Autism Spectrum Disorders

Autism - Symptoms

The severity of symptoms varies greatly, but all people with autism have some core symptoms in the areas of:

• Social interactions and relationships. Symptoms may include:
  • Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
  • Failure to establish friendships with children the same age.
  • Lack of interest in sharing enjoyment, interests, or achievements with other people.
  • Lack of empathy. People with autism may have difficulty understanding another person's feelings, such as pain or sorrow.
• Verbal and nonverbal communication. Symptoms may include:
  • Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak.¹
  • Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation after it has begun.
  • Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia).
  • Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.
• Limited interests in activities or play. Symptoms may include:
  • An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
  • Preoccupation with certain topics. For example, older children and adults may be fascinated by video games, trading cards, or license plates.
  • A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.
  • Stereotyped behaviors. These may include body rocking and hand flapping.

Symptoms during childhood

Symptoms of autism are usually noticed first by parents and other caregivers sometime during the child's first 3 years. Although autism is present at birth (congenital), signs of the disorder can be difficult to identify or diagnose during infancy. Parents often become concerned when their toddler does not like to be held; does not seem interested in playing certain games, such as peekaboo; and does not begin to talk. Sometimes, a child will start to talk at the same time as other children the same age, then lose his or her language skills. They also may be confused about their child's hearing abilities. It often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they grow older. Contrary to popular myths about children with autism, very few are completely socially isolated or "live in a world of their own."

Symptoms during teen years

During the teen years, the patterns of behavior often change. Many teens gain skills but still lag behind in their ability to relate to and understand others. Puberty and emerging sexuality may be more difficult for teens who have autism than for others this age. Teens are at an increased risk for developing problems related to depression, anxiety, and epilepsy.

Symptoms in adulthood

Some adults with autism are able to work and live on their own. The degree to which an adult with autism can lead an independent life is related to intelligence and ability to communicate. At least 33% are able to achieve at least partial independence.²
Some adults with autism need a lot of assistance, especially those with low intelligence who are unable to speak. Part- or full-time supervision can be provided by residential treatment programs. At the other end of the spectrum, adults with high-functioning autism are often successful in their professions and able to live independently, although they typically continue to have some difficulties relating to other people. These individuals usually have average to above-average intelligence.

Other symptoms

Many people with autism have symptoms similar to attention deficit hyperactivity disorder (ADHD). But these symptoms, especially problems with social relationships, are more severe for people with autism. For more information, see the topic Attention Deficit Hyperactivity Disorder.
About 10% of people with autism have some form of savant skills-special limited gifts such as memorizing lists, calculating calendar dates, drawing, or musical ability.¹
Many people with autism have unusual sensory perceptions. For example, they may describe a light touch as painful and deep pressure as providing a calming feeling. Others may not feel pain at all. Some people with autism have strong food likes and dislikes and unusual preoccupations.
Sleep problems occur in about 40% to 70% of people with autism.³

Other conditions

Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger's disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occurs when children display similar behaviors but do not meet the criteria for autism. Also, other conditions with similar symptoms may also have similarities to or occur with autism.

Autism 

What is autism?

Autism is a brain disorder that often makes it hard to communicate with and relate to others. With autism, the different areas of the brain fail to work together.
Most people with autism will always have some trouble relating to others. But early diagnosis and treatment have helped more and more people who have autism to reach their full potential.

What causes autism?

Autism tends to run in families, so experts think it may be something that you inherit. Scientists are trying to find out exactly which genes may be responsible for passing down autism in families.
Other studies are looking at whether autism can be caused by other medical problems or by something in your child’s surroundings.
Some people think that childhood vaccines cause autism, especially the measles-mumps-rubella, or MMR, vaccine. But studies have not shown this to be true. It’s important to make sure that your child gets all childhood vaccines. They help keep your child from getting serious diseases that can cause harm or even death.

What are the symptoms?

Symptoms almost always start before a child is 3 years old. Usually, parents first notice that their toddler has not started talking yet and is not acting like other children the same age. But it is not unusual for a child to start to talk at the same time as other children the same age, then lose his or her language skills.
Symptoms of autism include:

• A delay in learning to talk, or not talking at all. A child may seem to be deaf, even though hearing tests are normal.
• Repeated and overused types of behavior, interests, and play. Examples include repeated body rocking, unusual attachments to objects, and getting very upset when routines change.

There is no "typical" person with autism. People can have many different kinds of behaviors, from mild to severe. Parents often say that their child with autism prefers to play alone and does not make eye contact with other people.
Autism may also include other problems:

• Many children have below-normal intelligence.
• Teenagers often become depressed and have a lot of anxiety, especially if they have average or above-average intelligence.
• Some children get a seizure disorder such as epilepsy by their teen years.

How is autism diagnosed?

There are guidelines your doctor will use to see if your child has symptoms of autism. The guidelines put symptoms into three categories:

• Social interactions and relationships. For example, a child may have trouble making eye contact. People with autism may have a hard time understanding someone else’s feelings, such as pain or sadness.
• Verbal and nonverbal communication. For example, a child may never speak. Or he or she may often repeat a certain phrase over and over.
• Limited interests in activities or play. For example, younger children often focus on parts of toys rather than playing with the whole toy. Older children and adults may be fascinated by certain topics, like trading cards or license plates.

Your child may also have a hearing test and some other tests to make sure that problems are not caused by some other condition.

How is it treated?

Treatment for autism involves special behavioral training. Behavioral training rewards good behavior (positive reinforcement) to teach children social skills and to teach them how to communicate and how to help themselves as they grow older.
With early treatment, most children with autism learn to relate better to others. They learn to communicate and to help themselves as they grow older.
Depending on the child, treatment may also include such things as speech therapy or physical therapy. Medicine is sometimes used to treat problems such as depression or obsessive-compulsive behaviors.
Exactly what type of treatment your child needs depends on the symptoms, which are different for each child and may change over time. Because people with autism are so different, something that helps one person may not help another. So be sure to work with everyone involved in your child’s education and care to find the best way to manage symptoms.

How can your family deal with having a child with autism?

An important part of your child's treatment plan is making sure that other family members get training about autism and how to manage symptoms. Training can reduce family stress and help your child function better. Some families need more help than others.
Take advantage of every kind of help you can find. Talk to your doctor about what help is available where you live. Family, friends, public agencies, and autism organizations are all possible resources.
Remember these tips:

• Plan breaks. Daily demands of caring for a child with autism can take their toll. Planned breaks will help the whole family.
• Get extra help when your child gets older. The teen years can be a very hard time for children with autism.
• Get in touch with other families who have children with autism. You can talk about your problems and share advice with people who will understand.

Raising a child with autism is hard work. But with support and training, your family can learn how to cope.

High-Functioning Autism and Asperger's Syndrome

Autism is a brain disorder in which communication and interaction with others is difficult. The symptoms of autism may range from total lack of communication with others to difficulty in understanding others' feelings. Because of the range of symptoms, this condition is now called a utism spectrum disorder (ASD).
High-functioning autism is at one end of the ASD spectrum. Signs and symptoms are less severe than with other forms of autism. In fact, a person with high-functioning autism usually has average or above average intelligence. The differences from other forms of autism have led many psychiatrists to consider high-functioning autism as similar to or the same as Asperger's syndrome.
Whether it's labeled high-functioning autism or Asperger's syndrome, coping with this condition presents daily challenges -- for those who have it and for their family and friends.

What Are the Symptoms of High-Functioning Autism, Asperger's Syndrome?

People with high-functioning autism or Asperger's syndrome do not have the delayed language development that's typically found in people with autism. In addition, people with high-functioning autism have average or above average intelligence. However, they may show other behaviors and signs similar to what's seen with other types of autism:

• delay in motor skills
• lack of skill in interacting with others
• little understanding of the abstract uses of language, such as humor or give-and-take in a conversation
• obsessive interest in specific items or information
• strong reactions to textures, smells, sounds, sights, or other stimuli that others might not even notice, such as a flickering light

Unlike people with other forms of autism, people with high-functioning autism or Asperger's syndrome want to be involved with others. They simply don't know how to go about it. They may not be able to understand others' emotions. They may not read facial expressions or body language well. As a result, they may be teased and often feel like social outcasts. The unwanted social isolation can lead to anxiety and depression.

Causes of High-Functioning Autism, Asperger's Syndrome

Autism runs in families. The underlying causes, however, are not known. Potential causes under investigation include:

• inherited genetic conditions
• other medical problems
• environmental factors

Diagnosing High-Functioning Autism, Asperger's Syndrome

Children with high-functioning autism or Asperger's syndrome may not be diagnosed as early as children with more severe forms of autism. That's because the symptoms aren't as noticeable. Symptoms may not become a problem until a child is in school. A diagnosis is based on the doctor's assessment of the child's symptoms in three areas:

• social interactions -- symptoms such as lack of eye contact or an inability to understand another person's feelings
• verbal and non-verbal communication -- symptoms such as not speaking or repeating a phrase over and over again
• interests in activities, objects, or specialized information -- symptoms such as playing with only a part of a toy or being obsessed with a particular topic

The doctor may gather information about these areas in several ways:

• conducting psychological testing
• establishing the history of the child's development
• interviewing parents and others who have frequent contact with the child
• observing the child's behavior
• requesting physical, neurological, or genetic testing
• seeking a speech and language assessment

In addition, the doctor may request tests to rule out other causes of the behavior, such as hearing problems.

Treating High-Functioning Autism, Asperger's Syndrome

High-functioning autism and Asperger's syndrome can be treated with a variety of therapies. Behavior training is the primary method used to help people with high-functioning autism overcome problems with social interaction.
Applied behavior analysis (ABA) is a method of rewarding appropriate social behavior and communication skills. This method is based on the theory that rewarding behavior encourages it to continue.
Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a structured way of teaching communication and coping skills. The system uses the child's strengths in memorization and visual skills.
In addition, other treatments may be recommended. These will be based on the child's needs:

• medications to treat obsessive behaviors or depression
• physical or occupational therapy for assistance with motor skills
• speech and language therapy to help with communication and language development

Living With High-Functioning Autism, Asperger's Syndrome

High-functioning autism and Asperger's syndrome present ongoing challenges from childhood through adulthood.
In children. Young children may have problems at school in areas of behavior and communication. Because the focus in early grades is often on memorization of facts, they may do well academically.
In older children and teens. As children grow older, a lack of social skills and the presence of obsessive interests or behaviors may put the child in the position of being teased. Forming new friendships may become increasingly difficult.
In adults. It may be difficult to live independently as an adult. Work and personal relationships may be hard to establish and maintain.

How Loved Ones Can Help

Family and friends can help if they understand what high-functioning autism is and know the symptoms and treatments associated with the disorder.

How Loved Ones Can Help continued...

Family members can advocate for a child with high-functioning autism or Asperger's by being sure that the child receives medical treatment and any other services available. For example, the federal Individuals with Disabilities Education Improvement Act (IDEIA) requires that students with a disability be provided a free and appropriate education, which may include special services.
Other services that may be helpful include:

• counseling to assist with behavior therapy and coping skills
• finding a buddy or mentor who can give informal advice on social and communication challenges as they arise
• occupational therapy for any motor problems that affect daily activities
• speech and language therapy to address language and communications challenges

In addition, family and friends may want to seek out help and support from counselors or others who are also dealing with children who have high-functioning autism or Asperger's syndrome. Many online information and support groups are available.
Many individuals with high-functioning autism or Asperger's syndrome have found support in groups like The Global and Regional Autism Spectrum Partnership (GRASP). GRASP's members and leadership are drawn from people with some form of autism or Asperger's syndrome. Organizations such as GRASP give hope that while challenges are many, people with high-functioning autism can lead healthy, fulfilling lives.

Autism Spectrum Disorders

The forms of autism are thought to overlap considerably. But the fact that there is wide variation in symptoms among children with autism led to the concept of autism spectrum disorder.
Autism seems to be on the rise, and autism spectrum disorders affect between two and six children out of every 1,000 in the U.S. It's unclear, though, whether the growing incidence of autism represents a real increase or just improved detection.
Early diagnosis of an autism spectrum disorder is important. That's because detection leads to treatment, and with early treatment, a child with autism can gain improved language and social skills.

 

Signs of Autism Spectrum Disorder

Autism spectrum disorders affect three different areas of a child's life:

• social interaction
• communication (nonverbal and/or verbal)
• repetitive behaviors or interests

Each child with an autism spectrum disorder will have his or her own individual pattern of autism. Sometimes, a child's development is delayed from birth. Other children with autism develop normally before suddenly losing social or language skills. In some children, a loss of language is the impairment. In others, unusual behaviors (like spending hours lining up toys) predominate.
Parents are usually the first to notice something is wrong. However, the diagnosis of autism is often delayed. The parents or a physician often downplay early signs of autism. They may optimistically suggest "it's just a phase" or a trivial delay in development. Children with a suspected autism spectrum disorder should be evaluated by a professional team with experience in diagnosing autism.
There are three main types of autism spectrum disorder, and two rare, severe autistic-like conditions:

• Asperger's syndrome
• pervasive developmental disorder, not otherwise specified (PDD-NOS)
• autistic disorder
• Rett's syndrome
• childhood disintegrative disorder

Asperger's Syndrome

The mildest form of autism, Asperger's syndrome affects boys three times more often than girls. Children with Asperger's syndrome become obsessively interested in a single object or topic. They often learn all about their preferred subject, and discuss it nonstop. Their social skills are markedly impaired, though. They are often awkward and uncoordinated physically.
Because Asperger's syndrome is mild compared to other autism spectrum disorders, some doctors call it "high-functioning autism." As children with Asperger's syndrome enter young adulthood, though, they are at high risk for anxiety and depression.

Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

This mouthful of a diagnosis applies to most children with autistic spectrum disorder. Children whose autism is more severe than Asperger's syndrome but not as severe as autistic disorder are diagnosed with PDD-NOS.
Autism symptoms in kids with PDD-NOS vary widely, making it hard to generalize. Overall, compared to children with other autistic spectrum disorders, children with PDD-NOS have:

• impaired social interaction -- like all children with autistic spectrum disorder
• better language skills than kids with autistic disorder, but not as good as those with Asperger's syndrome
• fewer repetitive behaviors than children with Asperger's syndrome or autistic disorder
• a later age of onset

However, no two children with PDD-NOS are exactly alike in their symptoms. In fact, there are no agreed-upon criteria for diagnosing PDD-NOS. In effect, if a child seems autistic to professional evaluators but doesn't meet all the criteria for autistic disorder, he or she has PDD-NOS.

Autistic Disorder

Children who meet more rigid criteria for a diagnosis of autism have autistic disorder. They have more severe impairments involving social and language functioning, as well as repetitive behaviors. Often, they have mental retardation and seizures as well.
There are two rare, severe forms of autistic spectrum disorder that are considered separately from the others: Rett's syndrome and childhood disintegrative disorder.

Rett's Syndrome

Almost exclusively affecting girls, Rett's syndrome is rare. About one in 10,000 to 15,000 girls develop this severe form of autism. Between 6 and 18 months of age, a little girl stops responding socially, wrings her hands habitually, and loses language skills. Coordination problems appear and can become severe.
Rett's syndrome is usually caused by a genetic mutation. The mutation usually occurs randomly, rather than being inherited. Treatment focuses on physical therapy and speech therapy to improve function.

Childhood Disintegrative Disorder

The most severe autistic spectrum disorder, childhood disintegrative disorder (CDD), is also the least common.
After a period of normal development, usually between age 2 and 4, a child with CDD rapidly loses multiple areas of function. Social and language skills are lost, as well as intellectual abilities. Often, the child develops a seizure disorder. Children with childhood disintegrative disorder are severely impaired and don't recover their lost function.
Fewer than two children per 100,000 with an autistic spectrum disorder meet criteria for childhood disintegrative disorder. Boys are affected by CDD more often than girls.

Autism - Treatment

Early diagnosis and treatment helps young children with autism develop to their full potential. The primary goal of treatment is to improve the overall ability of the child to function.
Symptoms and behaviors of autism can combine in many ways and vary in severity. Also, individual symptoms and behaviors often change over time. For these reasons, treatment strategies are tailored to individual needs and available family resources. But in general children with autism respond best to highly structured and specialized treatment. A program that addresses helping parents and improving communication, social, behavioral, adaptive, and learning aspects of a child's life will be most successful.
The American Academy of Pediatrics (AAP) recommends the following strategies for helping a child to improve overall function and reach his or her potential:⁵

• Behavioral training and management . Behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication. Many types of treatments have been developed, including Applied Behavioral Analysis (ABA), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and sensory integration.
• Specialized therapies. These include speech, occupational, and physical therapy. These therapies are important components of managing autism and should all be included in various aspects of the child's treatment program. Speech therapy can help a child with autism improve language and social skills to communicate more effectively. Occupational and physical therapy can help improve any deficiencies in coordination and motor skills. Occupational therapy may also help a child with autism to learn to process information from the senses (sight, sound, hearing, touch, and smell) in more manageable ways.

• Medicines . Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.
• Community support and parent training . Talk to your doctor or contact an advocacy group for support and training.

Many people with autism have sleep problems. These are usually treated by staying on a routine, including a set bedtime and time to get up. Your doctor may try medicines as a last resort.³
Stories about alternative therapies, such as secretin and auditory integration training, have circulated in the media and other information sources. When you are thinking about any type of treatment, find out about the source of the information and about whether the studies are scientifically sound. Accounts of individual success are not sufficient evidence to support using a treatment. Look for large, controlled studies to validate claims.
Experts have not yet identified a way to prevent autism. Public concern over stories linking autism and childhood vaccines has persisted. But numerous studies have failed to show any evidence of a link between autism and the measles-mumps-rubella (MMR) vaccine.^{6, 7} If you avoid having your children immunized, you put them and others in your community at risk for developing serious diseases, which can cause serious harm or even death.

Hepatitis A

Definition

Hepatitis A is inflammation (irritation and swelling) of the liver caused by the hepatitis A virus.
See also:

• Hepatitis
• Hepatitis A vaccine
• Hepatitis B
• Hepatitis C

Alternative Names

Viral hepatitis

Causes, incidence, and risk factors

The hepatitis A virus is found mostly in the stools and blood of an infected person about 15 - 45 days before symptoms occur and during the first week of illness.
You can catch hepatitis A if:

• You eat or drink food or water that has been contaminated by the virus (fruits, vegetables, shellfish, ice, and water are common sources of the hepatitis A virus)
• You come in contact with the stool or blood of a person who currently has the disease

• A person with hepatitis A does not wash his or her hands properly after going to the bathroom and touches other objects or food
• You participate in sexual practices that involve oral-anal contact

There are about 100,000 hepatitis A infections in the United States every year.
Risk factors include:

• International travel, especially to Asia or South or Central America
• IV drug use
• Living in a nursing home or rehabilitation center
• Working in a health care, food, or sewage industry

Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. The other hepatitis infections may become chronic illnesses, but hepatitis A does not become chronic.

Symptoms

Symptoms will usually show up 2 - 6 weeks after being exposed to the hepatitis A virus. They are usually mild, but may last for up to several months, especially in adults.

Symptoms include:

• Dark urine
• Fatigue
• Itching
• Loss of appetite
• Low-grade fever
• Nausea and vomiting
• Pale or clay-colored stools
• Yellow skin (jaundice)

Signs and tests

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.
Hepatitis serology tests may show:

• Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)
• Elevated liver enzymes (liver function tests)

Treatment

There is no specific treatment for hepatitis A. Rest is recommended during the acute phase of the disease when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol).
Fatty foods may cause vomiting, because secretions from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

Expectations (prognosis)

The virus does not remain in the body after the infection has gone away.
Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.

There is a low risk of death, usually among the elderly and persons with chronic liver disease.

Complications

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hepatitis.

Prevention

The following tips can help reduce your risk of spreading or catching the virus:

• Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person's blood, stools, or other bodily fluid
• Avoid unclean food and water

The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.
If you have recently been exposed to hepatitis A and have not had hepatitis A before or have not received the hepatitis A vaccine series, ask your doctor or nurse about receiving either immune globulin or the hepatitis A vaccine. Common reasons why you may need to receive one or both of these include:

• You live with someone who has hepatitis A
• You recently had sexual contact with someone who has hepatitis A
• You recently shared illegal drugs, either injected or non-injected, with someone who has hepatitis A
• You have had close personal contact over a period of time with someone who has hepatitis A
• You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis A

Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6- to 12-month booster is required for long-term protection. See: Hepatitis A vaccine
Travelers should take the following precautions:

• Avoid dairy products.
• Avoid raw or undercooked meat and fish.
• Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
• Do not buy food from street vendors.
• Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
• Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
• If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
• Heated food should be hot to the touch and eaten right away.

References

American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents--United States, 2008. Pediatrics. 2008 Jan;121(1):219-20.
Recommended Immunization Schedule for Persons Aged 7–18 Years--United States, 2008. MMWR. October 19, 2007 / 56(41);Q1-Q4.
Brundage SC. Hepatitis A. Am Fam Physician. 2006;73:2162-2168.
Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, Favorov MO, Margolis HS, Bell BP. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685:1694.
Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007;56:1080-1084.

HIV/AIDS

HIV/AIDS Symptoms

Many people do not develop symptoms after getting infected with HIV. Some people have a flu-like illness within several days to weeks after exposure to the virus. They complain of fever, headache, tiredness, and enlarged lymph glands in the neck. These symptoms usually disappear on their own within a few weeks.

• Following initial infection, you may have no symptoms. The progression of disease varies widely among individuals. This state may last from a few months to more than 10 years.
  
  
  • During this period, the virus continues to multiply actively and infects and kills the cells of the immune system. The immune system allows us to fight against the bacteria, viruses, and other infectious causes.
    
  • The virus destroys the cells that are the primary infection fighters, called CD4+ or T4 cells.
• Once the immune system weakens, a person infected with HIV can develop the following symptoms:

• Lack of energy
  
• Weight loss
  
• Frequent fevers and sweats
  
• Persistent or frequent yeast infections
  
• Persistent skin rashes or flaky skin
  
• Short-term memory loss
  
• Mouth, genital, or anal sores from herpes infections.

AIDS is the most advanced stage of HIV infection. The definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ cells per microliter of blood. The definition also includes 26 conditions that are common in advanced HIV disease but that rarely occur in healthy people. Most of these conditions are infections caused by bacteria, viruses, fungi, parasites, and other organisms. Opportunistic infections are common in people with AIDS. Nearly every organ system is affected. Some of the common symptoms include the following:

• Cough and shortness of breath
  
• Seizures and lack of coordination
  
• Difficult or painful swallowing
  
• Mental symptoms such as confusion and forgetfulness
  
• Severe and persistent diarrhea
  
• Fever
  
• Vision loss
  
• Nausea, abdominal cramps, and vomiting
  
• Weight loss and extreme fatigue
  
• Severe headaches with neck stiffness
  
• Coma

 People with AIDS are prone to develop various cancers such as Kaposi sarcoma, cervical cancer, and cancers of the immune system known as lymphomas. Kaposi sarcoma causes round, brown, reddish or purple spots that develop in the skin or in the mouth. After the diagnosis of AIDS is made, the average survival time has been estimated to be 2-3 years.

Stages of HIV Infection

The U.S. Centers for Disease Control and Prevention (CDC) classify HIV infection into four stages.¹

Stages of HIV infection

• Stage 1: There are no AIDS-related conditions AND the CD4+ cell count is greater than 500 or the percent of CD4+ cells is at least 29% of all lymphocytes.
• Stage 2: There are no AIDS-related conditions AND the CD4+ cell count is 200 to 499 or the percent of CD4+ cells is 14% to 28% of all lymphocytes.
• Stage 3: The CD4+ cell count is lower than 200, the percent of CD4+ cells is less than 14% of all lymphocytes, or an AIDS-related condition is present.
• Stage unknown: No information is available on the CD4+ cell count or the presence of AIDS-related conditions.

In general, the higher the CD4+ count, the less likely it is that opportunistic diseases will occur. Most people who have untreated HIV experience a gradual drop in the number of CD4+ cells. Each person responds uniquely to this decline.

Understanding HIV/AIDS -- the Basics

AIDS (acquired immune deficiency syndrome) isn't a disease in itself. Instead, AIDS is a condition that develops when a person's body has been weakened by HIV (the human immunodeficiency virus). HIV is found in blood and sexual fluids and spreads mainly through unprotected sexual contact and the sharing of IV drug needles and equipment.
When a person becomes infected with HIV, it damages the immune system. A "deficient" immune system is unable to protect a person -- a problem called immunodeficiency. The immune system can no longer fight off the many germs and pathogens that a person normally encounters, so a person infected with HIV becomes ill from diseases that don't usually affect someone without HIV.
It can take HIV many years to damage the immune system enough to make the person vulnerable to these diseases, called opportunistic infections (OIs). These infections take the "opportunity" to invade because the immune system cannot fight them off. When doctors see someone with one of these diseases, they know that HIV is probably responsible, and the person may be diagnosed with AIDS.
As HIV slowly invades a specific immune cell -- the CD4 T-cell -- HIV uses the immune cell's genetic material to reproduce itself and then kills the CD4 T-cell.
An HIV-infected person may not have any symptoms of disease during this time -- called the asymptomatic period. This can last 10 years or more for some people. During this time, the person's CD4 T-cell count is watched closely to guide treatment. The goal is to keep an infected person from advancing to AIDS. Once the CD4 T-cell count goes below 200, a person is diagnosed with AIDS.

The Worldwide HIV/AIDS Pandemic

The first AIDS case was documented in 1981, and HIV has since spread worldwide. In 2009, almost 2 million people died worldwide, and the epidemic continues to spread. Sub-Saharan Africa has the greatest number of people who are infected. The World Health Organization (WHO) and the United Nations' UNA IDS office estimate that over 33% of adults are infected with HIV in some areas of Africa. Millions of children have been orphaned. The epidemic is also growing rapidly in Eastern Europe and Asia. More than 33 million people worldwide are now living with HIV.
In the United States and the developed world, the use of combination treatments has turned AIDS into a chronic disease. People now live long lives with HIV when they work closely with their health care providers and are committed to their treatment plans. Unfortunately, AIDS medications are expensive and unavailable to the majority of people in the world living with AIDS.
There are growing concerns that some high-risk groups believe they don't have to be worried about HIV anymore. The fact that people now live longer with HIV doesn't change the fact that HIV is a life-threatening illness and can infect anyone who exchanges infected blood or sexual fluids with another person.

What Causes HIV/AIDS?

HIV lives in human blood and sexual fluids (semen and vaginal secretions). The infection is spread from person to person when these body fluids are shared, usually during vaginal or anal sexual contact or when sharing IV drugs. HIV does not live in saliva, tears, urine, or perspiration -- so HIV cannot be spread by casual contact with these body fluids. It can be spread through oral sex, though the risk is small.
HIV cannot survive for long outside the human body and dies quickly when the body fluid it's in dries up. It is not spread by animals or insects and is not found on public surfaces. It's actually not as easy to get as other infectious diseases.
A mother can pass HIV to her child during birth when the child is exposed to the mother's infected blood. Breastfeeding does carry a risk for HIV infection, though in some areas of the developing world, breastfeeding is considered safer than feeding a newborn contaminated water.
There are two main types of HIV, called HIV-1 and HIV-2. HIV-2 is rarely found outside Africa and parts of Asia, so there is no need to test for it specifically -- unless a person has had contact with someone from an area of the world where HIV-2 is common.
All of the world's scientists working in the field of AIDS agree that HIV is the cause of the AIDS syndrome. Other theories are not supported by scientific evidence.
Dirty needles used for tattoos and body piercing can spread HIV. Be sure these needles are used only once and then thrown away.
Blood transfusions were once a concern, but all blood products used in the United States today are tested for several infectious diseases, including HIV. If signs of disease or other problems are found in donated blood, the person who donated the blood is notified to be retested by their health care provider and is not permitted to continue donating blood. Any donated blood that tests positive for HIV is disposed of and never makes it into the public blood supply.

Ear Infection

Ear Infections - Cause

Middle ear infections are caused by bacteria and viruses.
During a cold, sinus or throat infection, or an allergy attack, the eustachian tubes, which connect the middle ears to the throat, can become blocked. This stops fluid from draining from the middle ear. This fluid is a perfect breeding ground for bacteria or viruses to grow into an ear infection.

Recommended Related to Ear Infection

Understanding Swimmer's Ear -- the Basics

Known to medical professionals as otitis externa, swimmer's ear is an inflammation of the  ear canal. Its common name comes from the fact that it often occurs in children and young adults who swim frequently. However, any cause of dampness in the canal can lead  to irritation and chafing, very similar to diaper rash in babies. An inflammation of the skin can sometimes lead to an infection that can be very painful. Despite its name, you don't have to be a swimmer to get swimmer's ear.

• Bacterial infections . Bacteria cause most ear infections. The most common types are Streptococcus pneumoniae (also called pneumococcus), Haemophilus influenzae, and Moraxella catarrhalis.
• Viral infections. Viruses can also lead to ear infections. The respiratory syncytial virus (RSV) and flu (influenza) virus are the most frequent types found.

Causes of fluid buildup

When swelling from an upper respiratory infection or allergy blocks the eustachian tube, air can't reach the middle ear. This creates a vacuum and suction, which pulls fluid and germs from the nose and throat into the middle ear. The swollen tube prevents this fluid from draining. An ear infection begins when bacteria or viruses in the trapped fluid grow into an infection.
Inflammation and fluid buildup can occur without infection and cause a feeling of stuffiness in the ears. This is known as otitis media with effusion.
Understanding Ear Infection -- Symptoms

What Are the Symptoms of an Ear Infection?

In adults:

• Earache (either a sharp, sudden pain or a dull, continuous pain).
• A sharp stabbing pain with immediate warm drainage from the ear canal
• Nasal congestion may accompany or precede an ear infection but is not a symptom of it.
• A feeling of fullness in the ear
• Nausea may accompany an earache
• Muffled hearing
• Ear drainage

In children:

• Tugging at the ear
• Poor sleep
• Fever
• Irritability, restlessness
• Ear drainage
• Nasal discharge
• Diminished appetite
• Crying at night when lying down

Call Your Doctor About an Ear Infection If:

• Body temperature rises above 100 degrees; a fever signals the possibility of a more serious infection (especially in infants and young children).
• Your child develops a stiff neck.
• Your child is very lethargic, responds poorly, or is inconsolable.
• You or your child frequently develops ear infections; repeated bouts with the disorder can lead to hearing loss or more serious infections.
• You or your child has hearing problems; the infection may be the cause.
• You suspect that your young child has an ear infection; it's often difficult for a parent to tell if a child is having problems with his or her ears.

Ear Infections - Treatment Overview

Treatment for middle ear infections (acute otitis media) involves home treatment for symptom relief.
Your doctor can give your child antibiotics, but ear infections often get better without them. Talk about this with your doctor. Whether you use antibiotics will depend on how old your child is and how bad the infection is.
Follow-up exams with a doctor are important to check for persistent infection, fluid behind the eardrum (otitis media with effusion), or repeat infections.

• If your child has ongoing ear pain, a fever [101°F (38.33°C) or higher], or is grumpy or vomiting after 48 hours of treatment, see your doctor.
• Even if your child seems well, he or she may need a follow-up visit in about 4 weeks, especially if your child is young. If fluid behind the eardrum persists for 3 months, the child should have his or her hearing tested.

Initial treatment

The first treatment of a middle ear infection focuses on relieving pain. The doctor will also assess your child for any risk of complications.
If your child has an ear infection and appears very ill, is younger than 2, or is at risk for complications from the infection, your doctor will likely give antibiotics right away.
If your child has cochlear implants, your doctor will probably prescribe antibiotics, because bacterial meningitis is more common in children who have cochlear implants than in children who do not have cochlear implants.
For children ages 2 and older, more options are available. Some doctors prescribe antibiotics for all ear infections, because it's hard to tell which ear infections will clear up on their own. Other doctors ask parents to watch their child's symptoms for a couple of days, since most ear infections get better without treatment. Antibiotic treatment has only minimal benefits in reducing pain and fever. The cost of medicine and possible side effects are factors doctors consider before giving antibiotics. Also, many doctors are concerned about the growing number of bacteria that are becoming resistant to antibiotics because of frequent use of antibiotics.
If your child's condition improves in the first couple of days, treating the symptoms at home may be all that is needed. Some steps you can take at home to treat ear infection include:

• Using pain relievers. Pain relievers such as nonsteroidal anti-inflammatory medicines (such as Advil, Motrin, and Aleve) and acetaminophen (such as Tylenol) can help make your child more comfortable. Giving your child something for pain before bedtime is especially important. Follow all instructions on the label. If you give medicine to your baby, follow your doctor’s advice about what amount to give. Do not give aspirin to anyone younger than 20, because its use has been linked to Reye syndrome, a serious illness.
• Applying heat to the ear, which may help relieve the earache. Use a warm washcloth or a heating pad. Do not allow your child to go to bed with a heating pad, because he or she could get burned. Use a heating pad only if your child is old enough to tell you if it's getting too hot.
• Encouraging rest. Encourage your child to rest to let his or her body fight the infection. Arrange for quiet play activities.
• Using eardrops. Doctors often prescribe pain-relieving eardrops for earache. Don't use eardrops without a doctor's advice, especially if your child has ear tubes.

 Ear Infection: Should I Give My Child Antibiotics?

Decongestants, antihistamines, and other over-the-counter cold remedies do not often work for treating or preventing ear infection. Antihistamines that cause sleepiness may thicken fluids, which can make your child feel worse. Check with the doctor before giving these medicines to your child. Experts say not to give decongestants to children younger than 2.
If your child with an ear infection must take an airplane trip, talk with your doctor about how to cope with ear pain during the trip.
Fluid behind the eardrum after an ear infection is normal. And in most children, the fluid clears up within 3 months without treatment. Test your child's hearing if the fluid persists past that point. If hearing is normal, you may choose to continue monitoring your child without treatment.

Ongoing treatment

If a child has repeat ear infections (three or more ear infections in a 6-month period or four in 1 year), you may want to consider treatment to prevent future infections.
One option used a lot in the past is long-term oral antibiotic treatment. There is debate within the medical community about using antibiotics on a long-term basis to prevent ear infections. Many doctors don't want to prescribe long-term antibiotics, because they are not sure that they really work. Also, when antibiotics are used too often, bacteria can become resistant to antibiotics. Having tubes put in the ears is another option for treating repeat ear infections.
If your child has fluid buildup without infection, you may try watchful waiting. Fluid behind the eardrum after an ear infection is normal. In most children, the fluid clears up within a few months without treatment. Have your child's hearing tested if the fluid persists past 3 months. If hearing is normal, you may choose to keep watching your child without treatment.
If a child has fluid behind the eardrum for more than 3 months and has significant hearing problems, treatment is needed. Sometimes short-term hearing loss occurs, which is especially a concern in children ages 2 and younger. Normal hearing is very important when young children are learning to talk.

Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?

Treatment if the condition gets worse

Doctors may consider surgery for children with repeat ear infections or those with persistent fluid behind the eardrum. Procedures include inserting ear tubes or removing adenoids and, in rare cases, the tonsils.
Inserting tubes Inserting tubes into the eardrum (myringotomy or tympanostomy with tube placement) allows fluid to drain from the middle ear. The tubes keep fluid from building up and may prevent repeat ear infections. These tubes stay in place for 6 to 12 months and then fall out on their own. If needed, tubes are inserted again if more fluid builds up. About 8 out of 10 children need no further treatment after tubes are inserted for otitis media with effusion.
You can use antibiotic eardrops for ear infections while tubes are in place. In some cases, antibiotic eardrops seem to work better than antibiotics by mouth when tubes are present.
While tubes are in place, your doctor will recommend ear protection, including caution with water. The ear could get infected if any germs in the water get into the ear.

Removing adenoids and/or tonsils As a treatment for chronic ear infections, experts recommend removing adenoids and tonsils only after tubes and antibiotics have failed. Removing adenoids may improve air and fluid flow in nasal passages. This may reduce the chance of fluid collecting in the middle ear, which can lead to infection. Tonsils are removed if they are frequently infected. Experts do not recommend tonsil removal alone as a treatment for ear infections.

Caring for ruptured eardrums If your child has a ruptured eardrum, keep water from getting in the ear when your child takes a bath or a shower or goes swimming. The ear could get infected if any germs in the water get into the ear. If your doctor says it’s okay, your child may use earplugs. Or your doctor may have other advice for you. He or she can tell you when the hole in the eardrum has healed and when it’s okay to go back to regular water activities.
If a ruptured eardrum hasn't healed in 3 to 6 months, your child may need surgery (myringoplasty or tympanoplasty) to close the hole. This surgery is rarely done, because the eardrum usually heals on its own within a few weeks. If a child has had many ear infections, you may delay surgery until the child is 6 to 8 years old to allow time for eustachian tube function to improve. At this point, there is a better chance that surgery will work.

Ear Problems: Should My Child Be Treated for Fluid Buildup in the Middle Ear?

What To Think About

If amoxicillin-the most commonly used antibiotic for ear infections-does not improve symptoms in 48 hours, your doctor may try a different antibiotic.
When taking antibiotics for ear infection, it is very important that your child take all of the medicine as directed, even if he or she feels better. Do not use leftover antibiotics to treat another illness. Misuse of antibiotics can lead to drug-resistant bacteria.
Most studies find that decongestants, antihistamines, and other nonprescription cold remedies usually do not help prevent or treat ear infections or fluid behind the eardrum.
Children who have fluid behind the eardrum longer than 3 months (chronic otitis media with effusion) may have trouble hearing and need a hearing test. If there is a hearing problem, your doctor may also prescribe antibiotics to help clear the fluid. But that usually doesn't help. The doctor might also suggest placing tubes in the ears to drain the fluid and improve hearing.
If your child is younger than 2, your doctor may not wait 3 months to start treatment because hearing problems at this age could affect your child's speaking ability. This is also why children in this age group are closely watched when they have ear infections.
Children who get rare but serious problems from ear infections, such as infection in the tissues around the brain and spinal cord (meningitis) or infection in the bone behind the ear (mastoiditis), need treatment right away.
When used along with other treatments, removing adenoids (adenoidectomy) can help some children with repeat ear infections. But taking out the tonsils (adenotonsillectomy) is not very helpful.

Back Pain

Causes of Back Pain

What Causes Back Pain?

The causes of back pain can be complex. Some causes of back pain include accidents, muscle strains, and sports injuries.

How Is Back Pain Diagnosed?

In addition to performing a complete history and physical exam for your back pain, your doctor may suggest one of the following diagnostic studies:

• X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors, and fractures.
• CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
• MRI scans, which can provide details about the backs' discs and nerve roots. MRI scans are most commonly used for pre-surgical planning.
• CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.

A number of other imaging and electrical studies may also be used to identify back problems, and some injections are used for diagnostic purposes as well as for pain relief.

Types of Back Injury

Two main types of back injury include:

• Spondylolisthesis: This is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, can result in vertebrae slipping backward, forward, or over a bone below.
• Cervical Radiculopathy: Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation in various upper extremities, depending on where the damaged roots are located.

Causes of Spondylolithesis

There are many causes for spondylolithesis. A vertebra might be defective from the time a person is born, or a vertebra may be broken by trauma or a stress fracture. In addition, vertebrae can be broken down by infection or disease. Most commonly, this disorder occurs in children and adolescents who are active in sports.

Management of Back Pain

There can be many causes of back pain including accidents, strains, and injuries. Two types of back injury are spondylolisthesis and cervical radiculopathy. Both have their own set of symptoms, causes, and treatments.

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

• Cervical vertebrae: the seven vertebrae forming the upper part of the spine
• Thoracic vertebrae: the 12 bones between the neck and the lower back
• Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips
• The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.

Symptoms of Spondylolithesis

Symptoms of spondylolithesis include:

• Lower back pain
• Muscle tightness and stiffness
• Pain in the buttocks
• Pain radiating down the legs (due to pressure on nerve roots)

Spondylolithesis Treatments

Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. For patients who continue to have severe pain and disability after physical therapy, there is the option of surgical fusion (arthrodesis) of the vertebra to the bone below.

Causes of Cervical Radiculopathy

In cervical radiculopathy, damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis, or other injuries that put pressure on the nerve roots. In older people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc. This disc material then compresses the nerve root, causing pain.

Symptoms of Cervical Radiculopathy

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.

Cervical Radiculopathy Treatment

Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids (powerful anti-inflammatory drugs) or non-steroidal pain medication (Motrin or Aleve) and physical therapy. Steroids may be prescribed either orally or injected epidurally (into the dura, which is the membrane that surrounds the spinal cord).
Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain.
If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.

It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Medical problems that can cause back pain include the following:

Mechanical problems: A mechanical problem is due to the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Another cause of back pain is the wearing down of the facet joints, which are the large joints that connect each vertebrae to another. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.

Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic back pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.

Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis, which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, which causes fatigue and widespread muscle pain.

Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the discs that cushion the vertebrae, which is called discitis. Tumors, too, are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.

Although the causes of back pain are usually physical, it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful. Untreated depression and anxiety can make back pain feel much worse. Likewise, insomnia, or the lack of sleep, can also contribute to back pain.

Understanding Back Pain -- Symptoms

What Are the Symptoms of Back Pain?

Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms.
The symptoms for back pain are:

• Persistent aching or stiffness anywhere along your spine, from the base of the neck to the hips.
• Sharp, localized pain in the neck, upper back, or lower back -- especially after lifting heavy objects or engaging in other strenuous activity.
• Chronic ache in the middle or lower back, especially after sitting or standing for extended periods.
• Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes.
• Inability to stand straight without having severe muscle spasms in the low back.

Call Your Doctor About Back Pain If:

• You feel numbness, tingling, or loss of control in your arms or legs. This may signal damage to the spinal cord.
• The pain in your back extends downward along the back of the leg. You may be suffering from sciatica.
• The pain increases when you cough or bend forward at the waist. This can be the sign of a herniated disc.
• The pain is accompanied by fever, burning during urination, or strong-smelling urine. You may have a bacterial urinary tract infection.
• You have urine or fecal incontinence.
• You have dull pain in one area of your spine when lying in or getting out of bed. If you are over 50 you may be suffering from osteoarthritis.

Understanding Back Pain -- Diagnosis and Treatment

How Is Back Pain Diagnosed?

Before a doctor can begin treating back pain, he or she may do tests to diagnose what is causing the patient's problem. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem if that's something your doctor suspects. X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, magnetic resonance imaging (MRI) scans may be needed. A CT scan can be done instead for those who cannot have an MRI. X-rays and imaging studies are not usually indicated for first time back pain due to an overuse type injury, and are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as weakness or numbness in the arms or legs. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.

What Are the Treatments for Back Pain?

Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment for relieving back pain from strain or minor injury is rest. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.
Long-term bed rest, which is considered greater than 72 hours, is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.
If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe combination opioid/acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, these medications have their main effect on the brain, not the muscles, and often cause drowsiness and dependence. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves.

What Are the Treatments for Back Pain? continued...

The antidepressant Cymbalta (duloxetine) has been approved for chronic back pain as well. It's a serotonin-norepinephrine reuptake inhibitor, or SNRI, that was first approved by the FDA in 2004.
If your primary doctor isn't able to help you control back pain, he or she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain. In cases where there is a herniated disc or pinching of the nerve from the spinal cord, surgery may be indicated.
For those patients with long-standing back pain and nerve damage, some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. These procedures are not favored by some doctors who find them ineffective.
Knowing the cause of the pain and fixing the problem if possible should be primary in the course of your treatment, however.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain.TENS is not painful and may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not effective and cannot be recommended, according to the American Academy of Neurology (AAN).
Surgery for nonspecific back pain is a last resort. In cases of persistent pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Chiropractors have a role in the treatment of back pain. The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.
Acupuncture may bring moderate to complete back pain relief for many sufferers. It can be used alone or as part of a comprehensive treatment plan that includes medications and other bodywork. Clinical achievements, along with positive research results, prompted the National Institutes of Health (NIH) to declare acupuncture a reasonable treatment option for those suffering low back pain.

What Are the Treatments for Back Pain? continued...

If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo. Other comprehensive behavioral programs have shown similar success, with participants able to lessen the amount of medication they needed while improving their outlook and pain-related behavior.
If lower back pain is related to muscle tension or spasm, biofeedback can be effective for lessening pain intensity, decreasing drug use, and improving quality of life. Biofeedback may help you train your muscles to respond better to stress or movement.
The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help reduce pain and can relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic therapy and exercise can also improve flexibility and decrease pain for those with chronic low back problems. The unique properties of water make it an especially safe environment for exercising a sore back; it provides gentle resistance, comfort, and relaxation.

 

Asthma

What Is Asthma?

Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passages that results in a temporary narrowing of the airways that carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Some people refer to asthma as "bronchial asthma."

Even though there are seemingly miraculous treatments for asthma symptoms, asthma is still a serious -- even dangerous -- disease that affects more than 22 million Americans and causes nearly 2 million emergency room visits ever year. With proper asthma treatment, you can live well with this condition. Yet inadequate asthma treatment limits the ability to exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency room and even hospital admission, which can affect your performance at home and work.

In each of the following sections, there are in-depth articles that link to the topics. Be sure to read each health topic so you have a greater understanding of asthma and how it is diagnosed and treated.

There are three major features of asthma:

1. Airway obstruction. During normal breathing, the bands of muscle that surround the airways are relaxed, and air moves freely. But in people with asthma, allergy-causing substances and environmental triggers make the bands of muscle surrounding the airways tighten, and air cannot move freely. Less air causes a person to feel short of breath, and the air moving through the tightened airways causes a whistling sound known as wheezing.

(Fortunately, this airway narrowing is reversible, a feature that distinguishes asthma from other lung diseases such as bronchitis or emphysema.)

2. Inflammation. People with asthma have red and swollen bronchial tubes. This inflammation is thought to contribute greatly to the long-term damage that asthma can cause to the lungs. And, therefore, treating this inflammation is key to managing asthma in the long run.

3. Airway irritability. The airways of people with asthma are extremely sensitive. The airways tend to overreact and narrow due to even the slightest triggers such as pollen, animal dander, dust, or fumes.

Asthma Causes and Triggers

People with asthma have very sensitive airways that react to many different things in the environment called "asthma triggers." Contact with these triggers cause asthma symptoms to start or worsen. The following are common triggers for asthma:

• Infections such as sinusitis, colds, and flu
• Allergens such as pollens, mold spores, pet dander, and dust mites
• Irritants such as strong odors from perfumes or cleaning solutions, and air pollution
• Tobacco smoke
• Exercise, called exercise-induced asthma
• Weather; changes in temperature and/or humidity, cold air
• Strong emotions such as anxiety, laughter or crying, stress
• Medications, such as aspirin-sensitive asthma

No one really knows the causes of asthma. What we do know is that asthma is a chronic inflammatory disease of the airways. The causes of asthma symptoms can vary for different people. Still, one thing is consistent with asthma: when airways come into contact with an asthma trigger, the airways become inflamed, narrow, and fill with mucus.

When you have an asthma attack, spasms of the muscles around the airways, inflammation and swelling of the mucosal membrane lining the airways, and excessive amounts of mucus contribute to airway narrowing. This makes airway resistance increase and the work of breathing more difficult, causing shortness of breath, cough, and wheezing. You may have coughing with asthma because of the irritation inside the airway and the body's attempt to clean out the accumulations of thick mucus.

So why do you have asthma and your friend doesn't? No one really knows for sure. We do know that allergies play a role in many people with asthma but not in all. As with allergy, you can blame your family history, as there is a strong genetic component for asthma.
If you or a loved one has asthma, it's important to understand the many asthma triggers. Once you identify and reduce exposure to the specific triggers or causes of asthma, you can take an active role in controlling your asthma and reducing the frequency of asthma attacks. For example, if you find that allergies are the cause of your asthma, you may have allergic asthma. Being aware of allergies and avoiding them can significantly help in asthma prevention by reducing the frequency or severity of asthma attacks. Or if environmental pollution seems to cause your asthma, it's important to stay indoors during periods of heavy air pollution. Try to find the specific triggers or causes of your asthma, and then plan to avoid these triggers and have better asthma control.

Allergies Can Cause Asthma

Allergies with asthma is a common problem. Eighty percent of people with asthma have allergies to airborne substances such as tree, grass, and weed pollens, mold, animal dander, dust mites, and cockroach particles. In one study, children who had high levels of cockroach droppings in their homes were four times more likely to have childhood asthma than children whose homes had low levels. Asthma exacerbation after dust exposure is usually due to dust mite allergy.

Food and Food Additives Trigger Asthma

While it's not common for food allergies to cause asthma, food allergies can cause a severe life-threatening reaction. The most common foods associated with allergic symptoms are:

• Eggs
• Cow's milk
• Peanuts
• Soy
• Wheat
• Fish
• Shrimp and other shellfish
• Salads & fresh fruits

Food preservatives can also trigger asthma. Sulfite additives, such as sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite, and sodium sulfite, are commonly used in food processing or preparation and may trigger asthma in those people who are sensitive.

Exercise-Induced Asthma

Strenuous exercise can cause a narrowing of the airways in about 80% of people with asthma. In some people, exercise is the main trigger for their asthma symptoms. If you have exercise-induced asthma, you will feel chest tightness, coughing, and difficulty breathing within the first five to eight minutes of an aerobic workout. These symptoms usually subside in the next 20 to 30 minutes of exercise, but up to 50% of those with exercise-induced asthma may have another asthma attack six to 10 hours later.

Heartburn and Asthma

Severe heartburn and asthma often go hand-in-hand. Recent studies show that up to 89% of those with asthma also suffer from severe heartburn, known as gastroesophageal reflux disease (GERD). GERD generally occurs at night when the sufferer is lying down. Normally a valve between the esophagus and stomach prevents stomach acids from backing up into the esophagus. In GERD, the valve does not function properly. The stomach acids reflux, or back up, into the esophagus; if the acid reaches into the throat or airways the irritation and inflammation can trigger an asthma attack.
Certain clues that suggest reflux as the cause of asthma include the onset of asthma in adulthood, no family history of asthma, no history of allergies or bronchitis, difficult-to-control asthma, or coughing while lying down.
If your doctor suspects this problem, he or she may recommend specific tests to look for it.

Smoking and Asthma

People who smoke cigarettes are more likely to get asthma. If you smoke with asthma, it may make your symptoms such as coughing and wheezing worse. Women who smoke during pregnancy increase the risk of wheezing in their babies. Babies whose mothers smoked during pregnancy also have worse lung function than those whose mothers did not smoke. If you have asthma and you're a smoker, quitting is the most important step you can take to protect your lungs.

Sinusitis and Other Upper Respiratory Infections

Much like asthma causes inflammation in the lining of the airways, sinusitis causes inflammation in the mucous membranes that line the sinuses. This inflammation causes the mucous membranes in the sinuses to secrete more mucus -- also similar to asthma. When the sinuses get inflamed, the airways respond similarly in many people with asthma, leading to sinusitis with asthma. Prompt treatment of a sinus infection is often necessary to help relieve asthma symptoms.

Infections and Asthma

Cold, flu, bronchitis, and sinus infections can cause an asthma attack. These respiratory infections that trigger asthma can be viral or bacterial and are a common cause of asthma especially in children under age 10. This airway sensitivity that causes the airways to more easily narrow can last as long as two months after an upper respiratory infection. It's thought that anywhere from 20% to 70% of asthmatic adults have coexisting sinus disease. Conversely, 15% to 56% of those with allergic rhinitis (hay fever) or sinusitis have evidence of asthma.

Medications and Asthma

Many people with asthma have aspirin-sensitive asthma and it's possible they're sensitive to other medications such as anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), ketoprofen (Orudis) and beta-blockers (used to treat heart disease, high blood pressure, and glaucoma). If you know you're sensitive to these drugs, make sure your doctor has the problem documented on your chart, and always talk to your pharmacist about this reaction before taking a new medication.

Other Causes of Asthma

Irritants. Many irritants, including tobacco smoke, smoke from wood-burning appliances or fireplaces, strong odors from perfumes, cleaning agents, etc., are all irritants that can trigger asthma. In addition, air pollution, occupational dust or vapors can also trigger an attack.
Weather. Cold air, changes in temperature, and humidity can cause asthma.
Strong emotions. Stress and asthma are often seen together. Anxiety, crying, yelling, stress, anger, or laughing hard can trigger an asthma attack.

How Do Triggers Make Asthma Worse?

In people with asthma, the airways are always inflamed and very sensitive, so they react to a variety of external factors, or "triggers." Coming into contact with these triggers is what causes the symptoms of asthma -- the airways tighten and become inflamed, mucus blocks the airways and results in a worsening of asthma symptoms. An asthma attack can begin immediately after exposure to a trigger or several days or even weeks later.
There are many causes of asthma. Reactions to the causes of asthma are different for each person and vary from time to time. Certain causes of asthma may be harmless to some people but contribute to inflammation in others. Some people have many causes of their asthma while others have no identifiable ones. Recognizing and avoiding the specific causes of asthma, when possible, is an important way to control asthma. Keep in mind, however, that the best way to control is with asthma treatment and asthma drugs.

How Can I Tell What Causes and Triggers My Asthma?

Determining what factors were present when your asthma symptoms started is the first step to identifying the causes of your asthma. Although there are many different asthma triggers, you may not react to all of them. Some people have only one cause or trigger, while others have many causes.
Many causes of asthma can be identified through a history of reaction and skin or blood testing. Your doctor may also recommend using a device called a peak flow meter. The peak flow meter measures how much and how quickly air is exhaled from the lungs. It can alert you to changes in your breathing and the onset of asthma symptoms.
Ask your asthma doctor if using a peak flow meter would be helpful to you as you narrow down the causes of your asthma.

Asthma Attack

An asthma attack is a sudden worsening of symptoms. With an asthma attack, your airways tighten, swell up, or fill with mucus. Common symptoms include:

• Coughing, especially at night
• Wheezing (a high-pitched whistling sound when breathing out)
• Shortness of breath
• Chest tightness, pain, or pressure

What Is an Asthma Attack?

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm). During the asthma attack, the lining of the airways also becomes swollen or inflamed and thicker mucus -- more than normal -- is produced. All of these factors -- bronchospasm, inflammation, and mucus production -- cause symptoms of an asthma attack such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:

Severe wheezing when breathing both in and out

Coughing with asthma that won't stop

Very rapid breathing

Chest pain or pressure

Tightened neck and chest muscles, called retractions

Difficulty talking

Feelings of anxiety or panic

Pale, sweaty face

Blue lips or fingernails

Or worsening symptoms despite use of your medications

Some people with asthma may go for extended periods without having an asthma attack or other symptoms, interrupted by periodic worsening of their symptoms, due to exposure to asthma triggers or perhaps from overdoing it during exercise-induced asthma.
Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours after treatment. Severe asthma attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms of an asthma attack to help you prevent severe episodes and keep asthma under control.

What Happens if an Asthma Attack Goes Untreated?

Without immediate asthma medicine and asthma treatment, your breathing will become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your personal best reading will probably be reduced.
As your lungs continue to tighten during the asthma attack, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the "silent chest," and it is a dangerous sign. You may need to be taken to a hospital immediately with a severe asthma attack. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care.
If you do not receive adequate treatment for an asthma attack, you will eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as "cyanosis," means you have less and less oxygen in your blood. Without immediate aggressive treatment in an intensive care unit, you will lose consciousness and eventually die.

How Do I Recognize the Early Signs of an Asthma Attack?

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.
In general, these asthma attack symptoms are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse.
Early warning signs of an asthma attack include:

• Frequent cough, especially at night
• Reduced peak flow meter readings
• Losing your breath easily or shortness of breath
• Feeling very tired or weak when exercising
• Wheezing or coughing after exercise or exercise-induced asthma
• Feeling tired, easily upset, grouchy, or moody
• Decreases or changes in lung function as measured on a peak flow meter
• Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache)
• Trouble sleeping with nighttime asthma

The severity of an asthma attack can escalate rapidly, so it's important to treat these symptoms immediately once you recognize them.

Not every person with asthma has the same symptoms of an asthma attack. You may not have all of these symptoms, or you may have different symptoms at different times. Your symptoms may also vary from one asthma attack to the next, being mild during one attack and severe during another.

 

Adult-Onset Asthma

Asthma affects 22 million Americans. Asthma may occur at any age, although it's more common in younger individuals (under age 40).

People who have a family history of asthma have an increased risk of developing the disease. Allergies and asthma often occur together. Smoking with asthma, a dangerous combination, is still seen commonly.

However, anyone can develop asthma at any time, and adult-onset asthma happens frequently. If you have symptoms of asthma, talk to your doctor. If you have adult-onset asthma, your doctor will instruct you in using the asthma inhalers and other asthma medications to prevent further breathing problems.

Asthma in Children

Asthma is increasingly prevalent among children. Nearly one in 10 American children now has asthma, a sharp rise that still has scientists searching for a cause. An estimated 6.5 million children under age 18 (8.9%) are now diagnosed with the disease. The rate of childhood asthma has more than doubled since 1980, according to the CDC.

Asthma symptoms can vary from episode to episode in the same child. Signs and symptoms of asthma to look for include:

• Frequent coughing spells, which may occur during play, at nighttime, or while laughing. It's important to know that coughing with asthma may be the only symptom present.
• Less energy during play
• Rapid breathing
• Complaint of chest tightness or chest "hurting"
• Whistling sound when breathing in or out. This whistling sound is called wheezing.
• Seesaw motions in the chest from labored breathing. These motions are called retractions.
• Shortness of breath, loss of breath
• Tightened neck and chest muscles
• Feelings of weakness or tiredness