Osteoporosis Disease

Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist, but any bone can be affected. You can't "catch" osteoporosis or give it to someone else.

Risk Factors and Prevention

There are no symptoms of osteoporosis until a fracture occurs. That is why it is often called "silent." Certain factors can put you at risk for developing osteoporosis, but there are also steps you can take to prevent it.

Osteoporosis does not have any symptoms until a fracture occurs. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. But any fracture in an older person could be a warning sign that the bone is weaker than optimal.

Some people may be unaware that they have already experienced one or more spine fractures. Height loss of one inch or more may be the first sign that someone has experienced spine fractures due to osteoporosis. Multiple spine fractures can cause a curved spine, stooped posture, back pain, and back fatigue.
Women and men who have had a fracture are at high risk of experiencing another one. A fracture over the age of 45 or several fractures before that age may be a warning sign that a person has already developed osteoporosis. People over the age of 45 who have experienced a fracture should talk to their doctor about getting evaluated for osteoporosis.
The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong -- or dense -- your bones are and can help your doctor predict your risk for having a fracture. Bone density tests are painless, safe, and require no preparation on your part.
Bone density tests compare your bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells you how strong your bones are, whether you have osteoporosis or osteopenia -- low bone mass -- and your risk for having a fracture.
Some bone density tests measure the strength of the hip, spine, and/or wrist, which are the bones that break most often in people with osteoporosis. Other tests measure bone in the heel or hand. Although no bone density test is 100 percent accurate, it is the single most important diagnostic test to predict whether a person will have a fracture in the future.
The preferred bone density test is a DXA scan of the hip and spine. This test shows if you have normal bone density, low bone mass, or osteoporosis. It is the only bone density test that can be used to diagnose osteoporosis and monitor bone density changes over time in response to treatment.
The United States Preventive Service Task Force recommends that women aged 65 and older be screened for osteoporosis, as well as women aged 60 and older who are at increased risk for an osteoporosis-related fracture. However, the decision of whether or not to have a bone density test is best made between a patient and his or her physician.
Medicare will usually cover the cost of a bone density test in women age 65 and older. Under certain conditions, such as significant risk factors for osteoporosis, Medicare will cover women under age 65, men, and a followup bone density test every 2 years for certain individuals.

Treatment and Research

Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis.
Many family doctors have been learning about osteoporosis and can treat people who have it. Endocrinologists, rheumatologists, geriatricians, and internists are just a few of the specialists who can provide care to people with osteoporosis.
The goal of treatment is to prevent fractures. A balanced diet rich in calcium, adequate vitamin D, a regular exercise program, and fall prevention are all important for maintaining bone health.

Osteoporosis Treatment Medications

Several medications are approved by the Food and Drug Administration for the treatment of osteoporosis. Since all medications have side effects, it is important to talk to your doctor about which medication is right for you.
Bisphosphonates. Alendronate, risedronate, ibandronate, and zoledronic acid are from a class of drugs called bisphosphonates that slow bone loss, reduce fracture risk, and in some cases increase bone density. These drugs decrease the activity of bone-dissolving cells.
Alendronate is an oral medication in pill or liquid form and is available in daily and weekly doses for treating women and men. Risedronate is available in pill form in daily, weekly, and twice monthly doses for treating women and men. Ibandronate is available in a pill as a monthly dose or as an intravenous injection given once every 3 months for treating women. Zoledronic acid is available as an intravenous injection given once a year for treating women. Side effects of taking oral bisphosphonates may include nausea, heartburn, and stomach pain, including serious digestive problems if they are not taken properly.
A few people have muscle, bone, or joint pain while using these medicines. Side effects of intravenous bisphosphonates may include flu-like symptoms such as fever, pain in muscles or joints, and headaches. These symptoms usually stop after a few days. In rare cases, osteonecrosis of the jaw has occurred in people taking bisphosphonates.
Estrogen. Estrogen is approved for the treatment of menopausal symptoms and osteoporosis. Because of recent evidence that breast cancer, strokes, blood clots, and heart attacks may be increased in some women who take estrogen, the Food and Drug Administration recommends that women take the lowest effective dose for the shortest period possible. Estrogen should only be considered for women at significant risk for osteoporosis, and nonestrogen medications should be carefully considered first.
Raloxifene, available as a daily pill, is approved for use in postmenopausal women. From a class of drugs called estrogen agonists/antagonists, commonly referred to as selective estrogen receptor modulators (SERMs), raloxifene is a nonhormonal drug that has estrogen-like effects on the skeleton, but blocks estrogen effects in the breast and uterus. Raloxifene slows bone loss and reduces the risk of fractures in the spine, but no effect on hip fracture has been seen. Side effects may include hot flashes and an increased risk of blood clots in some women.
Calcitonin, available as a daily nasal spray or injection, is approved for the treatment of osteoporosis in women who are at least 5 years past menopause. It is a hormone produced by the thyroid gland that slows bone loss and reduces the risk of spine fractures. It has no serious side effects.
Teriparatide, a form of human parathyroid hormone, stimulates new bone formation. Given as a daily injection for up to 24 months, it increases bone tissue and bone strength, and has been shown to reduce the risk of spine and other fractures.Teriparatide is approved for use in postmenopausal women and men who are at high risk of fracture. Some patients experience leg cramps and dizziness from teriparatide.

Research

Research is currently underway to identify new treatments for osteoporosis. Studies are also underway to learn new ways to achieve the best possible bone health.
Scientists are also studying the impact of electromagnetic therapy and nutrients like vitamin K and phytoestrogens on bone health. The role of genetics and the environment in the development of osteoporosis is also being explored.

Headache Disease

Oh my aching head! Nearly everyone has had a headache. The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are more likely to get tension headaches if you work too much, don't get enough sleep, miss meals or use alcohol.

Other common types of headaches include migraines, cluster headaches and sinus headaches. Most people can feel much better by making lifestyle changes, learning ways to relax and taking pain relievers.

Headaches can have many causes, but serious causes of headaches are rare. Sometimes headaches warn of a more serious disorder. Let your health care provider know if you have sudden, severe headaches. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with a stiff neck, fever, confusion, loss of consciousness or pain in the eye or ear.

National Institute of Neurological Disorders and Stroke

Epilepsy Disease information

Epilepsy is a disorder of the brain. People with epilepsy have brain cells that create abnormal electricity, causing seizures. In some cases, a seizure may cause jerking, uncontrolled movements and loss of consciousness. In other cases, seizures cause only a period of confusion, a staring spell or muscle spasms.

A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures.

Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not contagious. Between seizures, a person with epilepsy is no different from anyone else.

What should I do when someone has a seizure?
If you have epilepsy, you may want to share the following information with your family, friends and coworkers. If someone near you has a seizure, use the following general guidelines:
Stay calm.
Don't move the person to another place.
Don't try to keep the person from moving or shaking.
Don't try to wake the person by shouting at or shaking them.
Take away items that could cause injury if the person falls or bumps into them.
Don't move the person to another place.
Gently turn the person on his or her side so any fluid in the mouth can safely come out. Never try to force the person's mouth open or put anything in it.
Place something soft (such as a pillow) under his or her head.
Most seizures aren't life-threatening. You don't need to call a doctor or an ambulance unless the person isn't known to have epilepsy or unless the seizure lasts longer than 5 minutes.
When the seizure is over, watch the person for signs of confusion. Allow the person to rest or sleep if he or she wishes.

If I have epilepsy, do I have to take medicine every day?
Yes. You must take your medicine every day, even when you aren't having seizures or when you think you won't have a seizure. To prevent seizures, you have to take the medicine regularly, just as your doctor tells you.

What should I do if I forget to take my medicine?
Usually you should take your medicine as soon as you realize you forgot a dose. If more than 24 hours have passed since your last dose, call your doctor for instructions.

Should I take extra medicine if I think I'm about to have a seizure?
No. The amount of medicine you take for your epilepsy is carefully set for your own specific needs. No extra medicine should be taken without your doctor's approval.

Will I have to take medicine forever?
It may be possible for some people with epilepsy to stop taking medicine. However, this decision must be made by your doctor. Before you and your doctor can decide to stop the medicine, several questions should be considered. These include how quickly your seizures were controlled, how long you have been free of seizures and if you have other illnesses that may affect your problem.

Can I take other drugs while taking medicine for epilepsy?
Because many drugs affect the ability of your epilepsy medicine to control your seizures, ask your doctor or pharmacist before taking other drugs, even drugs you can buy without a prescription

Can I drink alcohol if I have epilepsy?
You should avoid drinking alcohol if you have epilepsy. Alcohol can make it easier to have a seizure and can also affect your epilepsy medicine. Ask your doctor.

What if I become pregnant?
Uncontrolled seizures can affect the unborn baby. Epilepsy medicine may also affect the unborn baby. Decisions about taking medicine during pregnancy must be made by you and your doctor, after talking about the risks and the benefits.

Can I drive if my seizures are under control?
Laws about driving for people with epilepsy are different in each state. Ask your local epilepsy foundation or ask your doctor.

When should I call my doctor?
The seizure lasts longer than 5 minutes.
The way you usually feel during and after having a seizure changes.
It takes you longer than normal to recover after having a seizure.
Your seizures become more severe or happen more frequently.
A second seizure immediately occurs after the first.
You have a sudden headache, or numbness or weakness in one side of your body or problems with your vision or speech right before you have a seizure. These could be signs of a stroke.
Any time you change your seizure medicine or take any other medicines.

Alzheimer's Disease Information

Also called: AD

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. Over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

National Institute on Aging
What is Alzheimer's Disease?
Alzheimer's disease (AD) is a progressive, neurodegenerative disease characterized in the brain by abnormal clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles) composed of misplaced proteins. Age is the most important risk factor for AD; the number of people with the disease doubles every 5 years beyond age 65. Three genes have been discovered that cause early onset (familial) AD. Other genetic mutations that cause excessive accumulation of amyloid protein are associated with age-related (sporadic) AD. Symptoms of AD include memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Eventually AD destroys cognition, personality, and the ability to function. The early symptoms of AD, which include forgetfulness and loss of concentration, are often missed because they resemble natural signs of aging.

Is there any treatment?
There is no cure for AD and no way to slow the progression of the disease. For some people in the early or middle stages of AD, medication such as tacrine (Cognex) may alleviate some cognitive symptoms. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) may keep some symptoms from becoming worse for a limited time. A fifth drug, memantine (Namenda), was recently approved for use in the United States. Combining memantine with other AD drugs may be more effective than any single therapy. One controlled clinical trial found that patients receiving donepezil plus memantine had better cognition and other functions than patients receiving donepezil alone. Also, other medications may help control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety, and depression.

What is the prognosis?
AD is a progressive disease, but its course can vary from 5 to 20 years. The most common cause of death in AD patients is infection.

What research is being done?

The NINDS conducts and supports research on neurodegenerative and dementing disorders, including AD. Scientists are currently studying or testing different types of drugs and other substances to determine if they can stop AD progression, including nonsteroidal anti-inflammatory drugs (NSAIDS), statins (such as those used for lowering cholesterol), folic acid, gingko biloba, and vitamins E, B6, and B12. Studies in basic science are also exploring the potential of vaccines. The National Institute on Aging and the National Institute of Mental Health also support research related to AD

Hydrocephalus Disease Information

The term hydrocephalus is derived from two words: "hydro" meaning water, and "cephalus" referring to the head.

Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Although hydrocephalus is often described as "water on the brain," the "water" is actually CSF, a clear fluid surrounding the brain and spinal cord. CSF has three crucial functions: 1) it acts as a "shock absorber" for the brain and spinal cord; 2) it acts as a vehicle for delivering nutrients to the brain and removing waste; and 3) it flows between the cranium and spine to regulate changes in pressure within the brain. Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older. According to the National Institute of Neurological Disorders and Stroke, hydrocephalus is believed to affect approximately one in every 500 children. The majority of these cases are often diagnosed before birth, at the time of delivery, or in early childhood.

Common Causes of Hydrocephalus

Although rare, hydrocephalus can be inherited genetically or may be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain). Other causes can include bleeding within the brain, brain tumors, head injuries, complications of premature birth such as hemorrhage, or diseases such as meningitis or other infections. In some cases, normal flow of CSF within the brain is blocked, resulting in fluid build-up.

Symptoms of hydrocephalus vary greatly from person to person. According to the Hydrocephalus Association, some of the most common symptoms are listed below as a reference.
Symptoms of Hydrocephalus in infants Abnormal enlargement of the head; soft spot (fontanel) is tense and bulging; scalp can appear thin; bones separated in baby's head; prominent scalp veins; vomiting; drowsiness; irritability; downward deviation of baby's eyes; seizures; or poor appetite.

Symptoms of Hydrocephalus in toddlers/children
Abnormal enlargement of baby's head; headache; nausea; vomiting; fever; blurred or double vision; unstable balance; irritability; sleepiness; delayed progress in walking or talking; poor coordination; change in personality; inability to concentrate; loss of sensory motor functions; seizures; or poor appetite. Older children may experience difficulty in remaining awake or waking up.

Symptoms of Hydrocephalus in young and middle-aged adults
Headache; difficulty in remaining awake or waking up; loss of coordination or balance; bladder control problems; impaired vision and cognitive skills that may affect job performance and personal skills.

Symptoms of Hydrocephalus in older adults
Loss of coordination or balance; shuffling gait, memory loss; headache; or bladder control problems. Hydrocephalus is often categorized for age groups as either congenital or normal pressure hydrocephalus. Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness. Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure. Adult-onset NPH mainly occurs in adults age 60 and older. Patients with NPH often get misdiagnosed with Alzheimer’s disease or dementia, as some of the symptoms mimic these two conditions.

Diagnosing Hydrocephalus

Before your doctor can recommend a course of treatment, he or she will:
Review your medical history, and perform a physical examination
Perform a complete neurological examination including diagnostic testing if needed
Ask specific questions to determine if symptoms are caused by hydrocephalus

The neurological examination will also help to determine the severity of your condition. Further tests such as an ultrasound (if the patient is an infant), computed tomography (CT or CAT scan), or magnetic resonance imaging (MRI) may be ordered. The tests may reveal useful information about the severity of the condition and its likely cause.

When Surgery is Necessary

Hydrocephalus can be treated in a variety of ways. The problem area may be treated directly (by removing the cause of CSF obstruction), or indirectly (by diverting the fluid to somewhere else; typically to another body cavity). Indirect treatment is performed by implanting a device known as a shunt to divert the excess CSF away from the brain. The body cavity in which the CSF is diverted is usually the peritoneal cavity (the area surrounding the abdominal organs).

In some cases, two procedures are performed, one to divert the CSF, and another at a later stage to remove the cause of obstruction (e.g., a brain tumor). Once inserted, the shunt system usually remains in place for the duration of a patient's life (although additional operations to revise the shunt system are sometimes needed). The shunt system continuously performs its function of diverting the CSF away from the brain, thereby keeping the intracranial pressure within normal limits.

An alternative operation called endoscopic third ventriculostomy utilizes a tiny camera to look inside the ventricles, allowing the surgeon to create a new pathway through which CSF can flow.

Recovery

Your neurological function will be evaluated post surgery. If any neurological problems persist, rehabilitation may be required to further your improvement. However, recovery may be limited by the extent of the damage already caused by the hydrocephalus and by your brain's ability to heal.

Because hydrocephalus is an ongoing condition, long-term follow-up by a doctor is required. Follow-up diagnostic tests including CT scans, MRIs and x-rays, are helpful in determining if the shunt is working properly. Do not hesitate to contact your physician if you experience any of the following postoperative symptoms:
Redness, tenderness, pain or swelling of the skin along the length of the tube or incision
Irritability or drowsiness
Nausea, vomiting, headache or double vision
Fever
Abdominal pain
Return of preoperative neurological symptoms

Prognosis

The prognosis for hydrocephalus depends on the cause, the extent of symptoms, and the timeliness of diagnosis and treatment. Some patients show a dramatic improvement with treatment while others do not. In some instances of NPH, dementia can be reversed by shunt placement. Other symptoms such as headaches may disappear almost immediately if the symptoms are related to elevated pressure.

In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment. The longer the symptoms have been present, the less likely it is that treatment will be successful. Unfortunately, there is no way to accurately predict how successful surgery will be for each individual. Some patients will improve dramatically while others will reach a plateau or decline after a few months.

Shunt malfunction or failure may occur. The valve can become clogged or the pressure in the shunt may not match the needs of the patient, requiring additional surgery. In the event of an infection, antibiotic therapy may be needed. A shunt malfunction may be indicated by headaches, vision problems, irritability, fatigue, personality change, loss of coordination, difficulty in waking up or staying awake, a return of walking difficulties, mild dementia or incontinence. Fortunately, most complications can be dealt with successfully.

Liver Diseases Information

Also called: Hepatic disease

Your liver is the largest organ inside your body. It is also one of the most important. The liver has many jobs, including changing food into energy and cleaning alcohol and poisons from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion.

There are many kinds of liver diseases. Viruses cause some of them, like hepatitis A, hepatitis B and hepatitis C. Others can be the result of drugs, poisons or drinking too much alcohol. If the liver forms scar tissue because of an illness, it's called cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Like other parts of your body, cancer can affect the liver. You could also inherit a liver disease such as hemochromatosis.

Heart Diseases Information

Also called: Cardiac disease

If you're like most people, you think that heart disease is a problem for other folks. But heart disease is the number one killer in the U.S. It is also a major cause of disability. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks.

Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease.

You can help reduce your risk of heart disease by taking steps to control factors that put you at greater risk:
Control your blood pressure
Lower your cholesterol
Don't smoke
Get enough exercise

National Heart, Lung, and Blood Institute