available, but no intervention has yet been developed that prevents Alzheimer's or reverses its course. Some research suggests that risk factors for heart disease, such as high blood pressure, elevated cholesterol, and excess body weight may also increase risk of developing Alzheimer's. Studies also suggest that staying physically and mentally active and socially connected may be associated with a lower risk for the disease.

Providing care for people with Alzheimer's is physically and psychologically demanding. Nearly 70% of affected individuals live at home, where family or friends care for them. In advanced stages of the disease, many individuals require care in a nursing home. Nearly half of all nursing home residents in the U.S. have Alzheimer's.

People with Alzheimer's need a safe, stable environment and a regular daily schedule offering appropriate stimulation. Physical exercise and social interaction are important, as is proper nutrition. Security is also a consideration, because many people with Alzheimer's tend to wander. An identification bracelet listing the person's name, address, and condition may help ensure the safe return of an individual who wanders.
Warning Signs of Alzheimer's Disease

Forgetting recently learned information or inability to learn new information
Difficulty with everyday tasks such as cooking or dressing
Inability to remember simple words
Use of inappropriate words when communicating
Disorientation of time and place
Poor or decreased judgment
Problems with abstract thinking
Putting objects in inappropriate places
Rapid changes in mood or behavior
Increased irritability, anxiety, depression, confusion, and restlessness
Prolonged loss of initiative

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

Acquired Immune Deficiency Syndrome

Source: Centers for Disease Control and Prevention; www.cdc.gov

AIDS (Acquired Immune Deficiency Syndrome) is caused by the human immunodeficiency virus (HIV). HIV kills or disables crucial cells of the immune system, progressively destroying the body's ability to fight disease.

HIV is commonly spread through unprotected sexual contact with an infected partner. It is also spread through contact with infected blood. Where modern screening techniques are used it is rare to contract HIV from transfusion, but it can be contracted when intravenous drug users share syringes with others. Though HIV can be spread through semen, vaginal fluids, and breast milk, there is no evidence it can be spread through saliva. The rate of transmission from a pregnant woman to her infant is about 25% without treatment, but can be reduced to less than 2% with treatment. Studies have indicated no evidence of HIV transmission through casual contact such as the sharing of food utensils, towels and bedding, telephones, or toilet seats.

Some people experience flu-like symptoms a short time after infection with HIV, and scientists estimate that about half of those infected with HIV develop more serious, often chronic symptoms within ten years. Even when symptoms are not present, HIV is active in the body, multiplying, infecting, and killing CD4+ T cells, or "T-helper cells," the crucial immune cells that signal other cells in the immune system to perform their functions.

The term AIDS applies to the most advanced stages of HIV infection. According to the official definition set by the Centers for Disease Control and Prevention (CDC), an HIV-infected person with fewer than 200 CD4+ T cells can be said to have AIDS. (Healthy adults usually have 1,000 or more). An HIV-infected person, regardless of T cell count, is diagnosed with AIDS if he or she develops one of 26 conditions that typically affect people with advanced HIV. Most of these conditions are "opportunistic infections" that occur when the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses and microbes.

Months or years prior to the onset of AIDS, many people experience such symptoms as swollen glands, lack of energy, fevers and sweats, and skin rashes. People with full-blown AIDS may develop infections of the intestinal tract, lungs, brain, eyes, and other organs, with a variety of symptoms, and may become severely debilitated. They also are prone to developing certain cancers, especially those caused by viruses, such as Kaposi's sarcoma, cervical cancer, and lymphoma. Children with AIDS may have delayed development or failure to thrive.

HIV is primarily detected by testing a person's blood for the presence of antibodies (disease-fighting proteins) to HIV. In about 5% of infected individuals, HIV antibodies may take more than 6 months after exposure to reach detectable levels, but in most cases the antibodies are detectable in about 6 weeks. HIV testing may also be performed on oral fluid and urine samples. New rapid HIV tests can provide preliminary results in about 20 minutes.

The U.S. Food and Drug Administration has approved a number of drugs that may slow down the growth of HIV in the body and treat the infections and cancers associated with AIDS. The first group of drugs used to treat HIV, called nucleoside analog reverse transcriptase inhibitors (NRTIs), include the drug zidovudine (commonly known as AZT). Non-nucleoside reverse transcriptase inhibitors (NNRTIs) have also been approved to treat HIV. A third class of drugs, called protease inhibitors, are also approved for HIV. In 2003 the FDA granted accelerated approval of Fuzeon for use with other anti-HIV drugs to treat advanced cases of infection. Fuzeon was the first among a new class of medications called fusion inhibitors; drugs in this class interfered with HIV's entry into cells by hindering the fusion of viral and cellular membranes.

Patients are typically given a combination of different drugs, because HIV can much more easily become resistant to a single drug. While these drugs extend the period between HIV infection and serious illness, they do not prevent the spread of the disease to others, and can have severe side effects.

Since there is no vaccine or cure for AIDS, the only protection is to avoid activities that carry a risk. When it cannot be known with certainty whether a sexual partner has HIV, the CDC recommends abstinence (the only certain protection), mutual monogamy with an uninfected partner, or correct and consistent use of male latex condoms.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


What Is Coronary Heart Disease?

If you’re healthy, you live longer – that’s obvious. But what Thomas Perls found was not so obvious. The researcher at Boston University School of Medicine examined data on people who live past 90, and says nearly one third had heart disease, stroke or diabetes 15 years or more.

Perls says the capacity to keep doing ordinary daily activities seemed to be the difference.

``If you somehow have the resilience that is allowing you to still function well, that’s great news and I wouldn’t base your survival just on the presence of disease.’’

Perls’ study doesn’t show how to create that resilience. He believes, though, that good health habits such as being physically active when they were younger probably helped.

Heart disease is caused by narrowing of the coronary arteries that feed the heart. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by cholesterol and fat deposits--a process called atherosclerosis--and cannot supply enough blood to the heart, the result is coronary heart disease (CHD). If not enough oxygen-carrying blood reaches the heart, you may experience chest pain called angina. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing.

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body and that your body needs to function normally. It is present in cell walls or membranes everywhere in the body, including the brain, nerves, muscle, skin, liver, intestines, and heart. Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess is deposited in arteries, including the coronary arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.

What does cholesterol have to do with heart disease?

The Framingham Heart Study established that high blood cholesterol is a risk factor for coronary heart disease (CHD). Results of the Framingham study showed that the higher the cholesterol level, the greater the CHD risk. On the other end of the spectrum, CHD is uncommon at total cholesterol levels below 150 milligrams per deciliter (mg/dL). A direct link between high blood cholesterol and CHD has been confirmed by the Lipid Research Clinics-Coronary Primary Prevention Trial (1984) which showed that lowering total and LDL ("bad") cholesterol levels significantly reduces CHD. A series of more recent trials of cholesterol lowering using statin drugs have demonstrated conclusively that lowering total cholesterol and LDL-cholesterol reduces the chance of having a heart attack, needing bypass surgery or angioplasty, and dying of CHD-related causes.

The Benefits of Cholesterol Lowering

Recent studies have shown that cholesterol lowering in people without heart disease greatly reduces their risk for developing CHD, including heart attacks and CHD-related death. This is true for those with high cholesterol levels and for those with average cholesterol levels.

A 1995 study called the West of Scotland Coronary Prevention Study (WOSCOPS) found that cholesterol lowering reduced the number of heart attacks and deaths from cardiovascular causes in men with high blood cholesterol levels who had not had a heart attack. For 5 years, more than 6500 men with total cholesterol levels of 249 milligrams per deciliter (mg/dL) to 295 mg/dL were given either a cholesterol-lowering drug or a placebo (a dummy pill that looks exactly like the medication), along with a cholesterol lowering diet. The drug that was given is known as a statin (pravastatin), and it reduced total cholesterol levels by 20 percent and LDL ("bad") cholesterol levels by 26 percent. The study found that in those receiving the statin, the overall risk of having a nonfatal heart attack or dying from CHD was reduced by 31 percent. The need for bypass surgery or angioplasty was reduced by 37 percent and deaths from all cardiovascular causes by 32 percent. A very important finding is that deaths from causes other than cardiovascular disease were not increased, and the overall deaths from all causes were reduced by 22 percent.

In 1998, the results of the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) showed that cholesterol lowering in generally healthy people with average cholesterol levels reduced their risk for a first-time major coronary event by 37 percent. Study participants had no obvious evidence of CHD and relatively usual total cholesterol levels (average of 221 mg/dL) and LDL-cholesterol levels (average of 150 mg/dL) and lower than usual HDL ("good") cholesterol levels (average of 36 mg/dL for men and 40 mg/dL for women). This study used a statin drug (lovastatin) along with a low-saturated fat, low-cholesterol diet to lower cholesterol levels. Study participants who received a placebo followed the same low-saturated fat, low-cholesterol diet. After one year, total cholesterol levels in the treatment group were lowered by 18 percent and LDL-cholesterol levels by 25 percent. The risk for a heart attack was reduced 40 percent, unstable angina 32 percent, the need for bypass surgery or angioplasty 33 percent, and cardiovascular events 25 percent. The cholesterol-lowering benefits in this study extended to both men and women as well as older adults. There were no significant differences between treatment and placebo groups in non-cardiovascular disease deaths.

What Makes Your Cholesterol High or Low?

Your blood cholesterol level is affected not only by what you eat but also by how quickly your body makes LDL ("bad") cholesterol and disposes of it. In fact, your body makes all the cholesterol it needs, and it is not necessary to take in any additional cholesterol from the foods you eat.

Many factors help determine whether your LDL-cholesterol level is high or low. The following factors are the most important:

* Heredity
* What you eat
* Weight
* Physical activity/exercise
* Age and sex
* Alcohol
* Stress

Risk Factors and Heart Disease

Risk factors are conditions that increase your risk for developing heart disease. Some risk factors can be changed and others cannot. In general, the more risk factors you have, the greater your chance of developing heart disease. Fortunately, there are things you can do to address most of the risk factors for heart disease.

The risk factors that you cannot control include:

* Age (45 years or older for men; 55 years or older for women)
* Family history of early heart disease (father or brother affected before age 55; mother or sister affected before age 65)

The known risk factors for heart disease that you can do something about include:

* High blood cholesterol (high total cholesterol and high LDL ("bad") cholesterol)
* Low HDL ("good") cholesterol
* Smoking
* High blood pressure
* Diabetes -- if you have diabetes, your risk for developing heart disease is high, as high as a heart disease patient's risk for having a heart attack. You will need to lower your cholesterol under medical supervision, in much the same way as a heart disease patient, in order to reduce your high risk of getting heart disease.
* Obesity/overweight
* Physical inactivity

If you have not had your cholesterol level checked, talk to your doctor about getting it checked.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Human Gene Therapy

Human gene therapy has the potential to revolutionize how many medical conditions are treated. FDA is working to ensure that research in this developing field is conducted responsibly and safely.

Human gene therapy, although still in the developmental stages, offers tremendous potential to pave the way for more effective treatments for many serious medical conditions.

Human gene therapy is based on the theory that disease and abnormal medical conditions can be cured or treated by replacing patients' faulty genetic material with normal genetic material.

Scientists hope their work will one day lead to gene-based treatments for a wide range of conditions, including cancer, cystic fibrosis, heart disease, diabetes, hemophilia, wounds, and infectious diseases such as AIDS.

FDA regulates human gene therapies in the United States. The agency receives many requests from medical researchers and manufacturers to study gene therapy and to develop gene therapy products.

FDA has not yet approved any human gene therapy products for sale. There is still much to learn about how these products work, how to administer them safely, and whether the cells will continue to work properly in the body without causing adverse side effects.

How Does Gene Therapy Work?

Human genes can be thought of as extremely small pieces of information that are present in our bodies by the trillions and tell our bodies how to operate. They are embedded in our deoxyribonucleic acid (DNA), the molecular structure inside the nucleus of a cell that carries the genetic instructions for making living organisms.

Passed on from parents to children, genes also determine certain physical characteristics such as eye color.

Genes may also determine the likelihood that people will develop a disease or suffer from a medical condition that is prevalent in their family history.

With human gene therapy, normal genes are used to replace or cancel out the defective genes that are responsible for a disease or medical problem. The "good" genes would then find their way to the right spot in the body and begin to do the work required.

FDA's Role

FDA's responsibility is to ensure that drugs, medical devices, and biological products (such as blood and vaccines) used in the United States are safe and effective.

Manufacturers of gene therapy products must test their products extensively and meet FDA requirements for safety, purity, and potency if they wish to sell their products in the United States.

Before studying a gene therapy product in people, the researcher or company testing the product (the "sponsor") must first obtain an Investigational New Drug Application (IND) from FDA. An IND outlines what the sponsor proposes for human testing in clinical trials.

Upon reviewing the IND, FDA decides, based on the scientific data available, whether it is reasonably safe for the drug developers to move forward with the testing.

As part of the IND process, the sponsor

* provides information on how the study will be conducted, what possible risks may be involved, and what steps it will take to protect patients
* provides data in support of the study
* informs prospective participants about the potential risks and benefits
* obtains the consent of prospective participants

Another important part of the IND process is gaining approval from an Institutional Review Board (IRB). IRBs are boards or committees that ensure appropriate steps are taken to protect the rights and welfare of participants in studies. Composed of scientists, doctors and lay people, IRBs can approve or disapprove clinical trials proposed to take place within their jurisdiction—usually a hospital.

Looking Ahead

Continued research, along with advancements in other cutting-edge scientific endeavors, can make human gene therapy a versatile treatment strategy at the forefront of a new age of medicine.

Potential treatments could be administered to patients through a variety of techniques. Vaccination-like injections, or possibly microscopic mechanical devices—the result of nanotechnology research—could be used to deliver normal genes into a person's body.

It is possible that certain diseases such as hemophilia could be cured or treated throughout a person's lifetime by replacing faulty genes with normal ones. Genes may also be used to offer protection for a short time, as in cases involving wounds or the need for new blood vessels.

In the future, doctors may one day be able to turn off a "faulty" gene to stop the growth of a cancerous tumor. A faulty gene could also be replaced to produce necessary proteins or enzymes that may be deficient in a patient to ensure and maintain proper body functions.

Ensuring a Safe Approach

As researchers strive toward these goals, FDA wants the public to know that patient safety is the agency's highest priority. The agency will continue to work with manufacturers and medical researchers to ensure that new gene therapy products are as safe as possible, and that people enrolled in studies will not be harmed.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

Medications for High Blood Pressure

High blood pressure is called the 'silent killer' because it has no symptoms until it causes major damage. A number of FDA-approved drugs, along with lifestyle changes, can help treat this condition.

Nearly one in three adults in the United States has high blood pressure, also called hypertension. High blood pressure is dangerous because it increases the risk of stroke, heart attack, heart failure, kidney failure, death.

"High blood pressure is often called the 'silent killer' because it usually has no symptoms until it causes damage to the body," says Douglas Throckmorton, M.D., Deputy Director of FDA's Center for Drug Evaluation and Research. Many studies have shown that lowering the blood pressure with drugs decreases that damage.

A Lifelong Condition

Blood is carried from the heart to all parts of the body in vessels called arteries. Blood pressure is the force of the blood pushing forward through the body and against the walls of the arteries. The higher the blood pressure, the greater the risk of stroke, heart attack, heart failure, kidney failure, and death.

Blood pressure is made up of two numbers:

* The "top" number is the systolic blood pressure—the pressure while the heart is pumping blood out.
* The "bottom" number is the diastolic blood pressure—the pressure while the heart is filling up with blood, getting ready to pump again.

It was once believed that only diastolic pressure (the "bottom" number) was important, but this is not true. Elevated systolic pressure alone, particularly common in older people, is just as dangerous as elevations of both systolic and diastolic pressure.

Blood pressure is elevated for two main reasons:

* too high blood volume
* too narrow blood vessels due to a substance our kidneys make called angiotensin.

Most of the time, the cause of a person's high blood pressure is unknown. Once it develops, high blood pressure usually lasts the rest of the person's life. But it is treatable.

Some people can lower blood pressure by losing weight, limiting salt intake, and exercising, but for most people, these steps are not enough. Most people need medication for blood pressure control, and will probably need it all their lives.

Types of Medications

FDA has approved many medications to treat high blood pressure, including

* Diuretics, or "water pills," which help the kidneys flush extra water and salt from your body and decrease blood volume
* Several kinds of drugs that block the effects of angiotensin, reducing blood pressure by relaxing blood vessels, including
* Angiotensin converting enzyme (ACE) inhibitors
* Angiotensin II receptor blockers (ARBs)
* Beta blockers, which also cause the heart to beat with less force
* Drugs that directly relax the blood vessels, including
* Calcium channel blockers (CCBs)
* Other direct dilators (relaxers) of blood vessels
* Alpha blockers, which reduce nerve impulses that tighten blood vessels
* Nervous system inhibitors, which control nerve impulses from the brain to relax blood vessels

Many people with high blood pressure will need more than one medication to reach their goal blood pressure. Your health care provider can tell you if you should be on medication and, if so, which drug(s) may be best for you.

Tips for Consumers

Controlling your blood pressure is a lifelong task. Blood pressure is only one of a number of factors that increase your risk of heart attack, stroke, and death. High cholesterol and diabetes are other risk factors. Lifestyle changes—such as weight loss, a healthy diet, and physical activity—can affect all three risk factors, but many people will also need medications.

Take your medicines and monitor your blood pressure. Take the medications prescribed for you regularly and don't stop them except on the advice of your health care provider. Hypertension tends to worsen with age and you cannot tell if you have high blood pressure by the way you feel, so have your health care provider measure your blood pressure periodically. You may also want to buy a home blood pressure monitor, available in many drug stores, to measure your blood pressure more frequently. Your health care provider or pharmacist can help you choose the right device. Many drug stores also have blood pressure measuring devices you can use in the store.

Tell your health care provider about any side effects you are having. Some side effects may go away over time, others may be avoided by adjusting the dosage or switching to a different medication.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Walk This Way - Stroke Prevention

Scurrying to work can be good for you, if you do it regularly. A study says moderate levels of aerobic fitness can significantly reduce the risk of stroke.

Steven Hooker of the University of South Carolina says the more aerobic activity people do each day, the less likely they are to suffer a stroke. He bases that on 18 years of data on about 60,000 people who were stroke-free at the start.

Want to know which activities can be the most helpful? Hooker advises:

“Get up off the couch; take a walk on a regular basis, try to find something that you enjoy doing and do it, as far as physical activity is concerned.”

Stroke Prevention

All people can take steps to lower their risk for stroke, whether they have had a stroke or not. Things you can do to lower the risk of stroke include steps to prevent and control high blood pressure, heart disease, and other chronic conditions.

Prevent and control high blood pressure: High blood pressure is easily checked. It can be controlled with lifestyle changes and with medicines when needed. You can work with your doctor to treat high blood pressure and bring it down. Lifestyle actions such as healthy diet, regular physical activity, not smoking, and healthy weight will also help you to keep normal blood pressure levels. All adults should have their blood pressure checked on a regular basis.

Prevent and control diabetes: People with diabetes have a higher risk of stroke, but they can also work to reduce their risk. Further, recent studies suggest that all people can take steps to reduce their risk for diabetes. These include weight loss and regular physical activity.

No tobacco: Smoking can affect a number of things that relate to risk of high blood pressure, heart disease, and stroke. Not smoking is one of the best things a person can do to lower their risk of stroke. Quitting smoking will also help to lower a person's risk of stroke. The risk of stroke decreases a few years after quitting smoking. Your doctor can suggest programs to help you quit smoking.

Treat atrial fibrillation: Atrial fibrillation is an irregular beating of the heart. It can cause clots that can lead to stroke. A doctor can prescribe medicines to help reduce the chance of clots.

Prevent and control high blood cholesterol: High blood cholesterol is a major risk factor for heart disease, which can increase the risk for stroke. Preventing and treating high blood cholesterol includes eating a diet low in saturated fat and cholesterol and higher in fiber, keeping a healthy weight, and getting regular exercise. A lipoprotein profile can be done to measure several kinds of cholesterol as well as triglycerides (another kind of fat found in the blood). All adults should have their cholesterol levels checked once every five years, and more often if it is found to be high. If it is high, your doctor may prescribe medicines to help lower it.

Moderate alcohol use: Excessive alcohol use can increase the risk of high blood pressure. People who drink should do so in moderation.

Maintain a healthy weight: Healthy weight status in adults is usually assessed by using weight and height to compute a number called the "body mass index" (BMI). BMI is used because it relates to the amount of body fat for most people. An adult who has a BMI of 30 or higher is considered obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18 to 24.9. Proper diet and regular physical activity can help to maintain a healthy weight.

Regular Physical Activity: The Surgeon General recommends that adults should engage in moderate level physical activities for at least 30 minutes on most days of the week.

Diet and nutrition: Along with healthy weight and regular physical activity, an overall healthy diet can help to lower blood pressure and cholesterol levels. This includes eating lots of fresh fruits and vegetables, lowering or cutting out salt or sodium, and eating less saturated fat and cholesterol to lower the risk of high blood pressure and heart disease which can lead to stroke.

Genetic Risk Factors: Stroke can run in families. Genes play a role in stroke risk factors such as high blood pressure, heart disease, diabetes, and vascular conditions. It is also possible that an increased risk for stroke within a family is due to factors such as a common sedentary lifestyle or poor eating habits, rather than hereditary factors.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


The Risk of Dozing Off - How Is Sleep Apnea Treated?

People say they’re just resting their eyes. Before they know it, they’re asleep. But a study indicates it could mean trouble.

The study says constantly dozing off during the day can forewarn of an increased risk of a stroke among the elderly. The study was presented at the American Stroke Association’s International Stroke Conference 2008.

Bernadette Boden-Albala of Columbia University Medical Center says people who more commonly dozed off had a four-and-a-half times greater risk of a stroke.

That doesn’t necessarily mean you should fear the nap, if napping is your remedy for drowsiness.

"There's no evidence that suggests that, if you feel like taking a nap, you shouldn’t take the nap. Napping is not the risk. The risk here, we believe, is the poor sleep."

The study was supported by the National Institutes of Health.

How Is Sleep Apnea Treated?

Goals of Treatment

The goals of treating obstructive sleep apnea are to:

* Restore regular breathing during sleep
* Relieve symptoms such as loud snoring and daytime sleepiness

Treatment may help other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease, stroke, and diabetes.
Specific Types of Treatment

Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Currently, there are no medicines to treat sleep apnea.

Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea also will need breathing devices or surgery.
Lifestyle Changes

If you have mild sleep apnea, some changes in daily activities or habits may be all that you need.

* Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
* Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms.
* Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back.
* Keep your nasal passages open at night with nose sprays or allergy medicines, if needed. Talk to your doctor about whether these treatments might help you.
* Stop smoking.


A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea.

A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.

If you use a mouthpiece, it's important that you check with your doctor about discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better.
Breathing Devices

Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat.

The air presses on the wall of your airway. The air pressure is adjusted so that it's just enough to stop the airways from becoming narrowed or blocked during sleep.

Treating sleep apnea may help you stop snoring. But stopping snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's orders. After the initial setup, you may need to have the CPAP adjusted on occasion for the best results.

CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, sore eyes, and headaches. If your CPAP isn't properly adjusted, you may get stomach bloating and discomfort while wearing the mask.

If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce these side effects. These steps include adjusting the CPAP settings or the size/fit of the mask, or adding moisture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many different kinds of CPAP machines and masks. Be sure to tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different kind that may work better for you.

People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP.

Some people who have sleep apnea may benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.

Surgery to shrink or stiffen excess tissue in the mouth or throat is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. A series of such treatments may be needed to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a small piece of stiff plastic.

Surgery to remove excess tissue is only done in a hospital. You're given medicine that makes you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the tonsils, if they're blocking the airway, may be very helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow.

Living With Sleep Apnea

Obstructive sleep apnea can be very serious. However, following an effective treatment plan can often improve your quality of life quite a bit.

Treatment can improve your sleep and relieve daytime tiredness. It also may make you less likely to develop high blood pressure, heart disease, and other health problems linked to sleep apnea.

Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).
Ongoing Health Care Needs

Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing side effects that you can't handle.

This ongoing care is especially important if you're getting continuous positive airway pressure (CPAP) treatment. It may take a while before you adjust to using CPAP.

If you aren't comfortable with your CPAP device or it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects.

Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea.

Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy.

If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery.
How Can Family Members Help?

Often, people with sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea.

Family members can do many things to help a loved one who has sleep apnea.

* Let the person know if he or she snores loudly during sleep or has breathing stops and starts.
* Encourage the person to get medical help.
* Help the person follow the doctor's treatment plan, including CPAP.
* Provide emotional support.

Key Points

* Sleep apnea is a common breathing disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
* Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep 3 or more nights each week.
* Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, there are no blood tests for the condition. Most people who have sleep apnea don't know they have it because it only occurs during sleep.
* The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. This may cause shallow breathing or breathing pauses.
* Sleep apnea can cause daytime sleepiness, increase the risk for or worsen some medical conditions, and increase the chance of having a work- or driving-related accident.
* It's estimated that more than 12 million American adults have sleep apnea. More than half of the people who have this condition are overweight.
* The most common signs of sleep apnea are loud snoring and choking or gasping during sleep and being very sleepy during the day.
* Doctors diagnose sleep apnea based on your medical and family histories, a physical exam, and results from sleep studies.
* Treatment is aimed at restoring regular breathing during sleep and relieving symptoms. Treatment also may help other medical problems linked to sleep apnea.
* Lifestyle changes, mouthpieces, breathing devices, and/or surgery are used to treat sleep apnea. Continuous positive airway pressure (CPAP) is the most common treatment for moderate to severe sleep apnea.
* Sleep apnea can be very serious. However, following an effective treatment plan can often improve your quality of life quite a bit. Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment causes side effects that you can't handle.
* Family members can help a person who snores loudly or stops breathing during sleep by encouraging him or her to get medical help.
* Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep).

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Secondhand Smoke and Cystic Fibrosis

Secondhand smoke can make lung disease worse, and Johns Hopkins researchers can document it in cases of cystic fibrosis. CF is fatal, and the researchers say many people with CF still wind up breathing other people’s smoke.

The researchers measured lung function by seeing how much air people could breathe out in the first second they tried.

The study found CF patients who were exposed to secondhand smoke had 10 percent less lung function. And some had it worse. Johns Hopkins researcher Garry Cutting:

``If they have a particular genetic abnormality, it doubles the negative effect of secondhand smoke. So they have a 20 percent reduction in lung function.’’

The study in the Journal of the American Medical Association was supported by the National Institutes of Health.

Living With Cystic Fibrosis

If you have cystic fibrosis (CF), you should learn as much as you can about the disease and work closely with your doctors to learn how to manage it.

Ongoing medical care is important. You should seek treatment from a team of doctors, nurses, and respiratory therapists who specialize in CF. These specialists are often located at CF Foundation Centers in major medical centers.

Good self-care includes:

* Eating a healthy diet
* Avoiding tobacco smoke
* Washing your hands often to reduce your chances of infection
* Exercising frequently
* Drinking lots of fluids
* Doing chest physical therapy every day
* Having annual flu and other appropriate vaccinations
* Taking your medicines as prescribed

You can expect to have a normal sex life.

* Most men with CF are infertile, but they may be helped with modern reproductive techniques.
* Although most women with CF may be less fertile than women who don’t have CF, they usually can have children. Talk to your doctor before becoming pregnant.

Having a positive attitude is also helpful.

If you are a parent of someone with CF, do not feel guilty about passing it on to your child. And do not be overprotective; encourage your child to be active and self-reliant.

Key Points

* Cystic fibrosis (CF) is an inherited disease of your mucus and sweat glands. It affects mostly your lungs, pancreas, liver, intestines, sinuses, and sex organs.
* In CF, an abnormal gene called the cystic fibrosis transmembrane conductance regulator (CFTR) gene causes mucus to become thick and sticky. The mucus builds up in the lungs and blocks the airways, creating an environment that makes it easy for bacteria to grow. This leads to repeated serious lung infections that can damage your lungs.
* The mucus can also block tubes, or ducts, in your pancreas so that the digestive enzymes it produces cannot reach the intestines where they are needed to break down food.
* You have extremely salty sweat. When you perspire, your body loses large amounts of salt. This can upset the balance of minerals in your blood, which can cause a heat emergency.
* The most common symptoms of CF are frequent coughing with phlegm, frequent bouts of bronchitis and pneumonia, salty-tasting skin, dehydration, poor growth, and infertility, mostly in men.
* The sweat test is the most common diagnostic test for CF. It measures the amount of salt in your sweat.
* Other tests that can be used to help diagnose CF include a chest x ray, sinus
x ray, lung function tests, analysis of sputum cultures and/or stool samples, and genetic testing of a blood sample.
* Prenatal genetic testing can help you find out if your baby is likely to have CF.
* Antibiotics are the primary treatment for lung problems in CF. They treat airway infections. Other treatments include chest physical therapy, exercise, mucus-thinning drugs, and other medications to reduce inflammation in your airways and help open them up.
* Lung transplantation is an option for some people with CF.
* The digestive problems in people with CF can be managed with nutritional therapy, enemas, mucus-thinning drugs, and medications to reduce stomach acid.
* Ongoing medical care from a team of health care providers who specialize in CF is important. Good self-management includes eating a healthy diet, avoiding tobacco smoke, exercising frequently, doing chest physical therapy every day, drinking lots of fluids, and washing your hands often to reduce your chances of infection.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Drink eight glasses of water a day. And don’t read in dim light.

Can you believe this?

Drink eight glasses of water a day. And don’t read in dim light.

So they say.

But are they right?

Aaron Carroll of Indiana University School of Medicine reviewed medical truisms to see if they really are true. Carroll, whose work is supported by the National Institutes of Health, coauthored a report in BMJ, the British medical journal.

So about those eight glasses of water. You usually get what you need, and you don’t need to make a special point of eight glasses. And dim light may make your eyes sore, but reading in it doesn’t cause blindness.

Carroll advises patients and doctors – if you have questions, speak up:

``Asking why, and trying to understand better why we do what we do, is not a sin, and is not a problem. And it should be encouraged.’’

What Can I Ask? Getting Information

Asking questions is key to good communication with your doctor. If you don’t ask questions, he or she may assume you already know the answer or that you don’t want more information. Don’t wait for the doctor to raise a specific question or subject because he or she may not know it’s important to you. Be proactive. Ask questions when you don’t know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren’t clear (for example, does taking medicine with food mean before, during, or after a meal?).

Learn about medical tests — Sometimes doctors need to do blood tests, x rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap smears, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

Can I Find Information About Medical Tests Online?

Yes—there is a lot of information on the Internet about medical tests. The National Library of Medicine’s MedlinePlus website provides links to many trustworthy resources. Visit www.medlineplus.gov and enter “laboratory tests” in the search window at the top of the page. Then, select the link that applies to your situation. You can get information on preparing for lab tests, explanations of different tests, and tips on interpreting lab test results.

Questions to ask about medical tests:

* Why is the test being done?
* What steps does the test involve? How should I get ready?
* Are there any dangers or side effects?
* How will I fi nd out the results? How long will it take to get the results?
* What will we know after the test?

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Discuss your diagnosis and what you can expect — A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

If you understand your medical condition, you can help make better decisions about treatment. If you know what to expect, it may be easier for you to deal with the condition.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away completely. They can’t be cured, but they can be treated or managed.

Questions to ask about your diagnosis:

* What may have caused this condition? Will it be permanent?
* How is this condition treated or managed? What will be the long-term effects on my life?
* How can I learn more about my condition?

Find out about your medications — Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it.

Make notes about any other special instructions. There may be foods or drinks you should avoid while you are taking the medicine. Or you may have to take the medicine with food or a whole glass of water. If you are taking other medications, make sure your doctor knows, so he or she can prevent harmful drug interactions.

Sometimes medicines affect older people differently than younger people. Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. It is best not to stop taking the medicine on your own. If you want to stop taking your medicine, check with your doctor first.

What Are Side Effects?

“My headache prescription always makes me sleepy.” “Aunt Sarah’s cough syrup caused a rash.”

Unwanted or unexpected symptoms or feelings that happen when you take a medicine are called side effects.

Some side effects happen just when you start taking a medicine. Some happen only once in a while and you learn how to manage them. But other side effects may make you want to stop taking the medicine. Tell your doctor if this happens. He or she may be able to prescribe a different medicine or help you deal with these side effects in other ways.

If another doctor (for example, a specialist) prescribes a medication for you, call your primary doctor’s office and leave a message letting him or her know. Also call to check with your doctor’s office before taking any over-the-counter medications. You may find it helpful to keep a chart of all the medicines you take and when you take them. A sample chart is included at the back of this booklet.

The pharmacist is also a good source of information about your medicines. In addition to answering questions and helping you select over-the-counter medications, the pharmacist keeps records of all the prescriptions you get filled at that pharmacy. Because your pharmacist keeps these records, it is helpful to use the same store regularly. At your request, the pharmacist can fill your prescriptions in easy-to-open containers and may be able to provide large-print prescription labels.

Questions to ask about medications:

* What are the common side effects? What should I pay attention to?
* When will the medicine begin to work?
* What should I do if I miss a dose?
* Should I take it at meals or between meals? Do I need to drink a whole glass of water with it?
* Are there foods, drugs, or activities I should avoid while taking this medicine?
* Will I need a refill? How do I arrange that?

Understand your prescriptions — When the doctor writes you a prescription, it is important that you are able to read and understand the directions for taking the medication. Doctors and pharmacists often use abbreviations or terms that may not be familiar.

If you have questions about your prescription or how you should take the medicine, ask your doctor or pharmacist. If you do not understand the directions, make sure you ask someone to explain them. It is important to take the medicine as directed by your doctor.

Keeping a record of the medications you take and the instructions for taking them can help you get the most benefi t from them. A worksheet like the one at the back of this booklet can help.

Tips: Helping You Remember

No matter what your age, it’s easy to forget a lot of what your doctor says. Even if you are comfortable talking with your doctor, you may not always understand what he or she says. So, as your doctor gives you information, it’s a good idea to check that you are following along. Ask about anything that does not seem clear. For instance, you might say: “I want to make sure I understand. Could you explain that a little more?” or “I did not understand that word. What does it mean?”

Another way to check is to repeat what you think the doctor means in your own words and ask, “Is this correct?” Here are some other ideas to help make sure you have all the information you need.

Take notes — Take along a notepad and pencil and write down the main points, or ask the doctor to write them down for you. If you can’t write while the doctor is talking to you, make notes in the waiting room after the visit. Or, bring a tape recorder along, and (with the doctor’s permission) record what is said. Recording is especially helpful if you want to share the details of the visit with others.

Get written or recorded materials — Ask if your doctor has any brochures, DVDs, CDs, cassettes, or videotapes about your health conditions or treatments. For example, if your doctor says that your blood pressure is high, he or she may give you brochures explaining what causes high blood pressure and what you can do about it. Ask the doctor to recommend other sources, such as websites, public libraries, nonprofit organizations, and government agencies that may have written or recorded information you can use.

Talk to other members of the health care team — Sometimes the doctor may want you to talk with other health professionals who can help you understand and carry out the decisions about how to manage your condition. Nurses, physician assistants, pharmacists, and occupational or physical therapists may be able to take more time with you than the doctor.

Call or email the doctor — If you are uncertain about the doctor’s instructions after you get home, call the office. A nurse or other staff member can check with the doctor and call you back. You could ask whether the doctor, or other health professional you have talked to, has an email address you can use to send questions.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Sickle Cell Disease: 10 Things You Need to Know

More than 70,000 people in the U.S. have sickle cell disease and more than 2 million people carry the gene that allows them to pass it on to their children.

1. Did you know that African Americans are not the only people who get sickle cell disease?
Sickle cell disease affects millions of people throughout the world and is particularly common among people whose ancestors come from sub-Saharan Africa, Spanish-speaking regions in the Western Hemisphere (South America, Cuba, and Central America), Saudi Arabia, India, and Mediterranean countries such as Turkey, Greece, and Italy. Because of this, hospitals in the United States screen all newborn babies for sickle cell disease.

2. Did you know that it's important to know whether or not you have sickle cell trait?
People with sickle cell trait usually do not have any of the symptoms of the disease. However, it is possible for a person with sickle cell trait to have complications of the disease under extreme conditions, such as:

• High altitude (flying, mountain climbing, or cities with a high altitude)

• Increased pressure (scuba diving)

• Low oxygen (mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition)

• Dehydration (too little water in the body)

In addition, a person with sickle cell trait can pass the disease on to their children.

Fast Fact

People who inherit one sickle cell gene and one normal gene have the sickle cell “trait”.

3. Did you know that people with sickle cell trait are less likely to get malaria?
People with sickle cell disease can get malaria just like anyone else. However, people with sickle cell trait are less likely to get malaria. The trait doesn't completely protect a person from infection, but it makes death from malaria less likely.

Fast Fact

Sickle cell disease occurs more often in people from parts of the world where malaria is or was common.

4. Did you know that a pain “episode” or “crisis” is the most common symptom of sickle cell disease and the top reason that people with the disease go to the emergency room or hospital?
When sickle cells travel through small blood vessels, they can get stuck and clog the blood flow. This causes pain that can start suddenly, be mild to severe, and last for any length of time.

5. Did you know that a woman with sickle cell disease can have a healthy pregnancy?
Women with sickle cell disease can have a healthy pregnancy, but need to be extra careful to avoid problems during pregnancy that can affect their own health and the health of the unborn baby. The disease may become more severe and pain episodes may occur more frequently. There is a higher risk of preterm labor and of having a low-birthweight baby. However, with early prenatal care and careful monitoring throughout pregnancy, women with sickle cell disease can have a healthy pregnancy.

During pregnancy, there is a test to find out if the unborn baby will have sickle cell disease, sickle cell trait, or neither one. The test is usually conducted after the second month of pregnancy. Women with sickle cell disease might want to see a genetic counselor to find information about the disease and the chances that sickle cell disease will be passed to the baby.

6. Did you know that there are different types of sickle cell disease?
There are several different types of sickle cell disease. People who inherit two sickle cell genes, one from each parent, have a type of sickle cell disease called SS. This is commonly called “sickle cell anemia” and is usually the most severe form of the disease.

People who inherit a sickle cell gene from one parent and a gene for another type of abnormal hemoglobin (hemoglobin is a protein that allows red blood cells to carry oxygen to all parts of the body) from the other parent, have a different type of sickle cell disease.

Some types of sickle cell disease are very severe and some are milder. The disease affects each person differently.

7. Did you know that there is a cure for sickle cell disease?
Bone marrow/stem cell transplant can cure sickle cell disease.

Bone marrow is a soft, fatty tissue inside the center of the bones where blood cells are made. A bone marrow/stem cell transplant is a procedure that takes healthy cells that form blood from one person - the donor - and puts them into someone whose bone marrow is not working properly.

Bone marrow/stem cell transplants are very risky, and can have serious side effects, including death. For the transplant to work, the bone marrow must be a close match. Usually, the best donor is a brother or sister. Bone marrow/stem cell transplants are used only in cases of severe sickle cell disease for children who have minimal organ damage from the disease.

8. Did you know that people with sickle cell disease need to have their vision checked more often that people who do not have sickle cell disease?
Vision loss, including blindness, can occur when blood vessels in the eye become blocked with sickle cells and the retina (the thin layer of tissue inside the back of the eye) gets damaged.

People with sickle cell disease should have their eyes checked every year to look for damage to the retina. If possible, this should be done by an eye doctor who specializes in diseases of the retina. If the retina is damaged, laser treatment often can prevent further vision loss.

9. Did you know that there are a lot of things that a person with sickle cell disease can do to avoid some of the complications?
People with sickle cell disease can live full lives and enjoy most of the activities that other people do. There are things that people with sickle cell disease can do to stay as healthy as possible. Here a few examples:

• Get regular checkups. Regular health checkups with a primary care doctor can help prevent some serious problems.

• Prevent infections. Common illnesses, like the flu, can quickly become dangerous for a child with sickle cell disease. The best defense is to take simple steps to help prevent infections. See tips to help prevent getting an infection.

• Learn healthy habits. People with sickle cell disease should drink 8 to 10 glasses of water every day and eat healthy food. They also should try not to get too hot, too cold, or too tired.

• Look for clinical studies. New clinical research studies are happening all the time to find better treatments and, hopefully, a cure for sickle cell disease. People who participate in these studies might have access to new medicines and treatment options.

• Get support. Find a patient support group or community-based organization in your area that can provide information, assistance, and support.

10. Did you know that people with sickle cell disease should get vaccinations?
People with sickle cell disease, especially infants and children, are more at risk for harmful infections. Pneumonia is a leading cause of death in infants and young children with sickle cell disease. Vaccinations can protect against harmful infections.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

Older, Active and Vitamin E

In older people, low vitamin E concentration contributes to decline in physical function. A study found this when it looked at data on about 700 Italians.

Benedetta Bartali of Yale University School of Medicine and her colleagues measured vitamin E in the blood and assessed the abilities to walk a short distance, stand up from a chair, and balance.

In people with low vitamin E, the odds of declining in physical function after three years were greater than in those with higher levels.

Her conclusion:

``An adequate level of vitamin E may reduce the decline in physical function.’’

Good sources of vitamin E include olive oil, almonds and sunflower seeds.

The study, named InCHIANTI, in the Journal of the American Medical Association, was supported in part by the National Institutes of Health.

Vitamin E: What is it?

Vitamin E is a fat-soluble vitamin that exists in eight different forms. Each form has its own biological activity, which is the measure of potency or functional use in the body [1]. Alpha-tocopherol (α-tocopherol) is the name of the most active form of vitamin E in humans. It is also a powerful biological antioxidant [2-3]. Vitamin E in supplements is usually sold as alpha-tocopheryl acetate, a form of alpha-tocopherol that protects its ability to function as an antioxidant. The synthetic form is labeled "D, L" while the natural form is labeled "D". The synthetic form is only half as active as the natural form [4].

Antioxidants such as vitamin E act to protect your cells against the effects of free radicals, which are potentially damaging by-products of energy metabolism. Free radicals can damage cells and may contribute to the development of cardiovascular disease and cancer. Studies are underway to determine whether vitamin E, through its ability to limit production of free radicals, might help prevent or delay the development of those chronic diseases. Vitamin E has also been shown to play a role in immune function, in DNA repair, and other metabolic processes [2-3].

What foods provide vitamin E?

Vegetable oils, nuts, green leafy vegetables, and fortified cereals are common food sources of vitamin E in the United States (U.S.).

Who may need extra vitamin E to prevent a deficiency?

Individuals who cannot absorb fat require a vitamin E supplement because some dietary fat is needed for the absorption of vitamin E from the gastrointestinal tract. Intestinal disorders that often result in malabsorption of vitamin E and may require vitamin E supplementation include [3]:

* Crohn's Disease is an inflammatory bowel disease that affects the small intestines. People with Crohn's disease often experience diarrhea and nutrient malabsorption.
* Cystic Fibrosis is an inherited disease that affects the lungs, gastrointestinal tract, pancreas, and liver. Cystic fibrosis can interfere with normal digestion and absorption of nutrients, especially of fat soluble vitamins including vitamin E.

People who cannot absorb fat often pass greasy stools or have chronic diarrhea. People with an inability to secrete bile, a substance that helps fat digestion, may need a special water-soluble form of vitamin E.

Abetalipoproteinemia is a rare inherited disorder of fat metabolism that results in poor absorption of dietary fat and vitamin E [8]. The vitamin E deficiency associated with this disease causes problems such as poor transmission of nerve impulses, muscle weakness, and degeneration of the retina that can cause blindness. Individuals with abetalipoproteinemia may be prescribed special vitamin E supplements by a physician to treat this disorder [12].

Ataxia and vitamin E deficiency (AVED) is also a rare inherited disorder. It is caused by a genetic defect in a liver protein that is responsible for maintaining normal alpha-tocopherol concentrations in the blood. These individuals have such severe vitamin E deficiency that without supplements they are unable to walk (ataxia) [9].

Very low birth weight infants may be deficient in vitamin E [3,10]. Necrotizing enterocolitits, a condition sometimes seen in very low birth weight infants that is characterized by inflammation of the lining of the intestines, may lead to a vitamin E deficiency [4]. These infants are usually under the care of a neonatologist, a pediatrician specializing in the care of newborns who evaluates and treats the exact nutritional needs of premature infants.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.

Either or Both - Diet or Exercise

If you want to lose weight so your heart is healthier, a study indicates diet, exercise or both work – provided you lose the weight.

Sandor Kovacs and colleagues of Washington University School of Medicine in St. Louis found that in a look at the hearts of middle-aged men and women who cut calories or exercised for a year. The study in the American Journal of Physiology: Heart and Circulatory Physiology was supported in part by the National Institutes of Health.

Both groups lost about 12 percent of their weight, and had similar improvements in their hearts’ ability to fill and pump blood. Their hearts became more supple, like younger hearts.

Kovacs’ conclusion:

``If you want your heart to improve, and if you are overweight, you can lose weight either by dieting, or exercising, or doing both.’’

* Weight loss to lower elevated blood pressure in overweight and obese persons with high blood pressure.
* Weight loss to lower elevated levels of total cholesterol, LDL-cholesterol, and triglycerides, and to raise low levels of HDL-cholesterol in overweight and obese persons with dyslipidemia.
* Weight loss to lower elevated blood glucose levels in overweight and obese persons with type 2 diabetes.
* Use the BMI to assess overweight and obesity. Body weight alone can be used to follow weight loss, and to determine the effectiveness of therapy.
* The BMI to classify overweight and obesity and to estimate relative risk of disease compared to normal weight.
* The waist circumference should be used to assess abdominal fat content.
* The initial goal of weight loss therapy should be to reduce body weight by about 10 percent from baseline. With success, and if warranted, further weight loss can be attempted.
* Weight loss should be about 1 to 2 pounds per week for a period of 6 months, with the subsequent strategy based on the amount of weight lost.
* Low calorie diets (LCD) for weight loss in overweight and obese persons. Reducing fat as part of an LCD is a practical way to reduce calories.
* Reducing dietary fat alone without reducing calories is not sufficient for weight loss. However, reducing dietary fat, along with reducing dietary carbohydrates, can help reduce calories.
* A diet that is individually planned to help create a deficit of 500 to 1,000 kcal/day should be an intregal part of any program aimed at achieving a weight loss of 1 to 2 pounds per week.
* Physical activity should be part of a comprehensive weight loss therapy and weight control program because it: (1) modestly contributes to weight loss in overweight and obese adults, (2) may decrease abdominal fat, (3) increases cardiorespiratory fitness, and (4) may help with maintenance of weight loss.
* Physical activity should be an integral part of weight loss therapy and weight maintenance. Initially, moderate levels of physical activity for 30 to 45 minutes, 3 to 5 days a week, should be encouraged. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week.
* The combination of a reduced calorie diet and increased physical activity is recommended since it produces weight loss that may also result in decreases in abdominal fat and increases in cardiorespiratory fitness.
* Behavior therapy is a useful adjunct when incorporated into treatment for weight loss and weight maintenance.
* Weight loss and weight maintenance therapy should employ the combination of LCD's, increased physical activity, and behavior therapy.
* After successful weight loss, the likelihood of weight loss maintenance is enhanced by a program consisting of dietary therapy, physical activity, and behavior therapy which should be continued indefinitely. Drug therapy can also be used. However, drug safety and efficacy beyond 1 year of total treatment have not been established.
* A weight maintenance program should be a priority after the initial 6 months of weight loss therapy.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Kids and Cough Medicine

Kids can get into everything, which can be dangerous. The Centers for Disease Control and Prevention highlights one example – when kids swallow so much over-the-counter cough and cold medicine that they have to go to the emergency department.

The CDC’s Melissa Schaefer says it happens to about 7,000 kids each year. She says about 4,600 of those got into the medications without their parents knowing, and most were ages 2 years to 5 years.

Schaefer says child-resistant packaging by itself wasn’t enough:

``Parents should be reminded to keep all medications, not just cough and cold medications, out of the hands of their children, so secured in cupboards or cabinets where their kids can’t access them.’’

She says parents should remind kids meds are not candy, and should avoid taking their meds while the kids watch.

During the winter, it's common for children to pick up various respiratory germs that have them coughing and feeling bad. Parents may reach for children's cold and cough medications to try to ease the sniffling and coughs. But safety concerns have recently emerged about these types of medicines when used in children. Parents can take some steps now to help keep their children safe.

Each year, about 7,000 children ages 11 and younger go to hospital emergency rooms after taking cold and cough medicines, about two-thirds of them ingested without a parent or caregiver nearby, according to a recent CDC study. Children between the ages of 2 and 5 are most often affected. Unfortunately, past studies have also uncovered a number of deaths in very young children who were inadvertently given too much of the medicines.

Safety concerns about cold and cough medications for young children prompted the U.S. Food and Drug Administration (FDA) earlier this month to recommend that parents forgo using these types of drugs in children less than age 2. The manufacturers have voluntarily withdrawn the drugs specifically meant for the youngest children, which should help further reduce the number of children negatively affected by these medicines. Meanwhile, the FDA is currently assessing whether the drugs are safe for use in children older than age 2.

During the most recent study, most of the children who went to the emergency room didn't need to be admitted to the hospital. But many needed treatments to prevent further absorption of the medications into their bodies.

Parents can help prevent these types of events and protect their children by taking the following advice:

  • Don't leave medicines where your child might be able to reach them.
  • Don't tell children that medicine is candy.
  • Don't take adult medications in front of your child.
  • Don't give children younger than age 2 medicines intended for older children.
  • Throw away cold and cough medicines for children less than age 2.

Manufacturing changes to packaging and formulation could also be useful in reducing hospital visits associated with cold and cough medicines, particularly those due to unsupervised ingestion. Some strategies to make the medications more difficult to access and less inviting to children could include bottle-top adapters, child-resistant single-dose packaging, and the removal of unneeded color additives.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


New Safety Warnings for Chantix

FDA alerts the public and health care providers to mood and behavior changes associated with this medicine to help people quit smoking

FDA issued a Public Health Advisory on Feb. 1, 2008, to alert health care providers, patients, and caregivers to new safety warnings concerning Chantix (varenicline). Chantix is a prescription medication used to help people stop smoking.

Chantix was approved by FDA in May 2006. In November 2007, FDA issued an Early Communication to tell the public and health care providers that the agency was evaluating adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal thoughts, and attempted and completed suicide.

As FDA continues its review of the adverse event reports, it appears increasingly likely that there may be an association between Chantix and serious mood and behavior symptoms.

FDA has requested that Pfizer, the manufacturer of Chantix, give the safety information a more prominent position on the drug's prescribing information, or labeling. In addition, FDA is working with Pfizer to finalize a Medication Guide for patients.

"Chantix has proven to be effective in smokers motivated to quit, but patients and health care professionals need the latest safety information to make an informed decision regarding whether or not to use this product,” says Bob Rappaport, M.D., Director of FDA’s Division of Anesthesia, Analgesia and Rheumatology Products. "Patients should talk with their doctors about this new information and whether Chantix is the right drug for them."

Tips for Consumers

* Tell your health care provider about any history of psychiatric illness before you start taking Chantix.
* Immediately tell a doctor if you or someone you care for has any changes in mood and behavior while being treated with Chantix. In most cases, mood and behavior changes developed during treatment, but some people developed symptoms after they stopped taking Chantix.
* Be aware that vivid, unusual, or strange dreams may occur while taking Chantix.
* Chantix may affect your ability to drive or operate machinery.

Recommendations and Considerations for Healthcare Professionals

* Healthcare providers should monitor all patients taking Chantix for symptoms of serious neuropsychiatric symptoms. Symptoms include changes in behavior, agitation, depressed mood, suicidal ideation, and suicidal behavior. These symptoms have sometimes occurred in patients without pre-existing psychiatric illness and have worsened in some patients with pre-existing psychiatric illness treated with Chantix. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of Chantix therapy.

* Patients with serious psychiatric illness such as schizophrenia, bipolar disorder, and major depressive disorder, may experience worsening of their pre-existing psychiatric illness while taking Chantix. Patients with serious psychiatric illness did not participate in the pre-marketing studies of Chantix. The safety and efficacy of Chantix in these patients has not been established.

* While Chantix has demonstrated clear evidence of efficacy, it is important to consider these safety concerns and alert patients about these risks.

Information for the patient: Physicians who prescribe Chantix should discuss with their patients, patients’ families, and caregiver the following:

* Tell the doctor about any history of psychiatric illness prior to starting Chantix. Patients taking Chantix have experienced worsening of current psychiatric illness, even if it is currently under control, and the reoccurrence of previous psychiatric illness.
* Be alert to changes in mood and behavior. Symptoms include strange thoughts or behaviors, depressed mood, and thinking about or attempting suicide.
* Immediately report changes in mood and behavior to the doctor.
* Vivid, unusual, or strange dreams may occur while taking Chantix.

Background Information and Data

FDA first informed the public about the possibility of serious neuropsychiatric symptoms in the November 20, 2007 FDA Early Communication About an Ongoing Safety Review. At that time, information about serious neuropsychiatric symptoms in patients taking Chantix was added to the POST-MARKETING EXPERIENCE section of the prescribing information. As FDA’s review of the data has progressed and FDA has received additional information, it has become increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms. As a result, FDA requested that Pfizer, the manufacturer of Chantix, add the information to the WARNINGS and PRECAUTIONS sections of the Chantix prescribing information so that healthcare professionals and patients can be more alert to these issues [insert link to label]. In addition, FDA is working with Pfizer to finalize a Medication Guide for patients.

FDA will update healthcare professionals about new information from FDA’s continuing review of the data or new information that it receives on Chantix and serious neuropsychiatric symptoms. FDA may consider additional regulatory action as the data review and conclusions warrant.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


FDA Approves Drug-Eluting Heart Stent

FDA has approved The Endeavor Zotarolimus-Eluting Coronary Stent, manufactured by Medtronic, Inc., of Minneapolis. It's the first drug-eluting stent that FDA has approved since 2004

On Feb. 1, 2008, FDA announced approval of the first drug-eluting stent since 2004, for use in treating patients with narrowed coronary arteries, the blood vessels supplying the heart.

The Endeavor Zotarolimus-Eluting Coronary Stent, manufactured by Medtronic, Inc., of Minneapolis, is also the first drug-eluting stent to receive FDA approval since the agency held its Circulatory System Devices Panel in 2006. At this meeting, experts discussed evidence of the rare risk of blood clots occurring in patients who receive these stents.
How the Stent Works

Endeavor is a tiny metal mesh tube coated with a small amount of zotarolimus, a new drug developed only for use on a stent.

It is crimped around a balloon and delivered to the narrowed section of the coronary artery by a long thin catheter during a procedure known as an angioplasty. Once the stent is positioned, the balloon is inflated, expanding into the vessel wall where it will remain in place, acting as a mechanical scaffold to keep the artery open.

Slow release of zotarolimus over time prevents the artery from re-narrowing when new tissue begins to form.

Daniel Schultz, M.D., Director of FDA's Center for Devices and Radiological Health, says the Endeavor stent provides cardiologists with another option for treating the one million patients who undergo an angioplasty procedure every year to open their clogged coronary arteries. “This important approval is the result of a substantial amount of clinical evidence and a careful review by both FDA and its advisory committee,” he says.


Patients who are allergic to zotarolimus or to cobalt, nickel, chromium, or molybdenum, should not receive an Endeavor stent. Caution is also recommended for people who have had recent cardiac surgery and for women who are nursing or who may be pregnant.

Medtronic will continue to follow patients enrolled in six of the Endeavor clinical studies for five years. The company also will conduct a 2,000-patient U.S. post-approval study, which will be combined with 3,300 patients from a study conducted outside the United States, to assess the device's long-term safety and effectiveness and to look for rare adverse events.

Medtronic will also collect clinical data to identify the optimal duration of blood-thinning medication.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.


Serious Health Risks with Antiepileptic Drugs

FDA warns about possible risk of suicidal thoughts and behavior in patients taking antiepileptic drugs

FDA issued new information on Jan. 31, 2008, to alert health care professionals about an increased risk of suicidal thoughts and behaviors in patients who take medications called antiepileptics. Such drugs treat epilepsy, bipolar disorder, migraine headaches, and other conditions.

FDA studied suicidality reports from 11 antiepileptic drug studies and found that patients taking antiepileptics have about twice the risk of suicidal thoughts and behaviors, compared with patients receiving an inactive substance (placebo). This risk corresponds to an estimated 2.1 per 1,000 more patients in the drug treatment groups who experienced suicidality than in the placebo groups.

FDA recommends that

* Patients currently taking antiepileptic medicines not make any changes without first talking to their health care providers.
* Health care providers notify patients, their families, and caregivers of the potential for an increase in the risk of suicidality, so that patients can be closely observed for notable behavior changes.

Although only the following drugs were part of the analysis, FDA expects that all medications in the antiepileptic class share the increased risk of suicidality:

* Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
* Felbamate (marketed as Felbatol)
* Gabapentin (marketed as Neurontin)
* Lamotrigine (marketed as Lamictal)
* Levetiracetam (marketed as Keppra)
* Oxcarbazepine (marketed as Trileptal)
* Pregabalin (marketed as Lyrica)
* Tiagabine (marketed as Gabitril)
* Topiramate (marketed as Topamax)
* Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
* Zonisamide (marketed as Zonegran)

The agency will work with manufacturers of marketed antiepileptic drugs to include this new information in the labeling of these products. FDA anticipates that labeling changes will be applied broadly to the entire class of drugs.

Considerations for Physicians and Other Health Care Professionals

Data from 199 placebo-controlled clinical studies covering eleven different antiepileptic drugs were reviewed and analyzed for reports of suicidal behavior (completed suicides, suicide attempts and preparatory acts) and suicidal ideation. The studies examined the effectiveness of the drugs in epilepsy, psychiatric disorders (e.g., bipolar disorder, depression and anxiety) and other conditions (e.g., migraine and neuropathic pain syndromes). The analysis included a total of 43,892 patients ages five and older (27,863 in drug treatment groups and 16,029 in placebo groups).

There was a statistically significant increased risk of suicidal behavior and suicidal ideation in the patients randomized to receive an antiepileptic drug compared to patients who received a placebo. The estimated overall risk was about twice that of the placebo group. There were an estimated 2.1 per 1000 (95% CI: 0.7, 4.2) more patients in the drug treatment groups who experienced suicidal behavior or ideation than in the placebo groups.

Four of the patients who were taking one of the antiepileptic drugs committed suicide, whereas none of the patients in the placebo group did. The increased risk of suicidal behavior and suicidal ideation was observed at one week after starting the drug and continued to at least 24 weeks. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be reliably assessed.

FDA will be working with manufacturers of marketed antiepileptic drugs to include this new information in the labeling for these products. FDA is also planning to discuss these data at an upcoming advisory committee meeting.

All patients treated with antiepileptic drugs should be monitored for suicidality and other unusual changes in behavior. Symptoms such as anxiety, agitation, hostility, mania and hypomania may be precursors to emerging suicidality.

Healthcare professionals who prescribe antiepileptic drugs should:

* Balance the risk for suicidality with the clinical need for the drug
* Be aware of the possibility of the emergence or worsening of depression, suicidality, or any unusual changes in behavior;
* Inform patients, their families, and caregivers of the potential for an increase in the risk of suicidality so they are aware and able to notify their healthcare provider of any unusual behavioral changes.

Information for patients, family members, and caregivers:

* Taking antiepileptic medicines may increase the risk of having suicidal thoughts or actions;
* Do not make any changes to the medication regimen without first talking with the responsible healthcare professional;
* Pay close attention to any day-to-day changes in mood, behavior and actions. These changes can happen very quickly so it is important to be mindful of any sudden differences.
* Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:
o Talking or thinking about wanting to hurt yourself or end your life
o Withdrawing from friends and family
o Becoming depressed or having your depression get worse
o Becoming preoccupied with death and dying
o Giving away prized possessions

If these or any new and worrisome behaviors occur, contact the responsible healthcare professional immediately.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.