Datasets:

ridhomhd

/

MedAlpaca_diabetes_filtered

like 0

Causes of peripheral neuropathy include: trauma, infections, metabolic problems, and exposure to toxins. One of the most common causes of peripheral neuropathy is diabetes mellitus. It can also be inherited.

Peripheral neuropathy (Overview): Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body. Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes mellitus. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. Peripheral neuropathy care at Mayo Clinic

Causes of Peripheral Neuropathy What information does the National Library of Medicine have that states causes of peripheral neuropathy?

Peripheral neuropathy is nerve damage caused by a number of conditions that include: alcoholism; autoimmune diseases; diabetes; exposure to toxins, such as heavy metals and chemicals; medications, especially those used to treat cancer; certain viral or bacterial infections; tumors; vitamin deficiencies and occasionally, kidney disease, liver disease, connective tissue disorders and an underactive thyroid.

Peripheral neuropathy (Causes): Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Causes of neuropathies include: - Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies. - Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and necrotizing vasculitis. - Diabetes. More than half the people with diabetes develop some type of neuropathy. - Exposure to poisons. Toxic substances include heavy metals or chemicals. - Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy. - Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis C, leprosy, diphtheria and HIV. - Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy. - Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times. - Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of paraneoplastic syndrome. - Vitamin deficiencies. B vitamins - including B-1, B-6 and B-12 - vitamin E and niacin are crucial to nerve health. - Bone marrow disorders. These include abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (osteosclerotic myeloma), lymphoma and amyloidosis. - Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism). In a number of cases, no cause can be identified (idiopathic).

Causes of Peripheral Neuropathy What information does the National Library of Medicine have that states causes of peripheral neuropathy?

To keep your blood sugar in your target range, follow a meal plan that includes a variety of foods, about the same amount of carbohydrates at each meal and snack, and healthy fats. Carbohydrates in food give you energy, but carbohydrates also raise your blood sugar higher and faster than other kinds of food. The main kinds of carbohydrates are starches, sugars, and fiber. The plate method could help getting all the nutrients you need during meals. This method encourages larger portions of non-starchy vegetables (half the plate) and moderate portions of protein (one quarter of the plate) and starch (one quarter of the plate). If you are overweight, losing 10 pounds can help. You can achieve and maintain your desired weight by eating healthy foods and staying active, for example, walking 30 to 60 minutes of per day.

Diabetes type 2 - meal planning (Function): Your main focus is on keeping your blood sugar (glucose) level in your target range. To help manage your blood sugar, follow a meal plan that has: - Food from all the food groups - Fewer calories - About the same amount of carbohydrates at each meal and snack - Healthy fats Along with healthy eating, you can help keep your blood sugar in target range by maintaining a healthy weight. Persons with type 2 diabetes are often overweight. Losing just 10 pounds (4.5 kilograms) can help you manage your diabetes better. Eating healthy foods and staying active (for example, 30 to 60 minutes of walking per day) can help you meet and maintain your weight loss goal. HOW CARBOHYDRATES AFFECT BLOOD SUGAR Carbohydrates in food give your body energy. You need to eat carbohydrates to maintain your energy. But carbohydrates also raise your blood sugar higher and faster than other kinds of food. The main kinds of carbohydrates are starches, sugars, and fiber. Learn which foods have carbohydrates. This will help with meal planning so that you can keep your blood sugar in your target range. MEAL PLANNING FOR CHILDREN WITH TYPE 2 DIABETES Meal plans should consider the amount of calories children need to grow. In general, three small meals and three snacks a day can help meet calorie needs. Many children with type 2 diabetes are overweight. The goal should be a healthy weight by eating healthy foods and getting more activity (60 minutes each day). Work with a registered dietitian to design a meal plan for your child. A registered dietitian is an expert in food and nutrition. The following tips can help your child stay on track: - No food is off-limits. Knowing how different foods affect your child's blood sugar helps you and your child keep it in target range. - Help your child learn how much food is a healthy amount. This is called portion control. - Have your family gradually switch from drinking soda and other sugary drinks, such as sports drinks and juices, to plain water or low-fat milk. PLANNING MEALS Everyone has individual needs. Work with your doctor, registered dietitian, or diabetes educator to develop a meal plan that works for you. When shopping, read food labels to make better food choices. A good way to make sure you get all the nutrients you need during meals is to use the plate method. This is a visual food guide that helps you choose the best types and right amounts of food to eat. It encourages larger portions of non-starchy vegetables (half the plate) and moderate portions of protein (one quarter of the plate) and starch (one quarter of the plate). You can find more information about the plate method at the American Diabetes Association website: www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate. EAT A VARIETY OF FOODS Eating a wide variety of foods helps you stay healthy. Try to include foods from all the food groups at each meal. VEGETABLES (2½ to 3 cups or 450 to 550 grams a day) Choose fresh or frozen vegetables without added sauces, fats, or salt. Non-starchy vegetables include dark green and deep yellow vegetables, such as cucumber, spinach, broccoli, romaine lettuce, cabbage, chard, and bell peppers. Starchy vegetables include corn, green peas, lima beans, carrots, yams and taro. Note that potato should be considered a pure starch, like white bread or white rice, instead of a vegetable. FRUITS (1½ to 2 cups or 240 to 320 grams a day) Choose fresh, frozen, canned (without added sugar or syrup), or unsweetened dried fruits. Try apples, bananas, berries, cherries, fruit cocktail, grapes, melon, oranges, peaches, pears, papaya, pineapple, and raisins. Drink juices that are 100% fruit with no added sweeteners or syrups. GRAINS (3 to 4 ounces or 85 to 115 grams a day) There are 2 types of grains: - Whole grains are unprocessed and have the entire grain kernel. Examples are whole-wheat flour, oatmeal, whole cornmeal, amaranth, barley, brown and wild rice, buckwheat, and quinoa. - Refined grains have been processed (milled) to remove the bran and germ. Examples are white flour, de-germed cornmeal, white bread, and white rice. Grains have starch, a type of carbohydrate. Carbohydrates raise your blood sugar level. For healthy eating, make sure half of the grains you eat each day are whole grains. Whole grains have lots of fiber. Fiber in the diet keeps your blood sugar level from rising too fast. PROTEIN FOODS (5 to 6½ ounces or 140 to 184 grams a day) Protein foods include meat, poultry, seafood, eggs, beans and peas, nuts, seeds, and processed soy foods. Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying. When frying proteins, use healthy oils such as olive oil. DAIRY (3 cups or 245 grams a day) Choose low-fat dairy products. Be aware that milk, yogurt, and other dairy foods have natural sugar, even when they do not contain added sugar. Take this into account when planning meals to stay in your blood sugar target range. Some non-fat dairy products have a lot of added sugar. Be sure to read the label. OILS/FATS (no more than 7 teaspoons or 35 milliliters a day) Oils are not considered a food group. But they have nutrients that help your body stay healthy. Oils are different from fats in that oils remain liquid at room temperature. Fats remain solid at room temperature. Limit your intake of fatty foods, especially those high in saturated fat, such as hamburgers, deep-fried foods, bacon, and butter. Instead, choose foods that are high in polyunsaturated or monounsaturated fats. These include fish, nuts, and vegetable oils. Oils can raise your blood sugar, but not as fast as starch. Oils are also high in calories. Try to use no more than the recommended daily limit of 7 teaspoons (35 milliliters). WHAT ABOUT ALCOHOL AND SWEETS? If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care provider about how alcohol will affect your blood sugar and to determine a safe amount for you. Sweets are high in fat and sugar. Keep portion sizes small. Here are tips to help avoid eating too many sweets: - Ask for extra spoons and forks and split your dessert with others. - Eat sweets that are sugar-free. - Always ask for the smallest serving size or children's size. YOUR DIABETES CARE TEAM IS THERE TO HELP YOU In the beginning, meal planning may be overwhelming. But it will become easier as your knowledge grows about foods and their effects on your blood sugar. If you're having problems with meal planning, talk with your diabetes care team. They are there to help you.

Diabetes Type 2 I test before going to bed and the reading is 94 but when I test again in the morning, the reading is 165. How can I lower it? I eat dinner around 8PM and nothing until the next morning.

Lifestyle changes, such as eating healthy, exercising and losing weight if you are overweight, could delay or prevent the start of type 2 diabetes.

Diabetes: Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested: - A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. - An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be stored or used as fuel. People with diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, and/or because their liver makes too much glucose and releases it into the blood. This is because either: - Their pancreas does not make enough insulin - Their cells do not respond to insulin normally - Both of the above There are two major types of diabetes. The causes and risk factors are different for each type: - Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. This is because the pancreas cells that make insulin stop working. Daily injections of insulin are needed. The exact cause is unknown. - Type 2 diabetes is much more common. It most often occurs in adulthood, but because of high obesity rates, children and teens are now being diagnosed with this disease. Some people with type 2 diabetes do not know they have it. With type 2 diabetes, the body is resistant to insulin and doesn't use insulin as well as it should. - There are other causes of diabetes, and some people cannot be classified as type 1 or type 2. Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. If your parent, brother, or sister has diabetes, you may be more likely to develop the disease. A high blood sugar level can cause several symptoms, including: - Blurry vision - Excess thirst - Fatigue - Frequent urination - Hunger - Weight loss Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms. Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed. After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications, and include: - Eye problems, including trouble seeing (especially at night), light sensitivity, and blindness - Sores and infections of the leg or foot, which if untreated, can lead to amputation of the leg or foot - Damage to nerves in the body, causing pain, tingling, a loss of feeling, problems digesting food, and erectile dysfunction - Kidney problems, which can lead to kidney failure - Weakened immune system, which can lead to more frequent infections - Increased chance of having a heart attack or stroke A urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes. Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL (11.1 mmol/L). To confirm the diagnosis, one or more of the following tests must be done. Blood tests: - Fasting blood glucose level. Diabetes is diagnosed if the fasting glucose level is higher than 126 mg/dL (7.0 mmol/L) on two different tests. Levels between 100 and 126 mg/dL (5.5 and 7.0 mmol/L) are called impaired fasting glucose or prediabetes. These levels are risk factors for type 2 diabetes. - Hemoglobin A1c (A1C) test. Normal is less than 5.7%; prediabetes is 5.7% to 6.4%; and diabetes is 6.5% or higher. - Oral glucose tolerance test. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a sugar drink (this test is used more often for type 2 diabetes). Screening for type 2 diabetes in people who have no symptoms is recommended for: - Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 3 years. - Overweight adults (BMI of 25 or higher) who have other risk factors such as having high blood pressure, or having a mother, father, sister or brother with diabetes. - Adults over age 45, repeated every 3 years. Type 2 diabetes may be reversed with lifestyle changes, especially losing weight with exercise and by eating healthier foods. Some cases of type 2 diabetes can also be improved with weight loss surgery. There is no cure for type 1 diabetes. Treating either type 1 diabetes or type 2 diabetes involves medicines, diet, and exercise to control blood sugar level. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your provider about seeing a diabetes nurse educator. Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke. To prevent diabetes complications, visit your provider at least 2 to 4 times a year. Talk about any problems you are having. Follow your provider's instructions on managing your diabetes. Many resources can help you understand more about diabetes. If you have diabetes, you can also learn ways to manage your condition and prevent diabetes complications. Diabetes is a lifelong disease and there is no cure. Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control. After many years, diabetes can lead to serious health problems: - You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. - Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be amputated. Infection can also cause pain and itching in other parts of the body. - Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet. - Nerves in your body can get damaged, causing pain, tingling, and numbness. - Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. - High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant. Keeping an ideal body weight and an active lifestyle may prevent or delay the start of type 2 diabetes. If you're overweight, losing just 5% to 7% of your body weight even helps. Some medicines can also be used to delay or prevent the start of type 2 diabetes. At this time, type 1 diabetes cannot be prevented. But there is promising research that shows type 1 diabetes may be delayed in some high risk people. Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Diabetes Type 2 I test before going to bed and the reading is 94 but when I test again in the morning, the reading is 165. How can I lower it? I eat dinner around 8PM and nothing until the next morning.

Ask your provider about symptoms that you are having if they have not been discussed. Your provider will set the target range for your blood sugar, clarify what type of exercise you need and if you need to see a dietitian for discussing healthy eating and weight loss or maintenance goals. Your provider will tell you how often and when you need to check your blood sugar levels, and what to do if they are out of range.

Type 2 diabetes - what to ask your doctor (Questions): Ask your provider to check the nerves, skin, and pulses in your feet. Also ask these questions: - How often should I check my feet? What should I do when I check them? What problems should I call my provider about? - Who should trim my toenails? Is it OK if I trim them? - How should I take care of my feet every day? What type of shoes and socks should I wear? - Should I see a foot doctor (podiatrist)? Ask your provider about getting exercise: - Before I start, do I need to have my heart checked? My eyes? My feet? - What type of exercise program should I do? What type of activities should I avoid? - When should I check my blood sugar when I exercise? What should I bring with me when I exercise? Should I eat before or during exercise? Do I need to adjust my medicines when I exercise? When should I next have an eye doctor check my eyes? What eye problems should I call my doctor about? Ask your provider about meeting with a dietitian. Questions for the dietitian may include: - What foods increase my blood sugar the most? - What foods can help me with my weight loss goals? Ask your provider about your diabetes medicines: - When should I take them? - What should I do if I miss a dose? - Are there any side effects? How often should I check my blood sugar level at home? Should I do it at different times of the day? What is too low? What is too high? What should I do if my blood sugar is too low or too high? Should I get a medical alert bracelet or necklace? Should I have glucagon at home? Ask your provider about symptoms that you are having if they have not been discussed. Tell your provider about blurred vision, skin changes, depression, reactions at injection sites, sexual dysfunction, tooth pain, muscle pain, or nausea. Ask your provider about other tests you may need, such as cholesterol, A1C, and a urine test to check for kidney problems. Ask your provider about vaccinations you should have like the flu shot, hepatitis B, or pneumonia vaccines. How should I take care of my diabetes when I travel? Ask your provider how you should take care of your diabetes when you are sick: - What should I eat or drink? - How should I take my diabetes medicines? - How often should I check my blood sugar? - When should I call the provider?

Diabetes Type 2 I test before going to bed and the reading is 94 but when I test again in the morning, the reading is 165. How can I lower it? I eat dinner around 8PM and nothing until the next morning.

Ask your provider how to control symptoms that you are having and make your life better. Your provider will set the target range for your blood sugar, clarify what type of exercise you need and if you need to see a dietitian for discussing healthy eating and weight loss or maintenance goals. Your provider will tell you how often and when you need to check your blood sugar levels, and what to do if they are out of range.

Type 2 diabetes - what to ask your doctor: Type 2 diabetes is a lifelong disease that causes a high level of sugar (glucose) in your blood. It can damage your organs. It can also lead to a heart attack or stroke and cause many other health problems. You can do many things to control your symptoms, prevent damage due to diabetes, and make your life better. Below are questions you may want to ask your health care provider to help you take care of your diabetes. Ask your provider to check the nerves, skin, and pulses in your feet. Also ask these questions: - How often should I check my feet? What should I do when I check them? What problems should I call my provider about? - Who should trim my toenails? Is it OK if I trim them? - How should I take care of my feet every day? What type of shoes and socks should I wear? - Should I see a foot doctor (podiatrist)? Ask your provider about getting exercise: - Before I start, do I need to have my heart checked? My eyes? My feet? - What type of exercise program should I do? What type of activities should I avoid? - When should I check my blood sugar when I exercise? What should I bring with me when I exercise? Should I eat before or during exercise? Do I need to adjust my medicines when I exercise? When should I next have an eye doctor check my eyes? What eye problems should I call my doctor about? Ask your provider about meeting with a dietitian. Questions for the dietitian may include: - What foods increase my blood sugar the most? - What foods can help me with my weight loss goals? Ask your provider about your diabetes medicines: - When should I take them? - What should I do if I miss a dose? - Are there any side effects? How often should I check my blood sugar level at home? Should I do it at different times of the day? What is too low? What is too high? What should I do if my blood sugar is too low or too high? Should I get a medical alert bracelet or necklace? Should I have glucagon at home? Ask your provider about symptoms that you are having if they have not been discussed. Tell your provider about blurred vision, skin changes, depression, reactions at injection sites, sexual dysfunction, tooth pain, muscle pain, or nausea. Ask your provider about other tests you may need, such as cholesterol, A1C, and a urine test to check for kidney problems. Ask your provider about vaccinations you should have like the flu shot, hepatitis B, or pneumonia vaccines. How should I take care of my diabetes when I travel? Ask your provider how you should take care of your diabetes when you are sick: - What should I eat or drink? - How should I take my diabetes medicines? - How often should I check my blood sugar? - When should I call the provider? Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

Diabetes Type 2 I test before going to bed and the reading is 94 but when I test again in the morning, the reading is 165. How can I lower it? I eat dinner around 8PM and nothing until the next morning.

Symptoms of Stiff-Person Syndrome (SPS) include fluctuating rigidity of the muscles in the body and limbs, and sensitivity to noise, touch and emotional distress that can cause muscle spasms; abnormal postures that are hunched over and stiff; and being afraid to leave the house because of the street noises that could cause spasms and falls. Twice as many women as men have SPS. It is often associated with diabetes, thyroiditis, vitiligo, and pernicious anemia. The symptoms can be mistaken for Parkinson's disease, multiple sclerosis, fibromyalgia, psychosomatic illness, or anxiety and phobia. Your doctor could order blood tests that measure the level of glutamic acid decarboxylase (GAD) antibodies in the blood to see if you have SPS.

Stiff-Person Syndrome: Stiff-person syndrome (SPS) is a rare neurological disorder with features of an autoimmune disease.  SPS is characterized by fluctuating muscle rigidity in the trunk and limbs and a heightened sensitivity to stimuli such as noise, touch, and emotional distress, which can set off muscle spasms.  Abnormal postures, often hunched over and stiffened, are characteristic of the disorder.  People with SPS can be too disabled to walk or move, or they are afraid to leave the house because street noises, such as the sound of a horn, can trigger spasms and falls.  SPS affects twice as many women as men.   It is frequently associated with other autoimmune diseases such as diabetes, thyroiditis, vitiligo, and pernicious anemia.  Scientists don’t yet understand what causes SPS, but research indicates that it is the result of an autoimmune response gone awry in the brain and spinal cord.  The disorder is often misdiagnosed as Parkinson’s disease, multiple sclerosis, fibromyalgia, psychosomatic illness, or anxiety and phobia.  A definitive diagnosis can be made with a blood test that measures the level of glutamic acid decarboxylase (GAD) antibodies in the blood.  People with SPS have elevated levels of GAD, an antibody that works against an enzyme involved in the synthesis of an important neurotransmitter in the brain. People with SPS respond to high doses of diazepam and several anti-convulsants, gabapentin and tiagabine.  A recent study funded by the NINDS demonstrated the effectiveness of intravenous immunoglobulin (IVIg) treatment in reducing stiffness and lowering sensitivity to noise, touch, and stress in people with SPS.  Treatment with IVIg, anti-anxiety drugs, muscle relaxants, anti-convulsants, and pain relievers will improve the symptoms of SPS, but will not cure the disorder.  Most individuals with SPS have frequent falls and because they lack the normal defensive reflexes; injuries can be severe.  With appropriate treatment, the symptoms are usually well controlled.

Stiff person Syndrome. Please can you tell me what are the early symptoms I have severe cramps in my feet which are twisting into an arc,muscle spasms slowly getting worse and my muscles particularly in my legs are cramping like someone has pushed a knitting needle into them. Started off at night but now happening through the day my back and neck and voice box are also effected and my chest area has now seized to the point of restricting my breathing to very shallow at times I find that I am stretching out involuntarily right through my body and this is becoming more frequent

Your doctor will choose treatments depending on the stage of your cancer. Traditional treatments include surgery, chemotherapy and radiation. .Small early-stage localized cancers may be removed completely during a colonoscopy or laparoscopic surgery. If the cancer has grown into or through your colon, your surgeon may remove the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Chemotherapy, rugs that destroy cancer cells, may be used before or after surgery to reduce the risk of cancer recurrence. Radiation therapy uses powerful energy sources, such as X-rays, to kill cancer cells, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon cancer and rectal cancer. Drugs that target specific malfunctions that allow cancer cells to grow are available to people with advanced colon cancer, including: - Bevacizumab (Avastin) - Cetuximab (Erbitux) - Panitumumab (Vectibix) - Ramucirumab (Cyramza) - Regorafenib (Stivarga) - Ziv-aflibercept (Zaltrap) Targeted drugs can be given along with chemotherapy or alone. Targeted drugs are typically reserved for people with advanced colon cancer. Some patients with advanced colon cancer have a chance to benefit from immunotherapy with antibodies such as pembrolizumab (Keytruda) and nivolumab (Opdivo). Whether a colon cancer has the chance to respond to these immunotherapies can be determined by a specific test of the tumor tissue.

Colon cancer: Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer. Signs and symptoms of colon cancer include: - A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks - Rectal bleeding or blood in your stool - Persistent abdominal discomfort, such as cramps, gas or pain - A feeling that your bowel doesn't empty completely - Weakness or fatigue - Unexplained weight loss Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine. When to see a doctor If you notice any symptoms of colon cancer, such as blood in your stool or an ongoing change in bowel habits, do not hesitate to make an appointment with your doctor. Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend that colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease. In most cases, it's not clear what causes colon cancer. Doctors know that colon cancer occurs when healthy cells in the colon develop errors in their genetic blueprint, the DNA. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide - even when new cells aren't needed. As the cells accumulate, they form a tumor. With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis). Inherited gene mutations that increase the risk of colon cancer Inherited gene mutations that increase the risk of colon cancer can be passed through families, but these inherited genes are linked to only a small percentage of colon cancers. Inherited gene mutations don't make cancer inevitable, but they can increase an individual's risk of cancer significantly. The most common forms of inherited colon cancer syndromes are: - Hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC, also called Lynch syndrome, increases the risk of colon cancer and other cancers. People with HNPCC tend to develop colon cancer before age 50. - Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly increased risk of developing colon cancer before age 40. FAP, HNPCC and other, rarer inherited colon cancer syndromes can be detected through genetic testing. If you're concerned about your family's history of colon cancer, talk to your doctor about whether your family history suggests you have a risk of these conditions. Association between diet and increased colon cancer risk Studies of large groups of people have shown an association between a typical Western diet and an increased risk of colon cancer. A typical Western diet is high in fat and low in fiber. When people move from areas where the typical diet is low in fat and high in fiber to areas where the typical Western diet is most common, the risk of colon cancer in these people increases significantly. It's not clear why this occurs, but researchers are studying whether a high-fat, low-fiber diet affects the microbes that live in the colon or causes underlying inflammation that may contribute to cancer risk. This is an area of active investigation and research is ongoing. Factors that may increase your risk of colon cancer include: - Older age. The great majority of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently. - African-American race. African-Americans have a greater risk of colon cancer than do people of other races. - A personal history of colorectal cancer or polyps. If you've already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future. - Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer. - Inherited syndromes that increase colon cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome. - Family history of colon cancer. You're more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater. - Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat. - A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer. - Diabetes. People with diabetes and insulin resistance have an increased risk of colon cancer. - Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. - Smoking. People who smoke may have an increased risk of colon cancer. - Alcohol. Heavy use of alcohol increases your risk of colon cancer. - Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon and rectal cancer. Screening for colon cancer Doctors recommend certain screening tests for healthy people with no signs or symptoms in order to look for early colon cancer. Finding colon cancer at its earliest stage provides the greatest chance for a cure. Screening has been shown to reduce your risk of dying of colon cancer. People with an average risk of colon cancer can consider screening beginning at age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner. African-Americans and American Indians may consider beginning colon cancer screening at age 45. Several screening options exist - each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you. If a colonoscopy is used for screening, polyps can be removed during the procedure before they turn into cancer. Diagnosing colon cancer If your signs and symptoms indicate that you could have colon cancer, your doctor may recommend one or more tests and procedures, including: - Using a scope to examine the inside of your colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis and remove polyps. - Blood tests. No blood test can tell you if you have colon cancer. But your doctor may test your blood for clues about your overall health, such as kidney and liver function tests. Your doctor may also test your blood for a chemical sometimes produced by colon cancers (carcinoembryonic antigen or CEA). Tracked over time, the level of CEA in your blood may help your doctor understand your prognosis and whether your cancer is responding to treatment. Staging colon cancer Once you've been diagnosed with colon cancer, your doctor will order tests to determine the extent (stage) of your cancer. Staging helps determine what treatments are most appropriate for you. Staging tests may include imaging procedures such as abdominal, pelvic and chest CT scans. In many cases, the stage of your cancer may not be determined until after colon cancer surgery. The stages of colon cancer are: - Stage I. The cancer has grown through the superficial lining (mucosa) of the colon or rectum but hasn't spread beyond the colon wall or rectum. - Stage II. The cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes. - Stage III. The cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet. - Stage IV. The cancer has spread to distant sites, such as other organs - for instance, to your liver or lung. The type of treatment your doctor recommends will depend largely on the stage of your cancer. The three primary treatment options are surgery, chemotherapy and radiation. Surgery for early-stage colon cancer If your colon cancer is very small, your doctor may recommend a minimally invasive approach to surgery, such as: - Removing polyps during a colonoscopy. If your cancer is small, localized and completely contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy. - Endoscopic mucosal resection. Removing larger polyps may require also taking a small amount of the lining of the colon or rectum in a procedure called an endoscopic mucosal resection. - Minimally invasive surgery. Polyps that can't be removed during a colonoscopy may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located. Surgery for invasive colon cancer If the cancer has grown into or through your colon, your surgeon may recommend: - Partial colectomy. During this procedure, the surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy). - Surgery to create a way for waste to leave your body. When it's not possible to reconnect the healthy portions of your colon or rectum, you may need an ostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening. Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent. - Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer surgery and tested for cancer. Surgery for advanced cancer If your cancer is very advanced or your overall health very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms. This surgery isn't done to cure cancer, but instead to relieve signs and symptoms, such as bleeding and pain. In specific cases where the cancer has spread only to the liver but your overall health is otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your liver. Chemotherapy may be used before or after this type of surgery. This approach provides a chance to be free of cancer over the long term. Chemotherapy Chemotherapy uses drugs to destroy cancer cells. Chemotherapy for colon cancer is usually given after surgery if the cancer has spread to lymph nodes. In this way, chemotherapy may help reduce the risk of cancer recurrence and death from cancer. Sometimes chemotherapy may be used before surgery as well, with the goal of shrinking the cancer before an operation. Chemotherapy before surgery is more common in rectal cancer than in colon cancer. Chemotherapy can also be given to relieve symptoms of colon cancer that has spread to other areas of the body. Radiation therapy Radiation therapy uses powerful energy sources, such as X-rays, to kill cancer cells, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon cancer and rectal cancer. Radiation therapy either alone or combined with chemotherapy is one of the standard treatment options for the initial management of rectal cancer followed by surgery. Targeted drug therapy Drugs that target specific malfunctions that allow cancer cells to grow are available to people with advanced colon cancer, including: - Bevacizumab (Avastin) - Cetuximab (Erbitux) - Panitumumab (Vectibix) - Ramucirumab (Cyramza) - Regorafenib (Stivarga) - Ziv-aflibercept (Zaltrap) Targeted drugs can be given along with chemotherapy or alone. Targeted drugs are typically reserved for people with advanced colon cancer. Some people are helped by targeted drugs, while others are not. Researchers have recently made progress in determining who is most likely to benefit from specific targeted drugs. Until more is known, doctors carefully weigh the possible benefit of targeted drugs against the risk of side effects and the cost when deciding whether to use these treatments. Immunotherapy Some patients with advanced colon cancer have a chance to benefit from immunotherapy with antibodies such as pembrolizumab (Keytruda) and nivolumab (Opdivo). Whether a colon cancer has the chance to respond to these immunotherapies can be determined by a specific test of the tumor tissue. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Colon cancer cure seen on tv. My father has colon cancer and said he saw a commercial on tv about a cure for colon cancer. He cannot remember any details about it. I was wondering if you know anything about something like this. Please let me know. Thank you,

Doctors are not sure what causes frozen shoulder. It is more likely to occur in people who have diabetes or had their shoulder immobilized for a long time due to injury or surgery.

Frozen shoulder (Causes): The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture.

We have 14 siblings in our family , at least 10 of us has had a frozen shoulder. We are wondering why? should we be concerned?

Frozen shoulder may develop without a known cause. It is more likely to occur in people who have thyroid disease, diabetes, had shoulder injury, are unable to move their arm due to cast or stroke, and in women undergoing menopause. Most people have a full recovery with full range of motion.

Frozen shoulder - aftercare: A frozen shoulder is shoulder pain that leads to stiffness of your shoulder. Often the pain and stiffness are present all the time. The capsule of the shoulder joint is made of strong tissue (ligaments) that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones cannot move freely in the joint. This condition is called frozen shoulder. Frozen shoulder may develop with no known cause. It can also occur in people who: - Have thyroid disease, diabetes, or are going through menopause - Have a shoulder injury - Have had a stroke that makes them unable to use their arm - Have a cast on their arm that holds their arm in one position Symptoms of frozen shoulder often follow this pattern: - At first, you have a lot of pain, or a freezing feeling that prevents you from moving your arm. - Then your shoulder becomes very stiff and hard to move, but the pain lessens. It becomes hard to reach over your head or behind you. - Finally, the pain goes away and you can use your arm again. This is the thawing phase and can take months to end. It can take a few months to go through these stages of frozen shoulder. The shoulder can get very painful and stiff before it starts to loosen. It can take as long as 18 to 24 months for complete healing. To help speed healing, your health care provider will likely do the following: - Teach you exercises to restore motion in your shoulder joint. - Refer you to a physical therapist. - Prescribe medicines for you to take by mouth. These include drugs to reduce pain and inflammation in the shoulder joint. You may also receive a shot of anti-inflammatory drug directly into the joint. Most people have a full recovery with full range of motion without surgery. Using moist heat on your shoulder 3 to 4 times a day may help relieve some pain and stiffness. For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store. - Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. - DO NOT take more than the amount recommended on the bottle or by your provider. Get help setting up your home so that you can get to everything you need without reaching above your shoulders or behind your back. - Keep the clothes that you wear most often in drawers and shelves that are between your waist and shoulder level. - Store food in cupboards, drawers, and refrigerator shelves that are between your waist and shoulder level. Get help with house cleaning, taking out the garbage, gardening, and other household tasks. DO NOT lift heavy things or do activities that require a lot of shoulder and arm strength. You will learn some simple exercises and stretches for your shoulder. - At first, try to do these exercises once every hour, or at least 4 times a day. - It is more important to do the exercises often than to do them for a long time each time you do them. - Use moist heat before the exercises to help lessen pain and increase movement. - The exercises should focus on stretching of the shoulder and range of motion. - Avoid exercises to strengthen your shoulder until the range of motion has returned. Some of the exercises are: - Shoulder stretches - Pendulum - Wall crawl - Rope and pulley stretches - Movements to help with internal and external rotation, such as hand behind back Your provider or physical therapist will show you how to do these exercises. Call your doctor if: - The pain in your shoulder is getting worse - You re-injure your arm or shoulder - Your frozen shoulder is making you feel sad or depressed Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

We have 14 siblings in our family , at least 10 of us has had a frozen shoulder. We are wondering why? should we be concerned?

It is not known what causes frozen shoulder. Risk factors include: diabetes, thyroid problems, hormonal changes, e.g., during menopause, shoulder disease, injury or surgery, or other types of surgery. If you don't treat the risk factors and don't use the full range of motion, the frozen shoulder may return.

Frozen shoulder: Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation. The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint. Most of the time, there is no cause for frozen shoulder. Risk factors include: - Diabetes - Thyroid problems - Changes in your hormones, such as during menopause - Shoulder injury - Shoulder surgery - Open heart surgery - Cervical disk disease of the neck - Women 40 to 70 years old are most affected Main symptoms of a frozen shoulder are: - Decreased motion of the shoulder - Pain - Stiffness Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. This lack of movement can lead to stiffness and even less motion. Over time, you are not able to do movements such as reaching over your head or behind you. Your health care provider will ask about your symptoms and examine your shoulder. A diagnosis is often made when you are not able to rotate your shoulder. You may have x-rays of the shoulder. This is to make sure there is no other problem, such as arthritis or calcium deposits. Sometimes, an MRI exam shows inflammation, but these types of imaging tests are not needed to diagnose frozen shoulder. Pain is treated with NSAIDs and steroid injections. Steroid injections and physical therapy can improve your motion. It can take a few weeks to see progress. It may take as long as 6 to 9 months for complete recovery. Physical therapy is intense and needs to be done every day. Left untreated, the condition often gets better by itself within 2 years with little loss of motion. Risk factors for frozen shoulder, such as diabetes or thyroid problems, should also be treated. Surgery is recommended if nonsurgical treatment is not effective. This procedure (shoulder arthroscopy) is done under anesthesia. During surgery the scar tissue is released (cut) by bringing the shoulder through a full range of motion. Arthroscopic surgery can also be used to cut the tight ligaments and remove the scar tissue from the shoulder. After surgery, you may receive pain blocks (shots) so you can do physical therapy. Follow instructions on caring for your shoulder at home.  Treatment with physical therapy and NSAIDs often restores motion and function of the shoulder within a year. Even untreated, the shoulder may get better by itself in 2 years. After surgery restores motion, you must continue physical therapy for several weeks or months. This is to prevent the frozen shoulder from returning. If you do not keep up with physical therapy, the frozen shoulder may come back. Complications may include: - Stiffness and pain continue even with therapy - The arm can break if the shoulder is moved forcefully during surgery If you have shoulder pain and stiffness and think you have a frozen shoulder, contact your provider for referral and treatment. Early treatment may help prevent stiffness. Call your provider if you develop shoulder pain that limits your range of motion for an extended period. People who have diabetes or thyroid problems will be less likely to get frozen shoulder if they keep their condition under control. Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

We have 14 siblings in our family , at least 10 of us has had a frozen shoulder. We are wondering why? should we be concerned?

Frozen shoulder is more likely to occur in people over 40, particularly women, and in those who have thyroid disease, diabetes, cardiovascular disease, tuberculosis, Parkinson's disease, had shoulder injury, or are unable to move their arm due to cast or stroke.

Frozen shoulder: Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. Your risk of developing frozen shoulder increases if you're recovering from a medical condition or procedure that prevents you from moving your arm - such as a stroke or a mastectomy. Treatment for frozen shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely. It's unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder. Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months. - Freezing stage. Any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited. - Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult. - Thawing stage. The range of motion in your shoulder begins to improve. For some people, the pain worsens at night, sometimes disrupting sleep. The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement. Doctors aren't sure why this happens to some people, although it's more likely to occur in people who have diabetes or those who recently had to immobilize their shoulder for a long period, such as after surgery or an arm fracture. Certain factors may increase your risk of developing frozen shoulder. Age and sex People 40 and older, particularly women, are more likely to have frozen shoulder. Immobility or reduced mobility People who've had prolonged immobility or reduced mobility of the shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including: - Rotator cuff injury - Broken arm - Stroke - Recovery from surgery Systemic diseases People who have certain diseases appear more likely to develop frozen shoulder. Diseases that might increase risk include: - Diabetes - Overactive thyroid (hyperthyroidism) - Underactive thyroid (hypothyroidism) - Cardiovascular disease - Tuberculosis - Parkinson's disease During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your range of motion (active range of motion). Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both active and passive range of motion. In some cases, your doctor might inject your shoulder with a numbing medicine (anesthetic) to determine your passive and active range of motion. Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests - such as X-rays or an MRI - to rule out other problems. Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible. Medications Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), can help reduce pain and inflammation associated with frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs. Therapy A physical therapist can teach you range-of-motion exercises to help recover as much mobility in your shoulder as possible. Your commitment to doing these exercises is important to optimize recovery of your mobility. Surgical and other procedures Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest: - Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process. - Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. - Shoulder manipulation. In this procedure, you receive a general anesthetic, so you'll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. - Surgery. Surgery for frozen shoulder is rare, but if nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery with lighted, tubular instruments inserted through small incisions around your joint (arthroscopically). Continue to use the involved shoulder and extremity as much as possible given your pain and range-of-motion limits. Applying heat or cold to your shoulder can help relieve pain. Acupuncture Acupuncture involves inserting extremely fine needles in your skin at specific points on your body. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless. Transcutaneous electrical nerve stimulation (TENS) A TENS unit delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it's thought that it might stimulate the release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses.

We have 14 siblings in our family , at least 10 of us has had a frozen shoulder. We are wondering why? should we be concerned?

Gastroparesis could be caused by diabetes and other underlying conditions that your doctor could help to control. If gastroparesis cannot be controlled with diet and you are unable to tolerate any food or liquid, your doctor could recommend a feeding tube (jejunostomy tube) that is placed in the small intestine or a gastric venting tube to help relieve pressure from gastric contents. Temporary feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest. Experimental treatments include: a drug called relamorelin to reduce vomiting and speed up gastric emptying; endoscopic procedures that place stents that keep the connection between the stomach and the intestines open; and a surgically implanted device that stimulates stomach muscles (gastric electrical stimulation.)

Gastroparesis (Treatment): Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it. Changes to your diet Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with diet changes and dietary changes are the first step in managing this condition. Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest so that you're more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to: - Eat smaller meals more frequently - Chew food thoroughly - Eat well-cooked fruits and vegetables rather than raw fruits and vegetables - Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars - Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet - Try soups and pureed foods if liquids are easier for you to swallow - Drink about 34 to 51 ounces (1 to 1.5 liters) of water a day - Exercise gently after you eat, such as going for a walk - Avoid carbonated drinks, alcohol and smoking - Try to avoid lying down for 2 hours after a meal - Take a multivitamin daily Here's a brief list of foods recommended for people with gastroparesis (your dietitian can give you a more comprehensive list): - White bread and rolls and "light" whole-wheat bread without nuts or seeds - Plain or egg bagels - English muffins - Flour or corn tortillas - Pancakes - Puffed wheat and rice cereals - Cream of wheat or rice - White crackers - Potatoes, white or sweet (no skin) - Baked french fries - Rice - Pasta - Lean beef, veal and pork (not fried) - Chicken or turkey (no skin and not fried) - Crab, lobster, shrimp, clams, scallops, oysters - Tuna (packed in water) - Cottage cheese - Eggs - Tofu - Strained meat baby food - Baby food vegetables and fruits - Tomato sauce, paste, puree, juice - Carrots (cooked) - Beets (cooked) - Mushrooms (cooked) - Vegetable juice - Vegetable broth - Fruit juices and drinks - Applesauce - Bananas - Peaches and pears (canned) - Milk, if tolerated - Yogurt (without fruit pieces) - Custard and pudding - Frozen yogurt Medications Medications to treat gastroparesis may include: - Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.). Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea. A newer medication, domperidone, with fewer side effects, is also available with restricted access. - Medications to control nausea and vomiting. Drugs that help ease nausea and vomiting include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom). A class of medications that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting. Surgical treatment Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest. Treatments under investigation Researchers are continuing to investigate new medications to treat gastroparesis. One example is a new drug in development called relamorelin. The results of a phase 2 clinical trial found the drug could speed up gastric emptying and reduce vomiting. The drug is not yet approved by the Food and Drug Administration (FDA), but a larger clinical trial is currently underway. A number of new therapies are being tried with the help of endoscopy - a slender tube that's threaded down the esophagus. One procedure used endoscopy to place a small tube (stent) where the stomach connects to the small intestine (duodenum) to keep this connection open. Several research trials investigated the use of botulinum toxin administered through endoscopy without much success. This treatment is not recommended. Doctors are also studying the use of a minimally invasive surgical technique when someone needs a feeding tube placed directly into the small intestine (jejunostomy tube). Gastric electrical stimulation and pacing Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate stomach muscles to move food more efficiently. Study results have been mixed. However, the device seems to be most helpful for people with diabetic gastroparesis. The FDA allows the device to be used under a compassionate use exemption for those who can't control their gastroparesis symptoms with diet changes or medications. However, larger studies are needed. Gastric pacing also involves a surgically implanted device that stimulates the stomach muscles, but this device tries to more closely mimic normal stomach contractions. Currently, the device is too large and causes discomfort. Gastric pacing devices are only available in clinical trials right now.

I am a current Gastroparesis fighter with a GJ feeding tube. I am also one of the admins for a GP support group and an advocacy group. I have become a volunteer advocater. I would appreciate any info you can share about Gastroparesis, Feeding tubes, and even TPN. Thanks

Causes of gastroparesis, or delayed gastric emptying, are unknown in most people. The most common known cause is diabetes. The symptoms of gastrparesis, a disorder that mostly affects women, are nausea, gastroesophageal reflux, a feeling of fullness after eating only a small amount of food, and vomiting undigested food, sometimes several hours after a meal. Your doctor will diagnose gastroparesis through a physical examination, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal tract, and gastric emptying tests. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy (surgery to place a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum), and parenteral nutrition.

Gastroparesis: Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.Gastroparesis slows or stops the movement of food from the stomach to the small intestine.Gastroparesis slows or stops the movement of food from the stomach to the small intestine. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal. Other symptoms of gastroparesis includegastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach pain in the stomach area abdominal bloating lack of appetitegastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomachpain in the stomach areaabdominal bloatinglack of appetiteSymptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber—such as raw fruits and vegetables—or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy. Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test. Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis. Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy.Upper gastrointestinal (GI) endoscopy.Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test.Upper GI series.Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis.Ultrasound.Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.Gastric emptying scintigraphy.SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.SmartPill.Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.Gastric emptying breath test. Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition—the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal—instead of lying down—may assist with gastric emptying.A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars.When a person has severe symptoms, a liquid or puréed diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a puréed diet helps improve symptoms. Puréed fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met.When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given.MedicationsSeveral prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment.Metoclopramide (Reglan). This medication stimulates stomach muscle contractions to help with gastric emptying. Metoclopramide also helps reduce nausea and vomiting. The medication is taken 20 to 30 minutes before meals and at bedtime. Possible side effects of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesia—a disorder that affects movement.Metoclopramide (Reglan).Erythromycin. This antibiotic, prescribed at low doses, may improve gastric emptying. Like metaclopramide, erythromycin works by increasing the contractions that move food through the stomach. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps.Erythromycin.Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, medications known as antiemetics are used to help control nausea and vomiting.Other medications.Botulinum ToxinBotulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.11Gastric Electrical StimulationThis treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications. A gastric neurostimulator is a surgically implanted battery-operated device that sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. The procedure may be performed at a hospital or outpatient center by a gastroenterologist. General anesthesia may be required. The gastroenterologist makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the stomach to a video monitor, giving the gastroenterologist a close-up view of the tissues. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms.JejunostomyIf medications and dietary changes don’t work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy. The procedure is performed by a surgeon at a hospital or outpatient center. Anesthesia is needed. The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. The jejunostomy is used only when gastroparesis is extremely severe.Parenteral NutritionWhen gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition—an IV liquid food mixture supplied through a special tube in the chest. The procedure is performed by a surgeon at a hospital or outpatient center; anesthesia is needed. The surgeon inserts a thin, flexible tube called a catheter into a chest vein, with the catheter opening outside the skin. A bag containing liquid nutrients is attached to the catheter, and the nutrients are transported through the catheter into the chest vein and into the bloodstream. This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis. An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels to be erratic and difficult to control.The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen.To better control blood glucose, people with diabetes and gastroparesis may need totake insulin more often or change the type of insulin they take take insulin after meals, instead of before check blood glucose levels frequently after eating and administer insulin when necessarytake insulin more often or change the type of insulin they taketake insulin after meals, instead of beforecheck blood glucose levels frequently after eating and administer insulin when necessaryA health care provider will give specific instructions for taking insulin based on the individual’s needs and the severity of gastroparesis.In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable. The problems of gastroparesis can includesevere dehydration due to persistent vomiting gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form difficulty managing blood glucose levels in people with diabetes malnutrition due to poor absorption of nutrients or a low calorie intake decreased quality of life, including work absences due to severe symptomssevere dehydration due to persistent vomitinggastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagusbezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill formdifficulty managing blood glucose levels in people with diabetesmalnutrition due to poor absorption of nutrients or a low calorie intakedecreased quality of life, including work absences due to severe symptoms Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen.Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests.Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve.The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite.Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests.Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed.Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.Find out if clinical trials are right for youWhat clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.www.ClinicalTrials.govThis information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.www.fda.govThe U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.What is gastroparesis? Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Gastroparesis slows or stops the movement of food from the stomach to the small intestine. What causes gastroparesis? Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. What are the symptoms of gastroparesis? The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal. Other symptoms of gastroparesis include gastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach pain in the stomach area abdominal bloating lack of appetite Symptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber—such as raw fruits and vegetables—or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases. How is gastroparesis diagnosed? Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests: Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy. Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test. Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis. Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying. How is gastroparesis treated? Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition—the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible. Eating, Diet, and Nutrition Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal—instead of lying down—may assist with gastric emptying. A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars. When a person has severe symptoms, a liquid or puréed diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a puréed diet helps improve symptoms. Puréed fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met. When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given. Medications Several prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment. Metoclopramide (Reglan). This medication stimulates stomach muscle contractions to help with gastric emptying. Metoclopramide also helps reduce nausea and vomiting. The medication is taken 20 to 30 minutes before meals and at bedtime. Possible side effects of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesia—a disorder that affects movement. Erythromycin. This antibiotic, prescribed at low doses, may improve gastric emptying. Like metaclopramide, erythromycin works by increasing the contractions that move food through the stomach. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps. Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, medications known as antiemetics are used to help control nausea and vomiting. Botulinum Toxin Botulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.1 Gastric Electrical Stimulation This treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications. A gastric neurostimulator is a surgically implanted battery-operated device that sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. The procedure may be performed at a hospital or outpatient center by a gastroenterologist. General anesthesia may be required. The gastroenterologist makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the stomach to a video monitor, giving the gastroenterologist a close-up view of the tissues. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms. Jejunostomy If medications and dietary changes don’t work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy. The procedure is performed by a surgeon at a hospital or outpatient center. Anesthesia is needed. The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. The jejunostomy is used only when gastroparesis is extremely severe. Parenteral Nutrition When gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition—an IV liquid food mixture supplied through a special tube in the chest. The procedure is performed by a surgeon at a hospital or outpatient center; anesthesia is needed. The surgeon inserts a thin, flexible tube called a catheter into a chest vein, with the catheter opening outside the skin. A bag containing liquid nutrients is attached to the catheter, and the nutrients are transported through the catheter into the chest vein and into the bloodstream. This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis. How is gastroparesis treated if a person has diabetes? An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels to be erratic and difficult to control. The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen. To better control blood glucose, people with diabetes and gastroparesis may need to take insulin more often or change the type of insulin they take take insulin after meals, instead of before check blood glucose levels frequently after eating and administer insulin when necessary A health care provider will give specific instructions for taking insulin based on the individual’s needs and the severity of gastroparesis. In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable. What are the problems of gastroparesis? The problems of gastroparesis can include severe dehydration due to persistent vomiting gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form difficulty managing blood glucose levels in people with diabetes malnutrition due to poor absorption of nutrients or a low calorie intake decreased quality of life, including work absences due to severe symptoms Points to Remember Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen. References [1] Bai Y, Xu MJ, Yang X, et al. A systematic review on intrapyloric botulinum toxin injection for gastroparesis. Digestion. 2010;81(1):27–34. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

I am a current Gastroparesis fighter with a GJ feeding tube. I am also one of the admins for a GP support group and an advocacy group. I have become a volunteer advocater. I would appreciate any info you can share about Gastroparesis, Feeding tubes, and even TPN. Thanks

Causes of gastroparesis are mostly unknown. It is a common complication of diabetes, and sometimes surgeries.

Gastroparesis (Causes): The exact cause of gastroparesis is unknown. It may be caused by a disruption of nerve signals to the stomach. The condition is a common complication of diabetes. It can also follow some surgeries. Risk factors for gastroparesis include: - Diabetes - Gastrectomy (surgery to remove part of the stomach) - Systemic sclerosis - Use of medicine that blocks certain nerve signals (anticholinergic medicine)

I am a current Gastroparesis fighter with a GJ feeding tube. I am also one of the admins for a GP support group and an advocacy group. I have become a volunteer advocater. I would appreciate any info you can share about Gastroparesis, Feeding tubes, and even TPN. Thanks

Causes of gastroparesis are mostly unknown. It is a common complication of diabetes, and sometimes surgeries. Symptoms of gastroparesis include: nausea, vomiting undigested food eaten a few hours earlier, feeling full after eating just a few bites, acid reflux, abdominal bloating, abdominal pain, changes in blood sugar levels, lack of appetite, weight loss and malnutrition. Tests to diagnose this condition include: gastric emptying study, upper gastrointestinal endoscopy, ultrasound, and upper gastrointestinal series. Many people can manage gastroparesis with diet changes. For people with gastroparesis who are unable to tolerate any food or liquids, doctors may recommend a feeding tube (jejunostomy tube) placed in the small intestine or a gastric venting tube to help relieve pressure from gastric contents. In some cases, IV (parenteral) feeding tube that goes directly into a chest vein might be needed. Some new procedures involve endoscopy to keep the connection between the stomach and the small intestine open and gastric electrical stimulation and pacing.

Gastroparesis: Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly. Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. Although there's no cure for gastroparesis, changes to your diet, along with medication, can offer some relief. Gastroparesis care at Mayo Clinic Signs and symptoms of gastroparesis include: - Vomiting - Nausea - A feeling of fullness after eating just a few bites - Vomiting undigested food eaten a few hours earlier - Acid reflux - Abdominal bloating - Abdominal pain - Changes in blood sugar levels - Lack of appetite - Weight loss and malnutrition Many people with gastroparesis don't have any noticeable signs and symptoms. Make an appointment with your doctor if you have any signs or symptoms that worry you. It's not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve). The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested. The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine. Factors that can increase your risk of gastroparesis: - Diabetes - Abdominal or esophageal surgery - Infection, usually a virus - Certain medications that slow the rate of stomach emptying, such as narcotic pain medications - Scleroderma (a connective tissue disease) - Nervous system diseases, such as Parkinson's disease or multiple sclerosis - Hypothyroidism (low thyroid) Women are more likely to develop gastroparesis than are men. Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include: - Gastric emptying study. This is the most important test used in making a diagnosis of gastroparesis. It involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach. You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion. - Upper gastrointestinal (GI) endoscopy. This procedure is used to visually examine your upper digestive system - your esophagus, stomach and beginning of the small intestine (duodenum) - with a tiny camera on the end of a long, flexible tube.This test can also diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis. - Ultrasound. This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms. - Upper gastrointestinal series. This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up. Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it. Changes to your diet Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with diet changes and dietary changes are the first step in managing this condition. Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest so that you're more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to: - Eat smaller meals more frequently - Chew food thoroughly - Eat well-cooked fruits and vegetables rather than raw fruits and vegetables - Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars - Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet - Try soups and pureed foods if liquids are easier for you to swallow - Drink about 34 to 51 ounces (1 to 1.5 liters) of water a day - Exercise gently after you eat, such as going for a walk - Avoid carbonated drinks, alcohol and smoking - Try to avoid lying down for 2 hours after a meal - Take a multivitamin daily Here's a brief list of foods recommended for people with gastroparesis (your dietitian can give you a more comprehensive list): - White bread and rolls and "light" whole-wheat bread without nuts or seeds - Plain or egg bagels - English muffins - Flour or corn tortillas - Pancakes - Puffed wheat and rice cereals - Cream of wheat or rice - White crackers - Potatoes, white or sweet (no skin) - Baked french fries - Rice - Pasta - Lean beef, veal and pork (not fried) - Chicken or turkey (no skin and not fried) - Crab, lobster, shrimp, clams, scallops, oysters - Tuna (packed in water) - Cottage cheese - Eggs - Tofu - Strained meat baby food - Baby food vegetables and fruits - Tomato sauce, paste, puree, juice - Carrots (cooked) - Beets (cooked) - Mushrooms (cooked) - Vegetable juice - Vegetable broth - Fruit juices and drinks - Applesauce - Bananas - Peaches and pears (canned) - Milk, if tolerated - Yogurt (without fruit pieces) - Custard and pudding - Frozen yogurt Medications Medications to treat gastroparesis may include: - Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.). Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea. A newer medication, domperidone, with fewer side effects, is also available with restricted access. - Medications to control nausea and vomiting. Drugs that help ease nausea and vomiting include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom). A class of medications that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting. Surgical treatment Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest. Treatments under investigation Researchers are continuing to investigate new medications to treat gastroparesis. One example is a new drug in development called relamorelin. The results of a phase 2 clinical trial found the drug could speed up gastric emptying and reduce vomiting. The drug is not yet approved by the Food and Drug Administration (FDA), but a larger clinical trial is currently underway. A number of new therapies are being tried with the help of endoscopy - a slender tube that's threaded down the esophagus. One procedure used endoscopy to place a small tube (stent) where the stomach connects to the small intestine (duodenum) to keep this connection open. Several research trials investigated the use of botulinum toxin administered through endoscopy without much success. This treatment is not recommended. Doctors are also studying the use of a minimally invasive surgical technique when someone needs a feeding tube placed directly into the small intestine (jejunostomy tube). Gastric electrical stimulation and pacing Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate stomach muscles to move food more efficiently. Study results have been mixed. However, the device seems to be most helpful for people with diabetic gastroparesis. The FDA allows the device to be used under a compassionate use exemption for those who can't control their gastroparesis symptoms with diet changes or medications. However, larger studies are needed. Gastric pacing also involves a surgically implanted device that stimulates the stomach muscles, but this device tries to more closely mimic normal stomach contractions. Currently, the device is too large and causes discomfort. Gastric pacing devices are only available in clinical trials right now. If you're a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking. People with gastroparesis who are overweight are also less likely to get better over time. There is some evidence that certain alternative treatments can be helpful to people with gastroparesis, although more studies are needed. Some treatments that look promising include: - Acupuncture and electroacupuncture. Acupuncture involves the insertion of extremely thin needles through your skin at strategic points on your body. During electroacupuncture, a small electrical current is passed through the needles. Studies have shown these treatments to ease gastroparesis symptoms more than a sham treatment. - STW 5 (Iberogast). This herbal formula from Germany contains nine different herbal extracts. It hasn't been shown to speed up gastric emptying, but was slightly better at easing digestive symptoms than a placebo. - Rikkunshito. This Japanese herbal formula also contains nine herbs. It may help reduce abdominal pain and the feeling of post-meal fullness. - Cannabis. There aren't any published clinical trials on cannabis and gastroparesis. However, cannabis - commonly known as marijuana - is thought to ease nausea and other digestive complaints. Derivatives of cannabis have been used by people who have cancer in the past, but there are better FDA-approved medications available to control nausea now. Because cannabis is often smoked, there's concern about possible addiction and harm, similar to what occurs with tobacco smoke. In addition, daily users of marijuana (cannabis) may develop a condition that mimics the symptoms of gastroparesis called cannabis hyperemesis syndrome. Symptoms can include nausea, vomiting and abdominal pain. Quitting cannabis may help.

I am a current Gastroparesis fighter with a GJ feeding tube. I am also one of the admins for a GP support group and an advocacy group. I have become a volunteer advocater. I would appreciate any info you can share about Gastroparesis, Feeding tubes, and even TPN. Thanks

Gastroparesis occurs when food moves slowly from the stomach to the small intestine or stops moving altogether. In most cases, the causes of gastroparesis are unknown. Diabetes is the most common known cause of gastroparesis. The most common symptoms of gastroparesis are nausea; a feeling of fullness after eating only a small amount of food; vomiting undigested food, sometimes several hours after a meal; gastroesophageal reflux (GER); pain in the stomach area; abdominal bloating; and lack of appetite. Your doctor will diagnose gastroparesis through a physical examination, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal tract, and gastric emptying tests. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy (surgery to place a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum), and parenteral nutrition.

Gastroparesis (Points to Remember): Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen.Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests.Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve.The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite.Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests.Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed.Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen.

I am a current Gastroparesis fighter with a GJ feeding tube. I am also one of the admins for a GP support group and an advocacy group. I have become a volunteer advocater. I would appreciate any info you can share about Gastroparesis, Feeding tubes, and even TPN. Thanks

Glaucoma can damage the optic nerve due to increased pressure in the eye. Adults may have open-angle glaucoma, angle-closure glaucoma, also called closed-angle glaucoma or secondary glaucoma. Open-angle glaucoma occurs due to slow increase in eye pressure over time, and is the most common type of glaucoma. Its cause is unknown, but it tends to run in the families. Closed-angle glaucoma occurs due to a quick, severe rise in eye pressure. Dilating eye drops and certain medicines may trigger an acute glaucoma attack. Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: drugs such as corticosteroids, eye diseases such as uveitis, diabetes, eye injury. Most people cannot feel open-angle glaucoma. People may experience blind spots and slow loss of side (peripheral) vision (also called tunnel vision). Symptoms of closed-angle glaucoma may come and go at first, or steadily become worse. You may notice: sudden, severe pain in one eye decreased or cloudy vision, nausea and vomiting, rainbow-like halos around lights, red eye, feeling that an eye is swollen. The only way to diagnose glaucoma is by having a complete eye exam. You will be given a test to check your eye pressure (tonometry.) Eye pressure can be normal in some people with glaucoma. So you will need other tests to confirm glaucoma. They may include: using a special lens to look at the angle of the eye (gonioscopy), optic nerve imaging, checking your visual acuity, field of vision, retina and how your pupil responds to light (pupillary reflex response), 3-D view of your eye (slit lamp examination). The goal of treatment is to reduce your eye pressure. Treatment depends on the type of glaucoma that you have. If you have open-angle glaucoma, you will probably be given eye drops. You also may be given pills to lower pressure in the eye. If drops alone do not work, you may need laser treatment that uses a painless laser to open the channels for fluid to flow out. If drops and laser treatment do not work, you may need surgery. The doctor will open a new channel so fluid can escape. This will help lower your pressure. Recently, new implants have been developed that can help treat glaucoma in people having cataract surgery. An acute angle-closure attack is a medical emergency. If you have had acute glaucoma in one eye, your doctor is likely to treat your second eye to prevent an attack in that eye.You can become blind in a few days if you are not treated. You may be given drops, pills, and IV medicine to lower your eye pressure. Some people also need an emergency operation, called an iridotomy. If you have secondary glaucoma, treating the cause may help your symptoms go away. Other treatments also may be needed. Open-angle glaucoma cannot be cured. You can manage it and keep your sight by following your provider's directions. You cannot prevent open-angle glaucoma, but you can help prevent vision loss. A complete eye exam can help find open-angle glaucoma early, when it is easier to treat. All adults should have a complete eye exam by the age of 40. You should have regular eye exams as recommended by your provider. If you are at risk for closed-angle glaucoma, your provider may recommend treatment before you have an attack to help prevent eye damage and vision loss.

Glaucoma: Glaucoma is a group of eye conditions that can damage the optic nerve. This nerve sends the images you see to your brain. Most often, optic nerve damage is caused by increased pressure in the eye. This is called intraocular pressure. Watch this video about: Glaucoma Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma: - Open-angle glaucoma - Angle-closure glaucoma, also called closed-angle glaucoma - Congenital glaucoma - Secondary glaucoma The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is made in an area behind the colored part of the eye (iris). It leaves the eye through channels where the iris and cornea meet. This area is called the anterior chamber angle, or the angle. The cornea is the clear covering on the front of the eye that covers the iris, pupil, and angle. Anything that slows or blocks the flow of this fluid will cause pressure to build up in the eye. - In open-angle glaucoma, the increase in pressure is often small and slow. - In closed-angle glaucoma, the increase is often high and sudden. - Either type can damage the optic nerve. Open-angle glaucoma is the most common type of glaucoma. - The cause is unknown. The increase in eye pressure happens slowly over time. You cannot feel it. - The increased pressure pushes on the optic nerve. Damage to the optic nerve causes blind spots in your vision. - Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are also at higher risk for this disease. Closed-angle glaucoma occurs when the fluid is suddenly blocked and cannot flow out of the eye. This causes a quick, severe rise in eye pressure. - Dilating eye drops and certain medicines may trigger an acute glaucoma attack. - Closed-angle glaucoma is an emergency. - If you have had acute glaucoma in one eye, you are at risk for it in the second eye. Your health care provider is likely to treat your second eye to prevent a first attack in that eye. Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: - Drugs such as corticosteroids - Eye diseases such as uveitis (an infection of the middle layer of the eye) - Diseases such as diabetes - Eye injury Congenital glaucoma occurs in babies. - It often runs in families. - It is present at birth. - It is caused when the eye does not develop normally. OPEN-ANGLE GLAUCOMA - Most people have no symptoms. - Once vision loss occurs, the damage is already severe. - Slow loss of side (peripheral) vision (also called tunnel vision). - Advanced glaucoma can lead to blindness. ANGLE-CLOSURE GLAUCOMA Symptoms may come and go at first, or steadily become worse. You may notice: - Sudden, severe pain in one eye - Decreased or cloudy vision, often called "steamy" vision - Nausea and vomiting - Rainbow-like halos around lights - Red eye - Eye feels swollen CONGENITAL GLAUCOMA Symptoms are most often noticed when the child is a few months old. - Cloudiness of the front of the eye - Enlargement of one eye or both eyes - Red eye - Sensitivity to light - Tearing SECONDARY GLAUCOMA - Symptoms are most often related to the underlying problem causing the glaucoma. - Depending on the cause, symptoms may either be like open-angle glaucoma or angle-closure glaucoma. The only way to diagnose glaucoma is by having a complete eye exam. - You will be given a test to check your eye pressure. This is called tonometry. - In most cases, you will be given eye drops to widen (dilate) your pupil. - When your pupil is dilated, your eye doctor will look at the inside of your eye and the optic nerve. Eye pressure is different at different times of the day. Eye pressure can even be normal in some people with glaucoma. So you will need other tests to confirm glaucoma. They may include: - Using a special lens to look at the angle of the eye (gonioscopy). - Photographs or laser scanning images of the inside of your eye (optic nerve imaging). - Checking your retina. The retina is the light-sensitive tissue at the back of your eye. - Checking how your pupil responds to light (pupillary reflex response). - 3-D view of your eye (slit lamp examination). - Testing the clearness of your vision (visual acuity). - Testing your field of vision (visual field measurement). The goal of treatment is to reduce your eye pressure. Treatment depends on the type of glaucoma that you have. OPEN-ANGLE GLAUCOMA - If you have open-angle glaucoma, you will probably be given eye drops. - You may need more than one type. Most people can be treated with eye drops. - Most of the eye drops used today have fewer side effects than those used in the past. - You also may be given pills to lower pressure in the eye. If drops alone do not work, you may need other treatment: - Laser treatment uses a painless laser to open the channels where fluid flows out. - If drops and laser treatment do not work, you may need surgery. The doctor will open a new channel so fluid can escape. This will help lower your pressure. - Recently, new implants have been developed that can help treat glaucoma in people having cataract surgery. ACUTE ANGLE GLAUCOMA An acute angle-closure attack is a medical emergency. You can become blind in a few days if you are not treated. - You may be given drops, pills, and medicine given through a vein (by IV) to lower your eye pressure. - Some people also need an emergency operation, called an iridotomy. The doctor uses a laser to open a new channel in the iris. Sometimes this is done with surgery. The new channel relieves the attack and will prevent another attack. - To help prevent an attack in the other eye, the procedure will often be performed on the other eye. This may be done even if it has never had an attack. CONGENITAL GLAUCOMA - Congenital glaucoma is almost always treated with surgery. - This is done using general anesthesia. This means the child is asleep and feels no pain. SECONDARY GLAUCOMA If you have secondary glaucoma, treating the cause may help your symptoms go away. Other treatments also may be needed. Open-angle glaucoma cannot be cured. You can manage it and keep your sight by following your provider's directions. Closed-angle glaucoma is a medical emergency. You need treatment right away to save your vision. Babies with congenital glaucoma usually do well when surgery is done early. How you do with secondary glaucoma depends on what is causing the condition. If you have severe eye pain or a sudden loss of vision, get immediate medical help. These may be signs of closed-angle glaucoma. You cannot prevent open-angle glaucoma. Most people have no symptoms. But you can help prevent vision loss. - A complete eye exam can help find open-angle glaucoma early, when it is easier to treat. - All adults should have a complete eye exam by the age of 40. - If you are at risk for glaucoma, you should have a complete eye exam sooner than age 40. - You should have regular eye exams as recommended by your provider. If you are at risk for closed-angle glaucoma, your provider may recommend treatment before you have an attack to help prevent eye damage and vision loss. Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

Can you mail me patient information about Glaucoma, I was recently diagnosed and want to learn all I can about the disease.

Open-angle glaucoma occurs due to slow increase in eye pressure over time, and is the most common type of glaucoma. Its cause is unknown, but it tends to run in the families. Most people cannot feel open-angle glaucoma. Closed-angle glaucoma occurs due to a quick, severe rise in eye pressure. Dilating eye drops and certain medicines may trigger an acute glaucoma attack. Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: drugs such as corticosteroids, eye diseases such as uveitis, diabetes, eye injury.

Glaucoma (Causes): Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma: - Open-angle glaucoma - Angle-closure glaucoma, also called closed-angle glaucoma - Congenital glaucoma - Secondary glaucoma The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is made in an area behind the colored part of the eye (iris). It leaves the eye through channels where the iris and cornea meet. This area is called the anterior chamber angle, or the angle. The cornea is the clear covering on the front of the eye that covers the iris, pupil, and angle. Anything that slows or blocks the flow of this fluid will cause pressure to build up in the eye. - In open-angle glaucoma, the increase in pressure is often small and slow. - In closed-angle glaucoma, the increase is often high and sudden. - Either type can damage the optic nerve. Open-angle glaucoma is the most common type of glaucoma. - The cause is unknown. The increase in eye pressure happens slowly over time. You cannot feel it. - The increased pressure pushes on the optic nerve. Damage to the optic nerve causes blind spots in your vision. - Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are also at higher risk for this disease. Closed-angle glaucoma occurs when the fluid is suddenly blocked and cannot flow out of the eye. This causes a quick, severe rise in eye pressure. - Dilating eye drops and certain medicines may trigger an acute glaucoma attack. - Closed-angle glaucoma is an emergency. - If you have had acute glaucoma in one eye, you are at risk for it in the second eye. Your health care provider is likely to treat your second eye to prevent a first attack in that eye. Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: - Drugs such as corticosteroids - Eye diseases such as uveitis (an infection of the middle layer of the eye) - Diseases such as diabetes - Eye injury Congenital glaucoma occurs in babies. - It often runs in families. - It is present at birth. - It is caused when the eye does not develop normally.

Can you mail me patient information about Glaucoma, I was recently diagnosed and want to learn all I can about the disease.

The safest way to lose weight is to change your behavior for a long term and lead an active lifestyle, exercise and eat healthy. Work with your doctor and dietitian to lose weight while staying healthy. Make healthy food choices, read nutritional labels, and change the way you prepare food and snack. Reduce portion sizes and avoid sweetened drinks and extreme diets. Discuss supplements and herbal remedies with your doctor. If diet, exercise, or medicine do not help, discuss with your doctor if one of the following surgeries is a good option for you: laparoscopic gastric banding, gastric bypass surgery, sleeve gastrectomy, or duodenal switch.

Obesity (Treatment): CHANGING YOUR LIFESTYLE An active lifestyle and plenty of exercise, along with healthy eating, is the safest way to lose weight. Even modest weight loss can improve your health. You may need a lot of support from family and friends. Your main goal should be to learn new, healthy ways of eating and make them part of your daily routine. Many people find it hard to change their eating habits and behaviors. You may have practiced some habits for so long that you may not even know they are unhealthy, or you do them without thinking. You need to be motivated to make lifestyle changes. Make the behavior change part of your life over the long term. Know that it takes time to make and keep a change in your lifestyle. Work with your provider and dietitian to set realistic, safe daily calorie counts that help you lose weight while staying healthy. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your dietitian can teach you about: - Healthy food choices - Healthy snacks - Reading nutrition labels - New ways to prepare food - Portion sizes - Sweetened drinks Extreme diets (fewer than 1100 calories per day) are not thought to be safe or to work very well. These types of diets often DO NOT contain enough vitamins and minerals. Most people who lose weight this way return to overeating and become obese again. Learn ways to manage stress other than snacking. Examples may be meditation, yoga, or exercise. If you are depressed or stressed a lot, talk to your provider. MEDICINES AND HERBAL REMEDIES You may see ads for supplements and herbal remedies that claim they will help you lose weight. Some of these claims may not be true. And some of these supplements can have serious side effects. Talk to your provider before using them. You can discuss weight loss medicines with your doctor. Many people lose at least 5 pounds (2 kg) by taking these drugs, but they may regain the weight when they stop taking the medicine unless they have made lifestyle changes. SURGERY Bariatric (weight-loss) surgery can reduce the risk of certain diseases in people with severe obesity. These risks include: - Arthritis - Diabetes - Heart disease - High blood pressure - Sleep apnea - Some cancers - Stroke Surgery may help people who have been very obese for 5 years or more and have not lost weight from other treatments, such as diet, exercise, or medicine. Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after surgery. Talk to your doctor to learn if surgery is a good option for you. Weight-loss surgeries include: - Laparoscopic gastric banding - Gastric bypass surgery - Sleeve gastrectomy (less common) - Duodenal switch

help with obesity I would like help on my obesity problem and if I can get help

To reach and stay at a healthy weight, you may need to work with a dietitian, behavior counselor or an obesity specialist. They will help you understand and make changes in your eating habits and increase physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. In addition to dietary changes, exercise and activity, and behavior changes, you may need prescription weight-loss medications or weight-loss surgery.

Obesity (Treatment): The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals - including a dietitian, behavior counselor or an obesity specialist - to help you understand and make changes in your eating and activity habits. The initial treatment goal is usually a modest weight loss - 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits. All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include: - Dietary changes - Exercise and activity - Behavior change - Prescription weight-loss medications - Weight-loss surgery Dietary changes Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include: - Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men. - Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods - such as desserts, candies, fats and processed foods - are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall. - Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein - such as beans, lentils and soy - and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils. - Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories. - Meal replacements. These plans suggest that you replace one or two meals with their products - such as low-calorie shakes or meal bars - and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off. Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight - and keep it off - you have to adopt healthy-eating habits that you can maintain over time. Exercise and activity Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. To boost your activity level: - Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. - Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day. Behavior changes A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns. Behavior modification, sometimes called behavior therapy, can include: - Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs - those that include 12 to 26 sessions a year - may be more helpful in achieving your weight-loss goals. - Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers. Prescription weight-loss medication Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work. Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria: - Your body mass index (BMI) is 30 or greater - Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions. Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq), phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide (Saxenda). You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost. Weight-loss surgery In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks. Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and: - You have extreme obesity (BMI of 40 or higher) - Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure - You're committed to making the lifestyle changes that are necessary for surgery to work It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. Common weight-loss surgeries include: - Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. - Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. - Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon removing a large part of the stomach. The surgeon leaves the valve that releases food to the small intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the middle section of the intestine and attaches the last part directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. - Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch. Other treatments Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Preventing weight regain after obesity treatment Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile. One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost. You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.

help with obesity I would like help on my obesity problem and if I can get help

A healthy eating plan and regular physical activity may help you lose weight and keep it off over the long term. If these lifestyle changes are not enough, your doctor may prescribe medications. Some medications may help you feel less hungry or full sooner. Other medications may make it harder for your body to absorb fat from the foods you eat. Weight-loss medications are for people who may have health problems related to overweight or obesity. When combined with changes to behavior, including eating and physical activity habits, prescription medications may help some people lose weight.

Prescription Medications to Treat Overweight and Obesity: Health care providers use the Body Mass Index (BMI), which is a measure of your weight in relation to your height, to define overweight and obesity. People who have a BMI between 25 and 30 are considered overweight. Obesity is defined as having a BMI of 30 or greater. You can calculate your BMI to learn if you are overweight or obese. Being overweight or obese may increase the risk of health problems. Your health care provider can assess your individual risk due to your weight.Obesity is a chronic condition that affects more than one in three adults in the United States. Another one in three adults is overweight. If you are struggling with your weight, you may find that a healthy eating plan and regular physical activity help you lose weight and keep it off over the long term. If these lifestyle changes are not enough to help you lose weight or maintain your weight loss, your doctor may prescribe medications as part of your weight-control program. Prescription medications to treat overweight and obesity work in different ways. For example, some medications may help you feel less hungry or full sooner. Other medications may make it harder for your body to absorb fat from the foods you eat. Weight-loss medications are meant to help people who may have health problems related to overweight or obesity. Before prescribing a weight-loss medication, your doctor also will considerthe likely benefits of weight loss the medication’s possible side effects your current health issues and other medications your family's medical history costHealth care professionals often use BMI to help decide who might benefit from weight-loss medications. Your doctor may prescribe a medication to treat your overweight or obesity if you are an adult witha BMI of 30 or more or a BMI of 27 or more and you have weight-related health problems, such as high blood pressure or type 2 diabetes.Weight-loss medications aren’t for everyone with a high BMI. Some people who are overweight or obese may lose weight with a lifestyle program that helps them change their behaviors and improve their eating and physical activity habits. A lifestyle program may also address other factors that affect weight gain, such as eating triggers and not getting enough sleep. The U.S. Food and Drug Administration (FDA) has approved most weight-loss medications only for adults. The prescription medication orlistat (Xenical) is FDA-approved for children ages 12 and older. Medications don’t replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight-loss medications work best when combined with a lifestyle program. Ask your doctor or other health care professional about lifestyle treatment programs for weight management that will work for you.Weight-loss medications don’t replace physical activity and healthy eating habits. When combined with changes to behavior, including eating and physical activity habits, prescription medications may help some people lose weight. On average, people who take prescription medications as part of a lifestyle program lose between 3 and 9 percent more of their starting body weight than people in a lifestyle program who do not take medication. Research shows that some people taking prescription weight-loss medications lose 10 percent or more of their starting weight.1 Results vary by medication and by person.Weight loss of 5 to 10 percent of your starting body weight may help improve your health by lowering blood sugar, blood pressure, and triglycerides. Losing weight also can improve some other health problems related to overweight and obesity, such as joint pain or sleep apnea. Most weight loss takes place within the first 6 months of starting the medication. Experts are concerned that, in some cases, the side effects of prescription medications to treat overweight and obesity may outweigh the benefits. For this reason, you should never take a weight-loss medication only to improve the way you look. In the past, some weight-loss medications were linked to serious health problems. For example, the FDA recalled fenfluramine and dexfenfluramine (part of the “fen-phen” combination) in 1997 because of concerns related to heart valve problems.Possible side effects vary by medication and how it acts on your body. Most side effects are mild and most often improve if you continue to take the medication. Rarely, serious side effects can occur.Tips for Taking Weight-loss MedicationFollow your doctor's instructions about weight-loss medications. Buy your medication from a pharmacy or web distributor approved by your doctor. Take weight-loss medication to support your healthy eating and physical activity program. Know the side effects and warnings for taking any medication. Ask your doctor if you should stop taking your medication if you are not losing weight after 12 weeks. Discuss other medications, including supplements and vitamins, you are taking with your doctor when considering weight-loss medications. Avoid taking weight-loss medications during pregnancy or if you are planning a pregnancy. Choosing a medication to treat overweight or obesity is a decision between you and your doctor. Important factors to consider includethe likely benefits of weight loss the medication’s possible side effects your current health issues and other medications your family’s medical history costTalk with your doctor about which weight-loss medication might be right for you. How long you will need to take weight-loss medication depends on whether the drug helps you lose and maintain weight and whether you have any side effects. If you have lost enough weight to improve your health and are not having serious side effects, your doctor may advise that you stay on the medication indefinitely. If you do not lose at least 5 percent of your starting weight after 12 weeks on the full dose of your medication, your doctor will probably advise you to stop taking it. He or she may change your treatment plan or consider using a different weight-loss medication. Your doctor also may have you try different lifestyle, physical activity, or eating programs; change your other medications that cause weight gain; or refer you to a bariatric surgeon to see if weight-loss surgery might be an option for you.Because obesity is a chronic condition, you may need to continue changes to your eating and physical activity habits and other behaviors for years—or even a lifetime—to improve your health and maintain a healthy weight. You will probably regain some weight after you stop taking weight-loss medication. Developing and maintaining healthy eating habits and increasing physical activity may help you regain less weight or keep it off. Federal physical activity guidelines recommend at least 150 minutes of physical activity per week for adults—that’s about 30 minutes a day most days of the week. You may need to do more to reach or maintain your weight-loss goal. Some, but not all, insurance plans cover medications that treat overweight and obesity. Contact your insurance provider to find out if your plan covers these medications. The table below lists FDA-approved prescription medications for weight loss. The FDA has approved five of these drugs—orlistat (Xenical, Alli), lorcaserin (Belviq), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), and liraglutide (Saxenda)—for long-term use. You can keep taking these drugs as long as you are benefiting from treatment and not having unpleasant side-effects.Some weight-loss medications that curb appetite are approved by the FDA only for short-term use, or up to 12 weeks. Although some doctors prescribe them for longer periods of time, not many research studies have looked at how safe and effective they are for long-term use.Pregnant women should never take weight-loss medications. Women who are planning to get pregnant also should avoid these medications, as some of them may harm a fetus.Prescription Medications Approved for Overweight and Obesity TreatmentWeight-loss medication Approved for How it works Common side effects Warnings Orlistat (Xenical) Available in lower dose without prescription (Alli) Adults and children ages 12 and older Works in your gut to reduce the amount of fat your body absorbs from the food you eat diarrhea gas leakage of oily stools stomach pain Rare cases of severe liver injury have been reported. Avoid taking with cyclosporine. Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat. Lorcaserin (Belviq) Adults Acts on the serotonin receptors in your brain. May help you feel full after eating smaller amounts of food. constipation cough dizziness dry mouth feeling tired headaches nausea Tell your doctor if you take antidepressants or migraine medications, since some of these can cause problems when taken together. Phentermine-topiramate (Qsymia) Adults A mix of two medications: phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. May make you less hungry or feel full sooner. constipation dizziness dry mouth taste changes, especially with carbonated beverages tingling of your hands and feet trouble sleeping Don’t use if you have glaucoma or hyperthyroidism. Tell your doctor if you have had a heart attack or stroke, abnormal heart rhythm, kidney disease, or mood problems. MAY LEAD TO BIRTH DEFECTS. DO NOT TAKE QSYMIA IF YOU ARE PREGNANT OR PLANNING A PREGNANCY. Do not take if you are breastfeeding. Naltrexone-bupropion (Contrave) Adults A mix of two medications: naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking. May make you feel less hungry or full sooner. constipation diarrhea dizziness dry mouth headache increased blood pressure increased heart rate insomnia liver damage nausea vomiting Do not use if you have uncontrolled high blood pressure, seizures or a history of anorexia or bulimia nervosa. Do not use if you are dependent on opioid pain medications or withdrawing from drugs or alcohol. Do not use if you are taking bupropion (Wellbutrin, Zyban). MAY INCREASE SUICIDAL THOUGHTS OR ACTIONS. Liraglutide (Saxenda) Available by injection only Adults May make you feel less hungry or full sooner. At a lower dose under a different name, Victoza, FDA-approved to treat type 2 diabetes. nausea diarrhea constipation abdominal pain headache raised pulse May increase the chance of developing pancreatitis. Has been found to cause a rare type of thyroid tumor in animals. Other medications that curb your desire to eat include phentermine benzphetamine diethylpropion phendimetrazine Adults Increase chemicals in your brain to make you feel you are not hungry or that you are full. Note: FDA-approved only for short-term use—up to 12 weeks dry mouth constipation difficulty sleeping dizziness feeling nervous feeling restless headache raised blood pressure raised pulse Do not use if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma. Tell your doctor if you have severe anxiety or other mental health problems. Sometimes doctors use medications in a way that’s different from what the FDA has approved, known as “off-label” use. By choosing an off-label medication to treat overweight and obesity, your doctor may prescribea drug approved for treating a different medical problem two or more drugs at the same time a drug for a longer period of time than approved by the FDAYou should feel comfortable asking your doctor if he or she is prescribing a medication that is not approved just for treating overweight and obesity. Before using a medication, learn all you need to know about it. Researchers are currently studying several new medications and combinations of medications in animals and people. Researchers are working to identify safer and more effective medications to help people who are overweight or obese lose weight and maintain a healthy weight for a long time.Future drugs may use new strategies, such as tocombine drugs that affect appetite and those that affect addiction (or craving) stimulate gut hormones that reduce appetite shrink the blood vessels that feed fat cells in the body, thereby preventing them from growing target genes that affect body weight change bacteria in the gut to control weight [1] Yanovski SZ, Yanovski JA. JAMA. Long-term drug treatment for obesity: A systematic and clinical review. 2014; 311(1):74–86.

help with obesity I would like help on my obesity problem and if I can get help

Don't try to treat an ingrown nail at home and see your doctor right away, if you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail To treat an ingrown nail at home, soak the foot in warm water 3 to 4 times a day. After soaking, keep the toe dry, gently massage over the inflamed skin, place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic. When trimming your toenails, briefly soak your foot in warm water to soften the nails, use a clean, sharp trimmer, trim toenails straight across the top. Do not taper or round the corners or trim too short.  Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse. Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem. If this doesn't work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist). If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail: This procedure is called a partial nail avulsion. If the toe is infected, your doctor may prescribe antibiotics. After the procedure, follow the instructions for helping your nail heal.

Ingrown toenail (Treatment): If you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see a provider right away. Don't try to treat an ingrown nail at home. Otherwise, to treat an ingrown nail at home: - Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry. - Gently massage over the inflamed skin. - Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic. When trimming your toenails: - Briefly soak your foot in warm water to soften the nails. - Use a clean, sharp trimmer. - Trim toenails straight across the top. Do not taper or round the corners or trim too short.  - Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse. Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem. If this doesn't work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist). If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail: - Numbing medicine is first injected into the toe. - The ingrown part of the nail is removed. This procedure is called a partial nail avulsion. - It takes 2 to 4 months for the nail to regrow. If the toe is infected, your doctor may prescribe antibiotics. After the procedure, follow any instructions for helping your nail heal.

I have no help its about 4 years now I have ingrown toenail i have a problem of ingrown toenail its about 4 years now I have this problem i need help

Nephrotic syndrome is caused by different disorders that damage the kidneys., in adults, most commonly by glomerulonephritis. This damage leads to the release of too much protein in the urine. Other conditions that damage kidneys include cancer, diabetes, systemic lupus erythematosus, multiple myeloma, amyloidosis, immune disorders, and infections. Nephrotic syndrome can affect all age groups. In children, it is most common between ages 2 and 6. This disorder occurs slightly more often in males than females.

What causes Nephrotic syndrome?: Nephrotic syndrome is caused by different disorders that damage the kidneys. This damage leads to the release of too much protein in the urine. The most common cause in children is minimal change disease. Membranous glomerulonephritis is the most common cause in adults.In both diseases, the glomeruli in the kidneys are damaged. Glomeruli are the structures that help filter wastes and fluids. This condition can also occur from: - Cancer - Diseases such as diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis - Genetic disorders - Immune disorders - Infections (such as strep throat, hepatitis, or mononucleosis) - Use of certain drugs It can occur with kidney disorders such as: - Focal and segmental glomerulosclerosis - Glomerulonephritis - Mesangiocapillary glomerulonephritis Nephrotic syndrome can affect all age groups. In children, it is most common between ages 2 and 6. This disorder occurs slightly more often in males than females.

What is Nephrotic Syndrome. What are its causes and cures?

Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60. Factors that may increase your risk of rheumatoid arthritis include sex, family history, smoking, environmental exposures, and obesity. Women are more likely than men to develop rheumatoid arthritis. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. Cigarette smoking also increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity. Although uncertain and poorly understood, some environmental exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.

Rheumatoid arthritis: Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities. Signs and symptoms of rheumatoid arthritis may include: - Tender, warm, swollen joints - Joint stiffness that is usually worse in the mornings and after inactivity - Fatigue, fever and weight loss Early rheumatoid arthritis tends to affect your smaller joints first - particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Rheumatoid arthritis can affect many nonjoint structures, including: - Skin - Eyes - Lungs - Heart - Kidneys - Salivary glands - Nerve tissue - Bone marrow - Blood vessels Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission - when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place. Make an appointment with your doctor if you have persistent discomfort and swelling in your joints. Rheumatoid arthritis occurs when your immune system attacks the synovium - the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment. Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors - such as infection with certain viruses and bacteria - that may trigger the disease. Factors that may increase your risk of rheumatoid arthritis include: - Your sex. Women are more likely than men to develop rheumatoid arthritis. - Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60. - Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. - Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity. - Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis. - Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger. Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength. Blood tests People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Imaging tests Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body. There is no cure for rheumatoid arthritis. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs). Medications The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis. - NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage. - Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication. - Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections. - Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz). These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate. Therapy Your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms. Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas. Surgery If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. Rheumatoid arthritis surgery may involve one or more of the following procedures: - Synovectomy. Surgery to remove the inflamed synovium (lining of the joint). Synovectomy can be performed on knees, elbows, wrists, fingers and hips. - Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint. - Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option. - Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic. Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor. You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with your rheumatoid arthritis medications, can help you manage your signs and symptoms: - Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Avoid exercising tender, injured or severely inflamed joints. - Apply heat or cold. Heat can help ease your pain and relax tense, painful muscles. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. - Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as guided imagery, distraction and muscle relaxation can all be used to control pain. Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include: - Fish oil. Some preliminary studies have found that fish oil supplements may reduce rheumatoid arthritis pain and stiffness. Side effects can include nausea, belching and a fishy taste in the mouth. Fish oil can interfere with medications, so check with your doctor first. - Plant oils. The seeds of evening primrose, borage and black currant contain a type of fatty acid that may help with rheumatoid arthritis pain and morning stiffness. Side effects may include nausea, diarrhea and gas. Some plant oils can cause liver damage or interfere with medications, so check with your doctor first. - Tai chi. This movement therapy involves gentle exercises and stretches combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi may reduce rheumatoid arthritis pain. When led by a knowledgeable instructor, tai chi is safe. But don't do any moves that cause pain.

Are there any researches indicating how early an individual may experience any signs or symptoms of Rheumatoid Arthritis?

The cause of PCOS is unknown, but probably involves a combination of genetic and environmental factors

Polycystic ovarian syndrome (Summary): Polycystic ovarian syndrome (PCOS) is a health problem that can affect a woman's menstrual cycle, ability to have children, hormones , heart, blood vessels, and appearance. Women with this condition typically have high levels of  hormones called androgens, missed or irregular periods, and many small cysts in their ovaries. The cause of PCOS is unknown, but probably involves a combination of genetic and environmental factors . Treatment for PCOS may involve birth control pills and medications for diabetes and infertility. Medicines called anti-androgens are also used to speed the growth of hair and clear acne. [1] [2]

Polycystic ovarian syndrome Is it possible for parents to pass this on in the genes to their children - is there any other way this can be acquired?