Shawn's Health Blog: Jan 13, 2009

1/13/2009

Interstitial Cystitis: Diagnosis & treatment

Interstitial cystitis or IC refers to a clinical syndrome characterized by chronic urinary urgency feeling the need to urinate immediately and frequency or frequent urination. It could appear with or without pelvic pain. Symptoms of interstitial cystitis may vary among individuals and may even vary with time in the same individual with this problem. The term cystitis refers to any inflammation of bladder. In contrast to bacterial cystitis that results from an infection in the bladder, no infectious organism has were identified in people with interstitial cystitis. Interstitial cystitis is diagnosed when the symptoms occur without evidence for another cause of symptoms.

Overview of urinary function

The urinary system consists of two kidneys, ureters, bladder, and urethra. The kidneys are pair of purplish-brown organs, located below the ribs toward the middle of the back. The kidneys remove water and waste from the blood in the form of urine. This way kidneys are keeping a stable balance of salts and other substances in the blood. The kidneys also produce erythropoietin. That is hormone that stimulates the formation of human red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder. This is a triangle-shaped, muscular chamber in the lower abdomen. Like a balloon, the bladder%26rsquo;s muscular and elastic walls relax and expand to store urine and contract and flatten when urine is emptied through the urethra. The typical adult bladder can store about 1.5 cups of urine inside. Adults urinate about a quart and a half of urine each day, while the amount of urine varies depending on the fluids and foods a person consumes. The volume formed at night is about half that formed during all day. Normal urine contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi. The tissues of the bladder are isolated from urine and toxic substances. It is done by coating on the inside of the bladder that discourages bacteria from attaching and growing on the bladder Narrow tubes called ureters carry urine from the kidneys to the bladder, which is placed in lower abdomen.

What is interstitial cystitis?

Sometimes doctors use the term painful bladder syndrome or PBS to describe cases of pelvic pain that do not meet the strict criteria for interstitial cystitis established by the National Institute of Diabetes and Digestive and Kidney Diseases. An estimated one million Americans suffer from interstitial cystitis, and about 90 percent of patients with interstitial cystitis are women. While individuals of any age can be affected, including children, the average age of onset age is 40. Interstitial cystitis has not been considered to be a hereditary disorder, but multiple cases have occurred among some families. It is prompting ongoing investigation of the possible role of hereditary factors in the development of interstitial cystitis. Some associations with other medical conditions are seen with the probolem of interstitial cystitis. Women with interstitial cystitis are more likely to have had frequent urinary tract infections. These women also tend to have previous gynecologic surgery than women without interstitial cystitis. Certain chronic illnesses have been described as occurring more frequently in people with interstitial cystitis than in general population. Examples of these associated conditions are inflammatory bowel disease, systemic lupus erythematous, irritable bowel syndrome, allergies, endometriosis and fibromyalgia. Each of these conditions has been described in at least some studies to be more common in people with interstitial cystitis than in the general population, but there is no evidence that any of these conditions is cause of interstitial cystitis. Interstitial cystitis has been classified into two forms, ulcerative and nonulcerative. It is depending upon the presence or absence of ulcerations in the bladder lining as seen during cystoscopy. Citoscopy is visual examination of the inside of the bladder via a probe. Star-shaped ulcerations in the bladder wall are famous as Hunner%26rsquo;s ulcers. The ulcerative type of interstitial cystitis that is sometimes termed classic interstitial cystitis, is found in less than 10% of cases in the U. S. Problem is that over time, interstitial cystitis can cause physical damage to the bladder wall.

Scarring and stiffening of the bladder wall may occur as a result of the chronic inflammation. It could lead to a decrease in bladder capacity. Glomerulations, or areas of pinpoint bleeding, may be seen on the bladder wall.

What is cause of interstitial cystitis?

No one knows what causes interstitial cystitis, but doctors studying interstitial cystitis believe that it is a real, physical problem. They also say it is not a result, symptom, or sign of an emotional problem. Because the symptoms of interstitial cystitis are varied, most researchers believe that it represents a spectrum of disorders rather than only one single disease. One area of research on the cause of interstitial cystitis has focused on the layer that coats the lining of the bladder. This area is called the glycocalyx and is made up primarily of substances called mucins and glycosaminoglycans. This layer normally protects the bladder wall from toxic effects of the urine and its contents. Researchers have found that this protective layer of the bladder is leaky in about 70% of interstitial cystitis patients. Researches also hypothesized that this may allow substances in urine to pass into the bladder wall where they might trigger interstitial cystitis. Along with altered permeability of the bladder wall, researchers are also examining the possibility that interstitial cystitis results from decreased levels of protective substances found in the bladder wall. Reduced levels of glycosaminoglycans or other protective proteins might also be responsible for the damage to the bladder wall that is seen in interstitial cystitis. No matter what the mechanism for disruption of the bladder lining, potassium is one substance that may be involved in damage to bladder wall. Potassium is present in high concentrations in urine and is normally not toxic to the bladder lining, but if the tissues lining the inside of the bladder are disrupted or are abnormally leaky, potassium could then penetrate the lining tissues. Then it enters the muscle layers of the bladder, where it can cause damage and promote inflammation. Researchers have isolated a substance known as antiproliferative factor that appears to block normal growth of cells that make up lining of bladder. That antiproliferative factor has been identified almost exclusively in the urine of people suffering with interstitial cystitis. Research is underway to clarify the potential role of this factor in development of interstitial cystitis. Increased activation of sensory nerves in the bladder wall is also thought to contribute to the symptoms of interstitial cystitis. Cells known as mast cells, which play a role in the body%26rsquo;s inflammatory response to injury release some specific chemicals. These chemicals are believed to be capable of contributing to the symptoms of interstitial cystitis. Other theories about the cause of interstitial cystitis are that it is a form of autoimmune disorder or that infection with an unidentified organism may be producing the damage to the bladder.

The signs and symptoms of interstitial cystitis?

The symptoms of interstitial cystitis vary greatly from one person to another but have some similarities to those of urinary tract infection. These symptoms include decreased bladder capacity, an urgent need to urinate frequently day and night, feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum. Perineum is the area between the anus and vagina, or anus and scrotum, which may increase as the bladder fills and decrease as it empties. Patients are also complaining about painful sexual intercourse and discomfort or pain in the penis and scrotum. Most people suffering from interstitial cystitis have both urinary frequency and pelvic pain, although these symptoms may also occur singly or in any combination with others. In most women with interstitial cystitis, symptoms usually worsen around the time of their periods. As with many other illnesses, stress also may intensify the symptoms. However, stress does not cause them. The symptoms usually have a slow onset, and urinary frequency is erly symptom.

Diagnosis of interstitial cystitis

Because the symptoms of interstitial cystitis are similar to those of other disorders of the urinary system and because there is no definitive test to identify interstitial cystitis, doctors must exclude other conditions before making exact diagnosis. Medical tests that help identify other conditions include a urinalysis, urine culture, cystoscopy, biopsy of bladder wall and, in men, laboratory examination of prostatic secretions. Physical examination of an individual with interstitial cystitis may reveal tenderness of the bladder either when pushing on the abdomen over the bladder or during the pelvic examination in women. Laboratory tests should also be done to diagnose interstitial cystitis.

Treatment of interstitial cystitis?

The principal type of oral medication is the heparinoid drug pentosan polysulfate sodium. PPS is chemically similar to the substance that lines the bladder, and it is believed that PPS assists in the repair or restoration of the lining tissues in bladder. Other oral medications that may be used to treat interstitial cystitis along with PPS include antidepressants of tricyclic group. This is not due to a belief that interstitial cystitis is a psychological condition. It is rather due to the fact that tricyclic antidepressants can help reduce the hyper-activation of nerves within the bladder wall. Oral antihistamines may also be prescribed to help reduce allergy symptoms. that may be worsening the patient%26rsquo;s interstitial cystitis. Beside this, bladder distension sometimes is used for therapy of interstitial cystitis. Bladder distension helps reduce symptoms in approximately 20-30% of people with problem called interstitial cystitis.

Recurring Urinary Tract Infection

Urinary tract infections are common in adults but it is common problem in kids as well. By five years old, about 8% of girls and about 2% of boys have had at least one urinary tract infection or UTI. They occur when the kidneys, ureters, bladder, or urethra as the main parts of urinary tract become infected. Chronic urinary tract infection is a disorder involving repeated or prolonged bacterial infection of the bladder or lower urinary tract. Since this is common problem, we should all beter understant what does urinary tract infection means. We should also know something else, which even more serious condition, and those are recurring urinary tract infections.

What is recurrent urinary tract infection

Recurrence is common after both complicated and uncomplicated urinary tract infections. After a single uncomplicated acute urinary tract infection recurrence occurs in approximately 27% to 48% of women, where infections usually recur a few months apart. The risk after a complicated UTI is even higher. The fact is that between 50% and 60% of individuals will have recurrent infection by 4 to 6 weeks following treatment if the underlying problem is not corrected. Recurrence is often defined as either reinfection or relapse of urinary tract. Reinfection is huge problem, since about 80% of recurring urinary tract infections are reinfections. A reinfection occurs several weeks after antibiotic treatment has cleared up the initial episode. It is caused by a different organism from the one that caused the original episode. The infecting agent is usually introduced through the rectal region from fecal matter and moves up through urinary tract. Relapse is the less common form of recurrent urinary tract infection, and it is diagnosed when a UTI recurs within two weeks of treatment of the first episode and is caused by the same organism. Relapse usually occurs in kidney infection, or is associated with obstructions such as kidney stones, structural abnormalities, or, in men, chronic prostatitis.

Symptoms of urinary tract infection

Common symptoms are:

pain when urinating

changes in frequency, appearance, and smell of urine

nausea

lower abdominal pain

fever

lower back pain or discomfort

chills

loss of appetite

vomiting

Recurrent urinary tract infections can also cause bedwetting in children who were previously dry at night, while infants and young children may only show nonspecific signs such as fever, vomiting, or decreased appetite or activity.

Some children experience urinary tract infection again and again that is also called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage. It could be especially serious in children younger than six.

Types of urinary tract infections

Common types of urinary tract infections include cystitis, which is the most common type of UTI. That is a bladder infection that can occur when bacteria move up the urethra, which is the tube-like structure that allows urine to exit the body from the bladder, and into the bladder. Urethritis is problem which occurs when bacteria infect the urethra. Pyelonephritis, is infection, specifically a kidney infection that can occur when infected urine flows backward from the bladder to the kidneys, or when an infection in the bloodstream reaches the kidneys.

Related urinary tract conditions associated with recurrent UTIs

Recurrent urinary tract infections are sometimes seen in conjunction with some other conditions. It could be associated with vesico-ureteral reflux or VUR, which is found in 30% to 50% of children diagnosed with a UTI. It is a congenital condition, which means it is present at birth. When children have this problem, their urine flows backward from the bladder to the ureters. As you already know, ureters are thin, tube-like structures that carry urine from the kidney to the bladder, and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can sometimes lead to pyelonephritis. Hydronephrosis is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Children with hydronephrosis are sometimes at risk of recurrent urinary tract infections and may need to take daily low doses of antibiotics to prevent UTIs. However, not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding or when a child does not urinate frequently enough or does not relax properly while urinating, is a common cause of urinary tract infections. Unrelated conditions that compromise the body%26rsquo;s natural defenses, such as diseases of the immune system, can also lead to the problem with recurrent UTIs. Off course, also using a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.

Causes, incidence, and risk factors for reccurent urinary tract infections

Most urinary tract infections occur in the lower urinary tract, which includes the bladder and urethra, where cystitis is caused when the normally sterile lower urinary tract is infected by bacteria and becomes inflamed. Cystitis is very common and most of the time, symptoms of cystitis disappear within 24 - 48 hours after treatment begins. Chronic or recurrent urinary tract infection includes repeated episodes of cystitis that means more than two infections in a six months. It also refers to urinary tract infection that does not respond to the usual treatment or that lasts longer than two weeks. In young girls, recurrent urinary tract infections may be an indication of a urinary tract abnormality, such as vesicoureteral reflux. It should be evaluated by a medical care provider. In boys, even a single urinary tract infection should be evaluated. That is because urinary tract infections in boys are extremely uncommon in the absence of urinary tract abnormalities. The elderly population are at increased risk for developing cystitis. in this population, problem occuring is due to incomplete emptying of the bladder associated with such conditions as benign prostatic hyperplasia, prostatitis, and urethral strictures. Moreover, lack of enough fluids, bowel incontinence, immobility or decreased mobility, having a Foley catheter, and placement in a nursing home, all put a person at increased risk for developing cystitis or urinary tract infection.

Signs and tests for reccurent urinary tract infections

Chronic or recurrent urinary tract infection means that symptoms return two or more times in six months, that symptoms of a single episode last longer than two weeks, or symptoms last longer than 48 hours after treatment has begun. Tests that may be done include a urinalysis, which commonly reveals white blood cells or red blood cells. A urine culture or catheterized urine specimen may reveal bacteria in the urine. A urine culture that is positive for more than two weeks even with treatment indicates chronic or recurrent urinary tract infection. An abdominal ultrasound or KUB, known as abdominal x-ray may be needed to evaluate the status of the renal system.

Treatment for reccurent urinary tract infections

Mild cases of acute cystitis may disappear on their own without treatment, but since it is possible to get the risk of the infection spreading to the kidneys or complicated UTI, treatment is usually recommended. Also, due to the high death rate in the elderly, prompt treatment is recommended for each patient. Antibiotics may be used to control the bacterial infection, but you must finish the entire course of prescribed antibiotics. Commonly used antibiotics include Nitrofurantoin, sulfa drugs, Amoxicillin, Cephalosporins, Trimethoprim-sulfamethoxazole, Doxycycline, or Fluoroquinolones. Chronic or recurrent urinary tract infection should be treated thoroughly. This is very important because of the chance of kidney infection known as pyelonephritis. Antibiotics control the bacterial infection, so they may need to be given for long periods of time, as long as six months to two years. In some cases stronger antibiotics may be needed. As an additional precaution, low-dose antibiotics may be recommended after acute symptoms had subsided. Phenazopyridine hydrochloride may be used to reduce the burning and urgency associated with cystitis, and ascorbic acid may be recommended to decrease the concentration of bacteria in the urine. Surgery is generally not needed to treat urinary tract infections or UTIs.

Prevention

Preventive measures may reduce symptoms and prevent recurrence of infection, so if you keep the genital area clean and wipe from front to back, you may prevent dragging bacteria from the rectal area to the urethra. Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during sexual intercourse. Not urinating for a long period of time may allow bacteria time to multiply, so it is important to know that frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections. Increasing the intake of fluids, 2000 - 4000 cc per day, encourages frequent urination that flushes the bacteria from the bladder. You should avoid fluids that irritate the bladder, such as alcohol, citrus juices, and drinks containing caffeine. Follow-up urine cultures may be needed to make sure that bacteria are no longer present in the bladder after you were once diagnosed with urinary tract infection. Long-term use of prophylactic as preventative antibiotics may be recommended for some people who are prone to chronic or recurrent urinary tract infections.

Prognosis for urinary tract infection

Most cases are cured without complication after adequate treatment, although sometimes the treatment may be prolonged. Complications are pyelonephritis, kidney abscess, and swelling of the kidneys. You should call for an appointment with your health care provider if symptoms of cystitis persist after treatment, or recur more than two times in a six months. Call your health care provider if symptoms worsen or new symptoms develop, especially persistent fever, back pain or flank pain, or vomiting.

Implantation bleeding or period?

Implantation bleeding is vaginal discharge that usually contains small amount of pinkish or brownish blood. Only about a third of all pregnant women experience this implantation bleeding. You could suspect it is implantation bleeding if it occurs a bit earlier than expected, if it were scanty, spotty, pinkish and not red and heavy like a period. If your bleeding does not follow the normal pattern of a period it is probably implantation bleeding and not period.

How does implantation bleeding look like?

There is often the feeling that it is a period with light cramps and bloating, but the bleeding is shorter, lighter and simply not normal. If a woman is usually regular, and now all of a sudden develops this type of early spotting, and of course is at risk for a pregnancy, conception is recommended. Each woman should understand that implantation bleeding occurs during implantation of the egg cell. It occurs towards the end of implantation process. Trophoblast is a highly specialized tissue, which develops from the fertilized egg and surrounds the egg. It attaches the egg to the endometrium and as it is continuously growing it invades the endometrium, so as it eats its way into the endometrium it pulls the egg into the endometrium. The trophoblast also invades the mothers blood vessels and divert her blood to cavities inside the trophoblast. These cavities are than filled by maternal blood becoming blood lakes, and most of these lakes are connected. The trophoblast on the outer surface of the egg are thinner and slower growing but also contains cavities that are connected to other deeper cavities. Some of these outer cavities communicate or open into uterine cavity. Blood that leaks from these cavities are causing implantation bleeding, and it occurs shortly before the egg is completely implanted and completely covered with endometrium. Typical implantation bleeding occurs about four weeks after the last menstrual period, it is usually less and darker than the person%26rsquo;s normal menstruation.

The diagnosis of typical implantation bleeding is made in retrospect and duration of the pregnancy is four weeks more than expected, because commonly, the last period recorded by the patient was the implantation bleeding and not her last menstruation. Implantation bleeding has no adverse effects on a pregnancy, although some experts doubt the existence of implantation bleeding . If you search for implantation bleeding you will come across sites that doubt if it ever occurs, but the fact is that some women, about 1%-2%, has a bleeding about four weeks after the last menstrual period with a pregnancy duration four weeks longer than expected.

When does implantation bleeding usually occur?

It can happen at the time the fertilized egg implants in the uterus, on average between six to twelve days past ovulation. Unless accompanied by cramping, backache or increased bleeding, a small amount of blood being discharged should be considered as implantation bleeding, which is nothing to be concerned about.

Home pregnancy tests

Home pregnancy test detect hormone Human Chorionic Gonadotropin or hCG in a woman%26rsquo;s urine. This hormone is a hormone secreted by the developing placenta shortly after a fertilized egg has been implanted in the uterine lining, so if a woman is pregnant, the amount of Human Chorionic Gonadotropin in her system should be around 25 mIU at 10 dpo. Dpo means days past ovulation. It is also 50 mIU at 12 dpo, and 100 mIU at around two weeks dpo. Because of their high sensitivity factor in detecting human hCG, pregnancy tests can confirm pregnancy as early as 6-8 days past ovulation. To help lower the chances of a false negative, the best time to test at 9-10 days past ovulation would be advisable

What else can cause spotting?

Because of an increase in the blood supply to your cervix and greater blood flow to the area, you might spot after having a Pap smear. You can commonly bleed after an internal exam, or sex. Other causes include common implantation bleeding You may have very scant implantation bleeding, possibly around 11 or 12 days after fertilization. It is close to the time you might notice a missed period. It may be caused by the fertilized egg burrowing into the wall of your uterus, a process that starts just six days after fertilization, but no one knows for sure. The bleeding is very light, lasting only a day or two, and only a minority of pregnant women have this kind of spotting. Miscarriage or ectopic pregnancy could also cause spotting. Spotting can be an early sign of miscarriage or an ectopic pregnancy, especially if accompanied by abdominal pain or cramping. About a quarter of pregnant women have some spotting or bleeding in early pregnancy, and about half of these women miscarry, but if you have an ultrasound that shows a heartbeat between 7 and 11 weeks, your chances of continuing the pregnancy are greater than 90 percent. Spotting can also be caused by conditions unrelated to pregnancy, for example because of vaginal infection, such as a yeast infection or bacterial vaginosis. In some cases sexually transmitted infections, such as trichomoniasis, gonorrhea, chlamydia, or herpes can cause your cervix to become irritated or inflamed. An inflamed cervix is particularly susceptible to spotting after sex or after a Pap smear, and you may also spot or bleed after sex or a Pap smear if you have a cervical polyp. Placental problems or premature labor is also cause that some women might spotting. In the second or third trimester, bleeding or spotting can be a sign of a serious condition such as placenta previa, placental abruption, a late miscarriage, or premature labor. A mucus discharge that is tinged with blood after 37 weeks is most likely just a sign that the mucus plug has dislodged and the cervix is beginning to soften or dilate in preparation for normal labor. You should still report any bleeding or spotting at this point to your practitioner. In some cases, the cause of the spotting will remain a mystery. It is also important to know if your blood is Rh-negative, you will need a shot of Rh immune globulin whenever you have vaginal spotting or bleeding. It is necessary unless you know for sure that the baby%26rsquo;s father%26rsquo;s blood is also Rh-negative.

Pregnancy signs

Most likely you will not notice any symptoms until about the time you have missed a period or a week or two later. If you are not keeping track of your menstrual cycle or if it varies widely from one month to the next, you may not be sure when to expect your next period. However, if you start to experience some of the symptoms below and you have not had a period for a while, you may very well be pregnant. You could take a home pregnancy test to find out for sure. The most common pregnancy sings are:

Tender and swollen breasts

One of the early signs of pregnancy is sensitive, sore breasts caused by increasing levels of hormones during pregnancy. The soreness may feel like an exaggerated version of how your breasts feel before your period, and your discomfort should diminish significantly after the first trimester, as your body adjusts to the hormonal changes.

Fatigue

If you feel tired all of a sudden or even exhausted it could also be the pregnancy sign. No one knows for sure what causes early pregnancy fatigue, but could possible be that rapidly increasing levels of the hormone progesterone are contributing to woman%26rsquo;s sleepiness. You should start to feel more energetic once you hit your second trimester. However, fatigue usually returns late in pregnancy when you are carrying around a lot more weight and some of the common discomforts of pregnancy make it more difficult to get good night%26rsquo;s sleep.

Implantation bleeding

Some women have a small amount of vaginal bleeding called implantation bleeding, around 11 or 12 days after conception, close to the time you might notice a missed period. The bleeding may be caused by the fertilized egg burrowing into the blood-rich lining of the uterus. This process starts just six days after fertilization, but as I already said, no one knows that for sure. The bleeding is very light, appearing as red spotting or pink or reddish-brown staining, and lasts only a day or two. You should let your practitioner know if you notice any bleeding or spotting, particularly if it is accompanied by pain, since this can be a sign of an ectopic pregnancy.

Nausea or vomiting

If you are like most women, morning sickness will not hit you until about a month after conception. A lucky few women escape it altogether. However, some women do start to feel queasy a bit earlier and not just in the morning, either pregnancy-related nausea and vomiting can be a problem morning, noon, or night. About half of women with nausea feel complete relief by the beginning of the second trimester while for most others it takes another month or so for the queasiness to ease up.

Increased sensitivity to odors

If you are newly pregnant, it is not uncommon to feel repelled by the smell of a bologna sandwich or cup of coffee and for certain aromas to trigger your gag reflex, which could be a side effect of rapidly increasing amounts of estrogen in your system. You may also find that certain foods you used to enjoy are suddenly completely repulsive.

Abdominal bloating

Hormonal changes in early pregnancy may leave you feeling bloated, similar to the feeling some women have just before their period arrives, which is why your clothes may feel snugger than usual at the waistline, even early on when your uterus is still quite small.

Frequent urination

Shortly after you become pregnant, you may find yourself hurrying to the bathroom all the time, mostly because during pregnancy the amount of blood and other fluids in your body increases, which leads to extra fluid being processed by your kidneys and ending up in your bladder.

A missed period and basal body temperature stays high are signs for pregnancy you probably already know to recognize.

Puberty & my first body hair

At all ages, our skin has fine, short hairs all over it. The amount and type depends on our genes, you will know if you just take a look at your parents. When we are going through puberty, we start to grow thicker and darker hair around our genitals, which are called pubic hair, under our armpits and on our legs. The length, darkness and thickness of this varies between people. However, these first body hair could provoke problems if teenager does not know how to handle with it.

What girl should do about first body hair?

Some people choose to trim, lighten or remove body hair and others do not. This is only your choice. There is nothing wrong with feeling that you do not want to remove body hair. The fact is that European women often leave their body hair alone. Removing hair can cause some minor problems if the skin is nicked with a razor. Commonly skin is irritated by some creams or the re-growing hair gets stuck under the skin surface. For this reason everyone should be careful, and try different methods. You should find one that suits you, and keep the area very clean to prevent skin infections. Some girls and women are naturally more hairy than others, or have darker hair that is more noticeable then others. It is quite common to grow single or many hairs in the typical moustache area of the face. This case is especially as women get older or if they are taking some medications. Hair growth can also be influenced by your hormones or by some prescription drugs. If you have noticed that you are more hairy than your friends and you are not having periods, or your periods are irregular, or your periods have stopped, you should go to see your general practitioner, who can advise you.

What boy should do about first body hair?

During puberty, boys start to grow longer, darker and coarser hair on their legs, genitals, arms, face and their chest. In boys and men, the first hair that grows on their face is quite soft, slow-growing and usually on the upper lip and chin.

Even if you do not want to grow a moustache and beard, you probably will not need to remove this very often. Later on, you will get darker, thicker, faster-growing hair over a larger area of the face. If you do not want to grow a moustache and beard, you will probably need to remove this hair daily. Most boys and men remove this facial hair by shaving with razors. You can buy these razors at chemists and supermarkets. Scraping the skin every day with a sharp blade can cause it to become irritated, which is why most boys and men use shaving foam or shaving gel to help the blade slide over the skin easily.

Removing of the hair

As guys go through puberty, they start growing hair in just about every place you thought it would be impossible to grow, such as arms, legs, chest, belly underarms, pubic area, thighs. This means body hair will grow almost everywhere. Probably the most common concern about hair is when it is going to come in, and how much of hair will be there. As unfortunate as it is, it is absolutely impossible to tell so for the most part, you will just have to wait and see. However, if you are really desperate, then you can always ask your father. While it is not a given, sometimes sons and their fathers share a good bit of the same traits. If you're father is pretty hairy, you might be too, and if he is not so hairy, you might not be either. While it is by no means fool-proof, it can at least give you idea. For now, you must know that hair comes in at all different places in all sorts of different orders. Therefore, just because you have underarm hair, and some friend does not, but he has facial hair, does not mean you will be getting facial hair next. You could get hair on your arms, or legs, or just about anywhere as you have already hear. Then comes the second most popular question, whether it should be shaved off or not; the only one who can answer that is you, it is absolutely 100% personal preference. Some people like being hairy because they think it makes them look older and more manly. In the same time, others like being smoothe because they think it is more attractive. There is no given what type girls like better, just like with guys, it is a personal preference thing for girls as well. However, if you do want to shave it, be careful. Just like with using a blade on anything it will cut the skin if you try and move too fast. Use some shaving cream, and take your time for this process. You can shave just about anywhere, but be aware that it will itch when the hair grows back. Because of that, a lot of people prefer to trim their hairs instead of shave completely. This is most common when it comes to pubic hair, but off course it can apply anywhere. Generally though, it is only useful if you already have a good amount of hair. The most common myth about hair and shaving it is that it will grow back thicker and faster, which is absolutely not true and has no merit. While it might look thicker, and maybe darker, it actually is not. It is just that your eyes playing tricks on you.

You can do just about anything you want with your body hair, it is going to come in at it's own rate, and you cannot change that, but you can wait. After it is in, you can shave, trim, or leave it, it is all up to you.

Normal body hair growth

The normal pattern of body hair growth starts with pubic and axillary hair. For a very hairy man, the next area to grow hair is the legs, and then the abdomen and chest. The area around the coccyx can grow hair quite early in pubescence and the rest of the back is much later. Facial hair is variable in growth pattern, usually growing after the first appearance of abdominal or chest hair, giving a full pattern before the chest and abdominal hair. Upper arm hair grows quite late in the process and forearm hair is the most widely variable in the age at which growth occurs. Forearm hair can grow at any time from about the age of fourteen to twenty-five. It can grow before or after chest, abdomenal or facial hair. Men who are less hairy will follow the same basic pattern as the hairiest men but leaving out the areas where they do not have hair. The least hairy men just have pubic, axillary and facial hair. Growth pattern in women is similar but any woman who has significant quantities of body hair apart from pubic, axillary, leg and forearm hair should consult the doctor. There is a possibility of hormonal imbalance that should be investigated for each woman that is too hairy. It is not count the sometimes heavy downy facial hair that some women have as significant growth. The age variation for the onset of puberty that is biologically normal is nine to 21 years-old. However, the vast majority of people reach puberty between the ages of ten and sixteen. Given these wide tolerances for normality, it is not surprising that doctors consider almost everyone to be normal with regard to hair growth. There are some abnormalities such as precocious puberty in very young children and there are people who grow hair severely outside the normal sequence. In essence, some doctors define normality as a growth pattern that will give rise to a normal individual of normal height and intelligence without any physical disability, including sterility.

Why is body hair important?

Whether it is long, short, straight, or curly, the body hair is important. It protects skin from dirt and germs, provides cushioning for your sensitive parts. It also lessens the friction between skin and clothes, and holds in heat to keep you warm when you need it, which leads to more revealing clothes. Body hair even helps provide a subtle dating service by retaining human unique personal scent, conveyed by chemicals called pheromones. It helps a potential mate become attracted to you. Sometime after puberty, body starts sprouting hair in places that were probably baby smooth just a few short months before. It is especially around genitals, under arms, on legs, and for guys on the face and neck. Many guys find it exciting to start growing body and facial hair, because they think it is a sign that they are changing from boys to men. Some people choose to keep their new hair because they like how it looks, their partner prefers it, or they leave it for religious reasons, among others. However, other people prefer to bleach, trim, or completely remove hair from some or all parts of their bodies. No matter what you decide, the fact is that you have got plenty of options for dealing with your own body hair. It is the easiest option of all just sit back, and let it grow. You get all the benefits of having the hair, and you do not have to spend time or money trying to get rid of it. However, some people find that armpit hair can encourage the growth of bacteria there, leading to body odor, so they rather decide to remove it. You could also bleach or dissolve it. Chemical bleaches lighten hair so it is hard to see, while depilatories dissolve hair so it washes away. Both are good for places not only where you would rather not have hair, but also where hair removal is difficult. Both are easy to apply but can irritate sensitive skin, which is common problem. Off course, you always have option to shave it. Shaving hair is inexpensive and easy, where pack of three disposable razors costs around $1.50, and shaving cream costs around $4. The downside is that you are scraping a very sharp blade across delicate skin. You must be careful, or you could be in for some serious cuts. Most girls prefer plucking or waxing it. Pulling hair out by the roots leaves you smoother longer; it can take weeks for hair to grow back. However, it can also be painful, and some hairs can come back ingrown as common problem of recurrent hair growth.

How do I get rid of the man boobs?

Many young boys are having problems with, how they call it- “the ban boobs”! The condition is medically known as gynecomastia! Gynecomastia is a condition in which firm breast tissue forms in males. The breast tissue is usually less than 1-1/2 inches across and is located directly under ...

Many young boys are having problems with, how they call it- %26ldquo;the ban boobs%26rdquo;! The condition is medically known as gynecomastia! Gynecomastia is a condition in which firm breast tissue forms in males. The breast tissue is usually less than 1-1/2 inches across and is located directly under the nipple. Gynecomastia may be present on one side or on both sides. But not every case of ban boobs could be called gynecomastia because some men and boys have fat on their chests that makes it look like they have breasts.

This condition is called pseudogynecomastia or false gynecomastia. Although distressing to many teen boys who think that they are developing breasts, they should be reassured that gynecomastia is normal, common, and usually doesn't progress to the point that it is easily noticeable by their peers. And most importantly, in most cases, gynecomastia goes away without any treatment. In approximately 90% of cases, pubertal gynecomastia usually resolves in months to several years. Gynecomastia secondary to an underlying treatable cause usually responds to treatment or removal of the primary cause.

Incidence of the condition

Not too many people know that gynecomastia is the most common cause for male breast evaluation. Several studies have shown that almost 38% of boys aged 10-16 years reported a breast tissue greater than 5 cm in diameter. In another series, gynecomastia was noted in approximately 10% of boys aged 12-17 years. In yet another report, gynecomastia was noted in 36% of young military recruits and in approximately 57% of men older than 50 years.

Possible causes of gynecomastia

There are several potential pathologic causes of gynecomastia are and the most common are:

medications including hormones

increased serum estrogen

decreased testosterone production

androgen receptor defects

chronic kidney disease

chronic liver disease

other chronic illness

Unfortunately, the fact is that in 25% of cases, the cause of the gynecomastia is not known.

Medications

Everyone should know that medications cause 10-20% of cases of gynecomastia in post-adolescent adults. What medications are involved? Well, some of the most common include cimetidine, Omeprazole, Spironolactone, Finasteride and certain antipsychotics. It is important to know that some of these medications act directly on the breast tissue, while others lead to increased secretion of Prolactin from the pituitary by blocking the actions of dopamine in the anterior pituitary. People should also know that substance called Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Medications used in the treatment of prostate cancer, such as anti-androgens and GnRH analogs can also cause gynecomastia. Although, not too many people know about it- it is also proven that chronic use of Marijuana use is also thought by some to be a possible cause, but this is controversial.

Increased estrogen levels

Several researches done in the past have shown that increased estrogen levels that can occur in certain testicular tumors, and in hyperthyroidism can cause gynecomastia. It is also proven that some adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete HCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis. It is also proven that obesity tends to increase estrogen levels.

Decreased testosterone production

It is proven that decreased testosterone production can cause gynecomastia. This disorder can occur in congenital or acquired testicular failure, such as Klinefelter%26rsquo;s Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone. Abuse of anabolic steroids has a similar effect.

Obesity

Obesity can cause enlarged breasts in males. But this is due to excess fat tissue in the breasts.

Other causes include:

Exposure to estrogen or androgen hormones

Liver disease

Kidney failure

Side effect of some medications

Marijuana use

Overactive thyroid (hyperthyroidism)

Tumors of the pituitary gland

Testicular tumors

Histological Findings

It is important to know that characteristic histological findings of gynecomastia include proliferation of ductules and stroma consisting of connective-tissue elements such as fibroblasts, collagen, and myofibroblasts and occasional acini. Gynecomastia of short duration consists of a prominent ductular component with loose stroma. Long-standing gynecomastia consists of dense stroma with few ductules.

Diagnosis of gynecomastia

Patient%26rsquo;s history

Every doctor should ask patient questions about symptoms, such as how long he had the breast tissue, and whether or not the area is tender. Doctor will also probably ask about the illnesses the patient has had in the past, the medicines he take, and other matters relating to his health.

Physical examination.

When it is a case of a teenager, he will probably will not need more tests, since gynecomastia is common in teenage boys. As many as 65% of 14-year-old boys have gynecomastia. Good thing is only that the breast enlargement usually goes away on its own in 2 or 3 years. However, younger boys and adult men with gynecomastia may need to have some tests, because it is more possible that some kind of disease is causing the problem.

Testing, although not usually necessary in teen boys, might include:

liver function tests

plasma DHEAS or urinary 17-ketosteroids

plasma estradiol

plasma hCG%26amp;#225

plasma LH and testosterone

Teens who are very overweight may have pseudogynecomastia, in which they have enlarged breasts because of increased fat and not true breast tissue.

Gynecomastia treatment

Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should stop taking medications which can cause gynecomastia. Anti-estrogen medications, such as Tamoxifen and clomiphene or androgens can be used. After some time, however, the breast tissue tends to remain and harden, leaving surgery the only treatment option. There are people who choose to live with the condition and use a bra as an option for treatment. In some cases, male breast reduction surgery may be an option. Gynecomastia during puberty usually goes away without treatment after several months.

Surgical treatment

Indications

It is extremely important to keep in mind that surgery to correct gynecomastia can be performed only on healthy, emotionally stable men of any age. Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, it is proven that individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery.

The surgery

There are several options for surgery! If excess glandular tissue is the primary cause of the breast enlargement, it will be simply excised, or cut out, with a scalpel. In a typical procedure, an incision is made in an inconspicuous location--either on the edge of the areola or in the under arm area.
If liposuction is used to remove excess fat, the dren is usually inserted through the existing incisions. If gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out.

In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

Possible complications

When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are possible and, in most cases- they are rare and usually minor. Some of the most common include

Infection

skin injury

excessive bleeding

adverse reaction to anesthesia

excessive fluid loss or accumulation

noticeable scars

permanent pigment changes in the breast area

slightly mismatched breasts or nipples

Post op

Every patient will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by surgeon. Reasonably- the affected are will be swollen and bruised for awhile. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

Although there are no rules- in most cases any stitches will generally be removed about 1 to 2 weeks following the procedure. Surgeon could also advise a patient to avoid sexual activity for a week or two, and heavy exercise for about three weeks. Every patient should also avoid exposing the resulting scars to the sun for at least six months.

Most common causes of inflamed bladder

An inflamed bladder is medically called interstitial cystitis, or painful bladder syndrome (PBS). It is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case, and even in the same individual with time. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Most female patients report that their symptoms worsen during menstruation. They may also experience pain with vaginal intercourse. Several experts now believe that this disorder is not one, but several diseases because it varies so much in symptoms and severity. People with severe cases of inflamed bladder may even urinate as many as 60 times a day, including frequent nighttime urination (nocturia). Although there's no treatment that completely eliminates the signs and symptoms of interstitial cystitis, a number of medications and therapies offer relief.

Incidence

Interstitial cystitis affects between 700,000 and 1 million Americans. This disorder can have a long-lasting adverse impact on quality of life, and is far more common in women than in men. Of the estimated 1 million Americans with bladder problems, up to 90 percent are women.

Possible causes

No one really knows what causes this condition, although there are many theories. Some of the most common suggest that interstitial cystitis is an autoimmune, hereditary, infectious, or allergic condition, but none of these have been proved. Although some of the symptoms of this disease are similar to those of bacterial infection, medical tests reveal no organisms in the urine and patients do not respond to antibiotic therapy. It is interesting that, in recent years, a substance found almost exclusively in the urine of people with interstitial cystitis has been isolated, and named %26ldquo;antiproliferative factor%26rdquo; because it appears to block the normal growth of cells that line the inside wall of the bladder.

Diet: There is no scientific evidence linking diet to interstitial cystitis, but many doctors and patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Also, many patients feel that smoking makes their symptoms worse.

Possible symptoms

Although symptoms vary significantly among patients, people with interstitial cystitis may have some of the following common symptoms:

%26bull; An urgent need to urinate
%26bull; Pressure, pain and tenderness around the bladder, pelvis and perineum
%26bull; A bladder that won't hold as much urine as it did before
%26bull; Pain during sexual intercourse and painful ejaculation
%26bull; Discomfort or pain in the penis or scrotum
%26bull; Chronic pelvis pain
%26bull; In many women, the symptoms get worse before their menstrual period.

Risk factors

There are several risk factors associated with interstitial cystitis. Some of the most common are:

%26bull; Sex %26ndash; Women receive a diagnosis of interstitial cystitis far more often than men or children do.
%26bull; Age %26ndash; Most people with interstitial cystitis are diagnosed in their 30s or 40s
%26bull; Other chronic disorders - Irritable bowel syndrome, vulvodynia, fibromyalgia, and endometriosis.

Diagnosis

It can be difficult to detect interstitial cystitis because signs resemble those of many other disorders.

%26bull; Patient%26rsquo;s history: The first step in diagnosis of interstitial cystitis should be taking medical history and asking the patient to describe symptoms.
%26bull; Urinalysis and Urine Culture: Examining urine under a microscope and culturing the urine can detect and identify the primary organisms known to infect the urinary tract. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic.
%26bull; Cystoscopy: This test, sometimes used to rule out other causes of bladder pain, involves an examination of the bladder through a thin tube with a tiny camera %26ndash; a cystoscope. This procedure is generally performed with general or regional anesthetics to reduce discomfort. During cystoscopy under anesthesia, a sample of tissue may be removed from the bladder and the urethra for examination under a microscope to check for bladder cancer and other rare causes of bladder pain.
%26bull; Biopsy: A tissue sample examination under a microscope.

Possible complications

Interstitial cystitis can result in a number of complications, including:

%26bull; Lesser bladder capacity
%26bull; Reduced quality of life
%26bull; Relationship troubles
%26bull; Emotional troubles

Treatment

Unfortunately, there is no simple treatment to eliminate the symptoms of interstitial cystitis, and no one treatment works for everyone.

Medications:

Most commonly doctors prescribe an oral medication called pentosan (Elmiron%26reg;). This is the only oral drug approved by the FDA specifically for interstitial cystitis. The funny thing is, no one really knows how it works. Some say that it may be restoring the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It takes two to four months before a patient begins to feel pain relief, and up to six months to experience a decrease in urinary frequency. There are also several possible side effects such as minor gastrointestinal disturbances and possible hair loss. Not for use by pregnant women, Elmiron may cause bleeding and loss of pregnancy.

Other oral medications that may improve the symptoms of interstitial cystitis include ibuprofen (Advil%26reg;, Motrin%26reg;, others) and other non-steroidal pain medications. Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil%26reg;), may help relax bladder and block pain.

Nerve root modulation:

Sacral nerves, which run from th lower spinal cord to the bladder, pelvic floor, and lower bowel, regulate bladder and bowel control. A method of nerve stimulation called sacral nerve root modulation can be very helpful for people with interstitial cystitis. A small wire is placed next to the sacral nerves to determine if bladder symptoms will respond to neuromodulation. If the results are positive, a small battery-operated device is surgically implanted in the patient%26rsquo;s upper buttocks.

Bladder distention:

Some patients notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention - stretching of the bladder with water or gas.

Medications instilled into the bladder:

Although this is a very old method of treatment, it is still considered very helpful. The prescription medication dimethyl sulfoxide, or DMSO, is placed into the bladder through a thin, flexible tube. The solution is sometimes mixed with other medications, such as a local anesthetic or bicarbonate to change the pH levels of the DMSO. After remaining in the bladder for 15 minutes, the solution is expelled through urination. However, DMSO can adversely affect the patient%26rsquo;s liver.

Surgery

Doctors rarely use surgery to treat interstitial cystitis because partial or complete removal of the bladder doesn't relieve pain. Besides, it can lead to several other complications.

Surgical options include:

%26bull; Bladder augmentation: During this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of colon, but the pain still remains and most women need to empty their bladders with a catheter multiple times a day.
%26bull; Fulguration: This is a minimally invasive method which involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
%26bull; Resection: Another minimally invasive method, also involving insertion of instruments through the urethra to cut around any ulcers.

Useful diet habits

The foundation of therapy is a modification of diet to help patients avoid food which will further irritate the damaged bladder wall. Common bad diet habits include caffeine, herbal and green teas, sodas, concentrated fruit juice, multivitamins, monosodium glutamate, chocolate, and potassium-rich foods such as bananas. A patient should cut out all these, leaving just the basics, and then introduce new food one step at a time, to find out his trigger-food.

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Arthrocentesis - Joint fluid aspiration

A joint aspiration, or arthrocentesis, is a procedure which involves using a sterile needle and syringe to drain fluid from the joint. The procedure is also called joint fluid aspiration, joint tap, synovial fluid aspiration, etc. Joint aspiration is typically performed as an in-office procedure.

The most common indication for the procedure is a condition called arthritis %26ndash; a group of diseases affecting joints or their component tissues. There are several types of arthritis and they can be divided into groups by their clinical course and pathologic appearance.

The four basic types are:

%26bull; inflammatory arthritis
%26bull; degenerative joint disease
%26bull; non-articular rheumatism
%26bull; miscellaneous arthritis

What is the purpose of joint aspiration?

Joint aspiration is used to obtain joint fluid for laboratory examination. The analysis of joint fluid can help define causes of joint swelling or arthritis, such as infection, gout, and rheumatoid disease. In order to do this, doctors test joint fluid for white cell count, crystals, protein, glucose, as well as infection. Joint aspiration can also be helpful in relieving joint swelling and pain, because the removal of joint fluid is also removing the white blood cells which are sources of enzymes that can be destructive to the joint.

In some cases, cortisone medications are injected into the joint during the joint aspiration in order to rapidly relieve joint inflammation and further reduce symptoms.

Results of joint aspiration

Synovial fluid, which is aspirated from the joint, is normally clear and viscous. When it is:

%26bull; Opaque and turbid %26ndash; it may indicate inflammatory diseases
%26bull; Presence of pus %26ndash; it may signal septic arthritis cause by some bacteria
%26bull; Blood in the fluid %26ndash; it may indicate a fracture or blood disorder
%26bull; Crystals in the fluid %26ndash; it may be signal of gout or pseudogout
%26bull; A high white blood cell count may indicate an inflammatory disorder

There are also various other test which could be done, such as Gram stains for certain bacteria, cultures for infectious organisms, and glucose measurement.

Potential complications

There are several possible complications associated with joint aspiration, although they are very uncommon:

%26bull; local bruising
%26bull; minor bleeding into the joint
%26bull; loss of pigment in the skin

A rare, but serious, complication of joint aspiration is infection of the joint. The condition is then called septic arthritis.

If corticosteroids are injected into the joint, additional, although very uncommon, complications include:

%26bull; inflammation in the joint as a result of the medication crystallizing
%26bull; atrophy or loss of pigment of skin at the injection site
%26bull; increased blood sugar
%26bull; aggravation of preexisting infection somewhere in the body
%26bull; weight gain
%26bull; puffy face and trunk
%26bull; easy bruising

Temporomandibular (TM) disorders

Arthrocentesis is performed by an oral and maxillofacial surgeon. Doctors use needles to withdraw fluid from and inject medication into a joint space. Arthrocentesis of the temporomandibular (TM) joint is used:

%26bull; To treat painful and limited jaw movement or disc displacement that has caused chronic, severe pain.
%26bull; As a diagnostic tool, when there is a need to analyze joint fluid for signs of disease.

Arthrocentesis is done using local anesthetics, with or without a sedative. Sometimes doctor injects the fluid into the joint. Wash from the joint pain-causing chemicals created by the inflammation process reduces painful pressure or contact between the disc and bone and enlarges the joint space, making it easier to manipulate the joint

After the procedure, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control pain. After few days, patients are instructed about jaw exercises. In one study, 94% of people with severe closed lock of the temporomandibular joint gained long-term relief from arthrocentesis.

Knee arthritis

Osteoarthritis is the most common type of knee arthritis. This joint disorder is characterized by progressive wearing away of the cartilage of the joint. It typically affects patients over 50 years of age. It is also much more common in patients who are overweight. There is also a genetic predisposition of this condition, because knee arthritis tends to run in families.

Other factors that can contribute to developing knee arthritis include:

%26bull; trauma to the knee
%26bull; meniscus tears
%26bull; ligament damage
%26bull; fractures to the bone around the joint

Knee arthritis symptoms tend to progress as the condition worsens, but not always steadily with time. Often a patient reports good months and bad months, or symptom changes with weather changes.

The most common symptoms of knee arthritis are:

%26bull; Pain with activities
%26bull; Limited range of motion
%26bull; Stiffness of the knee
%26bull; Swelling of the joint
%26bull; Tenderness along the joint
%26bull; A feeling the joint may fall apart
%26bull; Deformity of the joint

Shoulder and elbow problems

Shoulder pain is an extremely common complaint and many different factors can cause it.
Because arms are so frequently used for so many common activities, shoulder pain can cause significant problems. Some of the most common causes are:

Shoulder Dislocation: A type of injury that occurs when the top of the arm bone (humerus) becomes disconnected from the shoulder blade (scapula). Shoulder dislocations occur also after falls or other serious injuries.

Shoulder Instability: A loose shoulder joint problem; patients may experience symptoms of an unstable joint. This shoulder disorder could be caused by a previous dislocation, or it may happen when the ligaments around the joint are too loose.

Shoulder Separation: The results of a disruption of the acromio-clavicular joint. This injury can cause pain and swelling of the shoulder.

Hip arthritis

As said before, osteoarthritis is the most common type of hip arthritis, and it is also called wear-and-tear arthritis. This disorder is characterized by progressive wearing away of the cartilage of the joint.

Hip arthritis symptoms tend to progress as the condition worsens. Patients report good months and bad months, or symptom changes with weather changes.

The most common symptoms of hip arthritis are:

%26bull; Pain with activities
%26bull; Limited range of motion
%26bull; Stiffness of the hip
%26bull; Walking with a limp

Read More...

Review of 10 most used pain killers

An analgesic, also known as a painkiller, is the term used for any member of the group of drugs used to relieve pain and to achieve analgesia - painless state. Analgesic drugs act in various ways on the peripheral and central nervous system. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals. There are several groups of pain killers and they include:

paracetamol (acetaminophen)

the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates

narcotic drugs such as morphine

synthetic drugs with narcotic properties such as Tramadol %26hellip;

Some other classes of drugs, which normally don%26rsquo;t belong to the group of pain killers, are used to treat some pain syndromes and these include tricyclic antidepressants and anticonvulsants.

It should be pointed out that some experts include aspirin and other non-steroidal anti-inflammatory drugs in the class of analgesics, because they have some analgesic properties but they primarily have an anti-inflammatory effect.

Groups of pain killers

Simply put, analgesics are a class of drugs used to relieve pain. There are basically two kinds of analgesics:

non-narcotics

narcotics

Non-Narcotic Analgesics

Paracetamol

Most people already know that Paracetamol or Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic. It is extremely popular pain-reliever because it is both effective for mild to moderate pain relief. It is also relatively inexpensive. Although not too many people take this drug seriously- it is proven that, if acetaminophen is not used according to the directions, serious side effects can occur. The most common side effect is increase the risk of liver damage. The risk of liver damage with acetaminophen use is also increased by ingesting alcohol.

This medication can be found in combination with other active ingredients in many cold, sinus, and cough medications.

Narcotic Analgesics

Everyone should know that there are two types of narcotic analgesics: the opiates and the opioids. What exactly are opiates? Well, they are the alkaloids found in opium. Opioids are any medication which bind to opioid receptors in the central nervous system or gastrointestinal tract.

They are used in medicine as strong analgesics, for relief of severe or chronic pain. What's interesting- there is no upper limit for the dosage of opioids used to achieve pain relief, but the dose must be increased gradually to allow for the development of tolerance to adverse effects.

There are four broad classes of opioids:

Endogenous opioid peptides- they are normally produced in the body and include endorphins, dynorphins, enkephalins%26hellip;

Opium alkaloids %26ndash; the most commons are morphine, codeine, thebaine

Semi-synthetic opioids %26ndash; most common are heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone, nicomorphine

Fully synthetic opioids %26ndash; the most common are Demerol, Methadone, Fentanyl, propoxyphene, pentazocine, buprenorphine, butorphanol, Tramadol%26hellip;

Oxycodone

It is important to point out that Oxycodone is a potent and addictive opioid analgesic medication. It is synthesized from thebaine. Its name is derived from codeine because the chemical structures are very similar. Oxycodone is one of the most powerful medications for pain control that can be taken orally and it is also used in treatment of moderate to severe chronic pain. OxyContin is available in 5, 10, 20, 40, 80, and 160 mg tablets, and it is effective for 8 to 12 hours. What's most important- In the United States, oxycodone is a type II controlled substance.

Morphine

Probably everyone knows that Morphine is one extremely powerful opiate analgesic drug. It represents an active ingredient of opium. It should be pointed out that, like other opiates, morphine acts directly on the central nervous system to relieve pain. Target tissue are synapses of the arcuate nucleus, in brain. There are several side effects that could occur and the most common are:

impairment of mental performance

euphoria

drowsiness

lethargy

blurred vision

constipation

The most important thing there is to know about this drug is that it is highly addictive when compared to other substances. Tolerance and physical and psychological dependence develop extremely quickly.

Tramadol

Tramadol is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. What makes it so special? Well, beside the fact that it is a synthetic agent, it also appears to have actions on the GABAergic, noradrenergic and serotonergic systems. This isn't case with other pain killers! Tramadol is available in both injectable and oral preparations. Dosages vary depending on the degree of pain experienced by the patient but it is useful to know that Tramadol is approximately 10% as potent as morphine. Oral doses range from 50%26ndash;400 mg daily, with up to 600 mg daily when given IV/IM.

Codeine

Everyone should know that Codeine is a narcotic analgesic painkiller used for pain relief. The drug codeine is also used in combination medications with the drug acetaminophen, in brand names such as Tylenol, Tylenol with Codeine, Empirin and Phenaphen with Codeine, or in drug combination with aspirin. It is extremely useful for treating moderate to mild pain!

Darvocet

Darvocet is a combination narcotic analgesic painkiller used for pain relief. Other brand name drugs which contain propoxy and acetaminophen include: Propacet, and Wygesic. It is very useful for treting all kind of pains, but the problem is that there are several possible side effects related to the use of this medication!

Propoxyphene

Two medications: Darvon and PP-Cap (generic drug name propoxyphene) are narcotic analgesic painkillers used for pain relief. It is important to point out that the medication propoxyphene comes as a tablet, capsule, and liquid to take by mouth. Darvocet contains the drugs propoxyphene and acetaminophen.

Duragesic

Duragesic is a narcotic analgesic painkiller used for severe pain relief. It is important to know that Duragesic comes only as a skin patch, which contains the generic drug Fentanyl. The medication is absorbed directly from the patch when applied to the skin.

Marijuana

The debate over the use of marijuana for medical purposes has been ongoing for years. Marijuana has been hailed as a prescription for many ills and physicians once used it to stimulate appetite, relieve chronic pain, and treat asthma and migraines. Most common indications for use of Marijuana are:

chronic pain

migraines

glaucoma

Multiple sclerosis%26hellip;

Many young users are saying that the addiction with marijuana isn't possible. Of course, this isn't true! Addiction is highly possible! Long-term marijuana use can lead to addiction for some people, which means that they use the drug compulsively even though it interferes with family, school, work, and recreational activities. When a person is chemically dependent on marijuana, it means that it needs to use more and more to get the same effect. Most common withdrawal symptoms are: depressed feelings, trouble sleeping and nausea.

Salicylic acid

Not too many people know that Salicylic acid is a colorless, crystalline organic carboxylic acid. Salicylic acid functions as a plant hormone because. It is important to point out that salicylic acid is toxic if ingested in large quantities. In small quantities is used as a food preservative and antiseptic in toothpaste. The medicinal properties of salicylates have been known since ancient times and everyone should know that the substance occurs in the bark of willow trees.
Aspirin can be prepared by the esterification of the phenol hydroxyl group of salicylic acid. It is often combined with bismuth and when combined the two key ingredients help control diarrhea, nausea, heartburn, and even gas. It is also very mildly anti-biotic.

Side Effects and Adverse Reactions of Opioids:

Common side effects and adverse reactions:

nausea

of the pupil)

orthostatic hypotension

urinary retention

vomiting

drowsiness

dry mouth

miosis

Less common side effects and adverse reactions:

bradycardia (slow heart rate)

tachycardia (rapid heart rate)

raised intracranial pressure

confusion

hallucinations

delirium

hives

itch

hypothermia ureteric or biliary spasm

muscle rigidity

flushing

respiratory depression

fatal overdose

Pros and cons for use of pain killers

There have been debates over the addictive potential of opioids vs. the benefit of their analgesic properties, especially for treating non-malignant chronic pain, such as chronic arthritis. Although they can be extremely helpful- there are several possible lethal side effects that can occur! Some experts believe opioids can be taken safely for years with minimal risk of addiction or toxic side effects. This could happen only if taken under close supervision of doctor!

On the Rag: Not just the period!

Despite what you might think, your period doesn't just effect you when you're on the rag. In fact, your period is only one part of a complex hormonal, physiological and emotional cycle that circles every month, and on some level, effects you every single day. Understanding how your menstrual cycle w...

Your menstrual cycle and your reproductive system house miracles that have held people in awe for thousands of years.Take a seatand a tour of how it all works, how to best manage it and use it to empower yourself and stay healthy, and find out what it allmeans now andwhat it hasmeant to others in the past.

The basics, period.

Like much of your sexuality, your reproductive cycle starts in your brain, in a section called the hypothalamus. It produces and then releases some substances which travel down to the pituitary gland and stimulate it so that the pituitary releases two hormones: the follicle-stimulating hormones (FSH) and the luteinizing hormone (LH). These create changes in the oversee that make an egg mature.

What came first -the egg or the ovary?

Eggs -- what are fertilized by sperm and create a baby, or which, when unfertilized, bring on your menses, or period -- aren't created every month, but instead mature, one at a time (in most women -- some women release more than one egg per cycle), and alternate in each ovary. That's why one month you can have a fairly mild period, but the next you can have painful cramps. The eggs in your body are held in your ovaries, and have been there since before you were born. You started with one to two million of them, and by the time you hit puberty, you have about three hundred to four hundred thousand of them left. These are the eggs that you have for the rest of your life, and when they're gone, they're gone.

When the FSH and LH stimulate an egg to maturity, the ovary that held it ruptures, and the egg is released into the fallopian tube. The little finger-like structures that appear to hold the ovary, the fimbriae, help to pull the egg into the tube. The wall of the fallopian tube then has a series of contractions that move the egg towards the uterus. At this time, another hormone, progesterone, is produced by the ovary, and this hormone is what prepares the lining of your uterus to nourish and house an egg, should it be fertilized by sperm. If the egg is fertilized, even more progesterone is released. If it is not, then the level of progesterone drops, and it is that drop that causes your period. That whole cycle takes on average, 28 days, and most women have menstrual cycles of anywhere from 23 to 35 days. From the time the egg is released until you get your period takes around 14 days. Let's look at this a different way: the menstrual cycle can be divided into three phases: the menstrual phase, the proliferative phase and the secretory, or luteal phase.

The Menstrual Phase:

Each of your monthly cycles starts on the first day of your period. You begin to bleed because the uterine lining that was prepared to nurture a fertilized egg is sloughed off because you did not get pregnant. It is perfectly normal to have a menstrual phase that lasts anywhere from just a couple days to seven or more days, and both light and heavy flow, or a combination of the two, are both also normal.

How can I tell I'm in this phase?

Because you're bleeding! In addition, when your flow decreases or stops, you'll notice that your vaginal secretions (you can see this on your underpants, or by putting a finger in your vagina and pulling a little from it's opening) is either hard to find at all (your vagina may be %26quot;dry%26quot;) or is a little thick. It is not abnormal for it to have a brownish color during this phase, because even when your flow stops, the vagina is discarding some old blood.

The Proliferative Phase:

The proliferative phase brings about more of another hormone, estrogen, and that stimulates the lining of the uterus to ready itself to nurture a fertilized egg. It is during the proliferative phase the you ovulate: the egg is released from the ovary and begins it's travels to the uterus.

How can I tell I'm in this phase?

Some women experience a little bit of cramping during ovulation. Your vaginal secretions may be a little thick or chalky, just like in the menstrual phase.

The Secretory Phase:

This follows right after ovulation, and is when the progesterone increases, and when you may be most fertile (able to get pregnant), and continues until either the egg is fertilized, or until it is not, at which time you will begin the cycle all over again by getting your period. Many birth control specialists will recommend that even when using a good birth control method, you get in the habit of keeping from sex during ovulation (between the end of the proliferative and the beginning of the secretor phase), and a few days before and after.

How can I tell I'm in this phase?

Your vaginal secretions will get a little thinner, and have a consistency that is like an egg white. This happens because it provides the best environment for sperm to reach the egg. You may also notice that during this time, you want sex a lot more, or are more easily aroused.

Flow Chart

It's a great idea to keep track of your menstrual cycles each month, from the very start of them, especially if you are sexually active. If you keep a journal or a calendar, there is an easy system to do this. The first day of your period, just make a little red dot on your calendar. Continue the dots until you are no longer bleeding. After that, pay attention to your vaginal secretions, or discharge. When I chart, I note a %26quot;D%26quot; when my mucus is dry or thick, and an %26quot;O%26quot; when it seems thinner, a sign of being fertile. Charting your cycles will help you to best understand them, and help you be more alert when you may have any problems, and when the best time is for you to avoid sex altogether, birth control or not. Later in your life, when you want to conceive, or have a child, knowing your cycles will help you to do so most easily.

The Rag, When it's a Drag

It is absolutely normal, and quite common for the menstrual cycle to take up to as much as five years to really get regular. You might find that you go a few months without a period sometimes, or have shorter cycles, bleeding every three weeks instead of every four. Just remember that regardless of how often you get your period, from the first time you get it, you're able to get pregnant, even if you go months without bleeding.

It is also possible, if you're missing periods, that it is due to diet or exercise. If you aren't eating enough, or are overexercising (more than four hours a day, or running over ten miles a day), it throws your system out of whack, and you may begin to miss periods. Take care of yourself. Be sure to eat enough calories for the calories you burn, get enough rest, and eat a well-balanced diet. Stress can also make you miss a period, and more times than not that stress is because women think they may be pregnant, which can actually fool your body into acting like it is, thus causing you to miss a period. If you're sexually active, get rid of that stress by using sound birth control and STD protection, and just don't have sex at all while you're ovulating.

Menstrual flow (how much blood there is) can vary greatly, from light to heavy. Cramps are also normal, and can be taken care of very nicely with some ibuprofen. I remember when there wasn't any ibuprofen yet (your mom probably does, too...ask her), and boy, did having cramps stink!

There are some good herbal and vitamin remedies for helping your cycles and the discomfort you may experience. Vitamins E and K, which are usually in a regular daily multivitamin help with regularity, and to slow a very heavy flow. You can also make an herbal tea of red raspberry leaf, strawberry leaf, peppermint and ginger (and it tastes nice, too) to help with cramps and to balance your cycles. If it tastes gross, add some honey. Go to your local health food store, and they can help you find what you need.

Flow with It, Baby: Pads, Tampons and Other Solutions

You have a lot of choices when it comes to how you absorb your menstrual flow. Whenmy momfirst startedher period, there were actually still old pads that attached to these heinous belts with clips and all number of confusing elements. Thankfully, things have improved. You can basically choose between commercial pads, natural/reusable pads, tampons, sponges or cups. To find out what might be best for you, I have listed the choices.. Bear in mind, too, to consider the waste you create with your choice. It often happens that what is best for our bodies is also best for our ecosystem. If you can use a method that creates minimal waste, you're doing the whole world a favour!

Disposable Pads: Pads are usually the best choice when you're first starting your period, if you have a heavy flow, and at night when you're sleeping. Most have an adhesive backing (sticky) that you pull paper away from and attach to your underwear. If you're going to use pads, make sure you do not get any that are scented, or have any added perfumes, as these can cause vaginal infections. Organic cotton is the best thing you can do for your body, if you're going to use disposable pads. No one is going to smell your period unless you aren't changing your pad often enough. Some women complain though that pads make them feel like they're wearing a Nappy. In that case, you may try using smaller pads and changing them more often.

Reusable Pads: They're made out of a cotton liner, wrapped in fabric, and you just wash and dry them for reuse. Some brands have a %26quot;filler%26quot; you can remove as well. Some have snaps on little wings that you just snap around your underwear, and other attach like a pair of underwear , with a little g-string. I cannot encourage women enough to try using Washable pads: not only are they better for the environment, they're better for you, both physically and emotionally. Great Reusable Pads: LunaPads are the best thing since sliced bread.

Tampons: Tampons are good for when you're swimming, if you're active, if you have a special occasion, or if you just don't like pads. They are best for lighter flows, since the larger, more absorbent tampons can cause problems as I'll explain in a moment. Again, be sure to buy the kind without any fragrance or perfumes, and to really get to know your body, I prefer the kind without the applicator. It is possible if you have an unbroken hymen that it might be more difficult for you to use tampons, and in that event, you should ask a parent for some help. To insert a tampon, it's easiest if you sit on the toilet or squat. If you're using one without an applicator, press your finger into the bottom of it where the string is, and push the tampon up deeply into your vaginal canal. You do not have to worry about losing it in there, as there is not an endless canal in which it goes. If you're using a tampon with an applicator, you press the curved top of the applicator into your vagina, and then push the bottom oft the applicator up, until it releases the tampon.

Something serious you need to be aware of with tampons is that it is VERY important you change them often. Tampons not changed often (every few hours), and especially commercial brands that contain rayon fibers and bleaches (and all of them do) can pose a serious risk of Toxic Shock Syndrome (TSS). TSS can cause severe medical problems such as hair loss, shock, kidney failure, heart and lung disease, and in as many as 15% of cases, death. To safeguard, make sure you only use tampons during the day (use a pad at night), change them often and buy 100% cotton tampons (again, in your health food store) when possible.

Natural Sponges: For many years I used small sponges (you can get them in the cosmetics section of your health food store or at a bath store) instead of tampons. They're recyclable, natural, and all you do is insert them inside your vagina, then to change them, pull it out, rinse it and boil it, and put in a fresh one. This is a good alternative if you feel %26quot;poked%26quot; by tampons, or are looking for an alternative that creates less waste

Menstrual Cups: The Keeper and Instead (which you can get at drug stores) are another choice. These are not as easy to insert as tampons or sponges, but many women find they work very well, and enjoy them because they do not have to worry about the possibility of TSS as they do with tampons. To insert a cup, you simply squeeze its sides and slide it into your vagina. If it is placed right, you shouldn't feel it at all. It may be helpful to use a little lubricant (like KY Jelly) to insert it.

Meaning and Menses: Where We're at With it All

Many women are at very embarrassed when they first get our periods (also called, %26quot;menarche%26quot;), but really shouldn't be. Some of that shame may simply come from the fact that in our modern-day culture, and in a lot of European history, a girl getting her period isn't treated very well. A lot of that attitude is based on very old notions that a woman is %26quot;dirty,%26quot; and mainly in fear because before people really understood menstruation, blood of any sort meant that something was wrong with someone. That women could bleed for days and not get ill or die was a great source of fear simply because no one understood WHY that could happen. On some level, this is often the case with much of sexuality, and many people still have a hard time talking about it, but the best remedy for that is just to try and keep talking, listening and learning.

However, in many cultures and traditions, and still today, menarche -- the time at which a girl gets her period -- and menstruation are both seen as reasons for joy and celebration. Basically, your period and your menstrual cycle are a symbol of the miracle of birth and reproduction.

In some parts of Africa, when a girl gets her first period, she can stay home from school, spending the day with her female relatives who celebrate and explain her cycles, and later her friends and family give her a big party. In parts of Asia, a feast is served in her honor, or she is given new clothes. Many cultures hold great celebrations and traditional rituals, and some cultures, like Native American culture, consider menstruation to be a time of great power for women, a time for meditating and reflecting. Aboriginal men in Australia even sometimes cut their penises to copy and mimic a woman's menstruation.

At the same time, many cultures still carry on traditions based in taboo and superstition that a woman may spoil things, or are having periods as a result of punishment from God. However, again, bear in mind that many of those fears and taboos are based in ignorance, but have become matters of tradition and religion. Did people know thousands of years ago what we know today, their outlook may have been far different.

Another interesting fact is the correlation between the female menstrual cycle and the cycle of the moon. The moon's cycle is the same number of days as the average menstrual cycle, and even the word %26quot;menses%26quot; is related to the original word for month, and our months used to be determined not by a number of days, but by each cycle of the moon. As noted at the Red Spot (http://onewoman.com/redspot/), %26quot;experiments have shown that women with irregular menstrual cycles have become more regular by sleeping with a soft light on in their rooms (to stand in for the light of a full moon) during the fourteenth, fifteenth and sixteenth days of their cycle, the days they would ideally be ovulating. After a few months, their cycles regulate. This is called the Dewan effect, and it seems to show a connection between light and the menstrual cycle.%26quot;

All in all, finding peace and joy in your cycles will make you really feel like you and your body are working together, and it will make all of sex a lot less mysterious. Create your own rituals. On the first day of your period, find some way to celebrate it. You can use it for reflection or meditation, or even just give yourself a quiet day of your own. If you're not the quiet type, have a party! Write something, or create. Many women artists have even created art with their menses (don't you say %26quot;eeew%26quot;), and in ancient times, the time of menses was seen as a good time for prophecy, or dreaming.

Take a big step towards helping the world come back to celebrating the female. If you're a parent, prepare something special for your daughter at her first menarche. Or if you're a teen, perhaps you have a friend or sibling coming into that time who you can help to teach these things to, and help to celebrate themselves and this important time in their lives.

1/13/2009

Overview of urinary function

What is interstitial cystitis?

What is cause of interstitial cystitis?

The signs and symptoms of interstitial cystitis?

Diagnosis of interstitial cystitis

Treatment of interstitial cystitis?

What is recurrent urinary tract infection

Symptoms of urinary tract infection

Types of urinary tract infections

Related urinary tract conditions associated with recurrent UTIs

Causes, incidence, and risk factors for reccurent urinary tract infections

Signs and tests for reccurent urinary tract infections

Treatment for reccurent urinary tract infections

Prevention

Prognosis for urinary tract infection

How does implantation bleeding look like?

When does implantation bleeding usually occur?

Home pregnancy tests

What else can cause spotting?

Pregnancy signs

Tender and swollen breasts

Fatigue

Implantation bleeding

Nausea or vomiting

Increased sensitivity to odors

Abdominal bloating

Frequent urination

What girl should do about first body hair?

What boy should do about first body hair?

Removing of the hair

Normal body hair growth

Why is body hair important?

Incidence of the condition

Possible causes of gynecomastia

Medications

Increased estrogen levels

Decreased testosterone production

Obesity

Histological Findings

Diagnosis of gynecomastia

Patient%26rsquo;s history

Physical examination.

Gynecomastia treatment

Indications

The surgery

Possible complications

Incidence

Possible causes

Possible symptoms

Risk factors

Diagnosis

Possible complications

Treatment

Surgery

Useful diet habits

What is the purpose of joint aspiration?

Results of joint aspiration

Potential complications

Temporomandibular (TM) disorders

Knee arthritis

Shoulder and elbow problems

Hip arthritis

Groups of pain killers

Non-Narcotic Analgesics

Paracetamol

Narcotic Analgesics

Oxycodone

Morphine

Tramadol

Codeine

Darvocet

Propoxyphene

Duragesic

Marijuana

Salicylic acid

Side Effects and Adverse Reactions of Opioids:

Pros and cons for use of pain killers

The basics, period.

What came first -the egg or the ovary?