Graves’ disease  also called diffuse toxic goiter or thyrotoxicosis. Graves disease is the most common cause of hyperthyroidism.  It  may develop at any age and in either men or women, Graves’ disease is more common in women and usually begins after age 20. Graves’ disease is rarely life-threatening. Graves disease represents part of a more extensive autoimmune process called autoimmune polyglandular syndrome, which is also associated with pernicious anemia, vitiligo, diabetes mellitus type 1, autoimmune adrenal insufficiency, and systemic lupus erythematosus. In Graves disease, B and T lymphocyte–mediated autoimmunity are known to be directed at 4 well-known thyroid antigens: thyroglobulin, thyroid peroxidase, sodium-iodide symporter, and the thyrotropin receptor. Graves disease is the most common cause of hyperthyroidism in the United States. Females are much more likely to contract the disease than males, with the highest-risk ages for either sex being between 40 and 60 years.

Graves disease is much more common at any age in girls than in boys. The female preponderance has been estimated as 4-7 girls for every boy affected. Graves’ disease is triggered by some process in the body’s immune system, which normally protects us from foreign invaders such as bacteria and viruses. The immune system destroys foreign invaders with substances called antibodies produced by blood cells known as  lymphocytes. Many people inherit an immune system that can cause  problems.  In Graves’ disease, antibodies bind to  the surface of thyroid cells and stimulate those cells to overproduce thyroid hormones. This results in an overactive thyroid. Physicians have  long suspected that severe emotional stress, such as the death of a loved  one, can set off Graves’ disease in some patients. Graves’ disease patients often experience temporary remission of their symptoms during pregnancy, a phenomenon that has sharpened our understanding of how autoimmunity is normally sustained in this disease.

Their lymphocytes make antibodies against their own tissues  that stimulate or damage them. Medical treatment of Graves’ disease includes antithyroid drugs, radioactive iodine and thyroidectomy. Beta-blockers such as propranolol are often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled. Hyperthyroidism is treated with antithyroid medications, radioactive iodine, or surgery. Taping the eyes closed at night to prevent drying may sometimes be required. Sunglasses and eyedrops may lessen irritation of the eyes. Adjunctive therapy with a beta-blocking agent can also be useful. Iodine-131 therapy is quick, easy, relatively inexpensive, avoids surgery, and is without significant risk in adults and probably late teenagers. Radiation and chemotherapy may be used when primary orbital tumors can’t be fully excised as encapsulated lesions, such as in rhabdomyosarcoma lesions.

Graves Disease Treatment  Tips 

1. Applying cool compresses to the eyes.

2. Using lubricating eyedrops.

3. Wearing sunglasses.

4. Elevating the head of the bed.

5. Radioactive iodine (radioiodine) treatment.

Depression is a very common condition that is believed by many experts to be the number one cause of disability in the world.  Depression is a medical disorder with a biological and chemical basis. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Depression is more common in adults than in children, but it does occur in children. When children are depressed, their symptoms might be different from adults. Certain medical conditions or medications can cause depression or symptoms that look like depression. For example, hypothyroidism (low levels of thyroid hormone) can look like depression in some people. Depression is much more than grieving or a bout of the blues.  Depression in children and adolescents can look quite distinct from that of adults. Irritability—rather than depression—is frequently the predominant mood. Depression in Men – Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies.

Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. People afflicted with SAD may notice that they become depressed in the winter months. It may cause headaches, irritability and a low energy level. Dysthymia  is a less severe but more chronic form of depression. Having dysthymia places you at an increased risk of major depression. Depression can also cause a wide variety of physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Depression also afflicts many poor single working mothers of young children.  Signs  and  symptoms of depression including is Changes in appetite (decreased appetite most common) often signaled by rapid weight gain or loss. Changes in weight. An increased or reduced appetite and unexplained weight gain or loss may indicate depression. Children, teens and older adults may react differently to depression.

Older adults tend to complain more about the physical rather than the emotional symptoms of depression, and so their mood disorder often goes unrecognized. Older people may be more willing to discuss the physical manifestations of depression, instead of their emotional difficulties. Loss of interest in normal daily activities. Poor concentration, attention and/or memory. Medicines are commonly used to treat depression. Psychotherapy is sometimes called “talking therapy.” It is used to treat mild and moderate forms of depression. Electroconvulsive therapy, or ECT, is a procedure in which an electric current is used to produce a seizure in the patient. Hormone replacement is a treatment currently used to relieve symptoms of menopause such as night sweats and hot flashes. Tricyclic and tetracyclic antidepressants  medications also affect neurotransmitters, but by a different mechanism than that of SSRIs. Tricyclic antidepressants are amitriptyline, desipramine (Norpramin) and nortriptyline.

Depression Treatment  Tips

1. SSRIs (selective serotonin re-uptake inhibitors) such as fluoxetine (eg Prozac) and paroxetine (eg Seroxat) are the most commonly prescribed type of antidepressant.

2. Tricyclics are as effective as SSRIs, but they can have different side-effects

3. There are several other types of antidepressants which work in a different way from SSRIs and tricyclics.

4. Electric current is passed through the brain, while the person is under general anaesthetic.

5. Other treatments, such as a combination of cognitive, behavioural and interpersonal therapy, have a much lower rate of relapse.

Back is a well-designed structure made up of bone, muscles, nerves and other soft tissues. The pain may be have a sudden onset or it can be a chronic pain. Back pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Back pain is one of humanity’s most frequent complaints.  About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. Back pain can be a sign of a serious medical problem. The first attack of low back pain typically occurs between the ages of 30 and 40. Muscle strains are the most common cause of low back pain. A ruptured intervertebral disc, also called a herniated disc, is another common cause of back pain. Spinal stenosis causes back pain in the aging population. As we age, the spinal canal can become constricted, due in part to arthritis and other conditions. Arthritis most commonly affects joints such as the knees and fingers. However, arthritis can affect any joint in the body, including the small joints of the spine. Arthritis of the spine can cause back pain with movement.

Back pain may be mild or extreme, quick or constant. Some believe this pain to be caused by tension myositis syndrome. Back pain becomes more common with age. Weak back and abdominal muscles may not properly support the spine. Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a fracture or other injury. Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention. Back pain from osteoporosis is most commonly related to compression fractures of the vertebra. Osteoporosis causes weak bones and can lead to these fractures. Chronic back pain may be related to changes in how nerves respond to frequent pain stimuli. Injury-Damage to the bones, ligaments, or muscles of the back can cause severe pain. Symptoms include  is  muscle spasm, pain with walking, concentration of pain to one side, and no radiculopathy (radiating pain down buttock and leg). 

Most individuals recover completely by simply avoiding strain to their spine. A regular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. Heat therapy is useful for back spasms or other conditions. Bed rest is recommended for only 1–2 days at most.  Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic massage. Patients often find help from ice, heat, and medications. Acetaminophen and ibuprofen are most commonly recommended for pain relief. Electrical stimulation. A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the skin to nerve pathways. Other treatments-Anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube (catheter) attached to a programmed pump. Chiropractors and osteopaths manipulate the spine, called an adjustment, to relieve pain arising from musculoskeletal conditions.

Back Pain Treatment Tips

1. Acetaminophen and ibuprofen are most commonly recommended for pain relief.

2. Chronic back pain  treated with tricyclic antidepressants, such as amitriptyline   and nortriptyline (Pamelor ).

3. Selective nerve root block (SNRB) uses a steroid with anesthetic.

4. Physical therapy are to decrease pain, increase function, restore normal movement, and prevent recurrences.

5. Massage therapy increases circulation to the affected area. There are several techniques and devices used in massage therapy.

6. Electrotherapy involves sending gentle electric currents through the skin to stimulate muscular contraction.

Brain tumors are tumors that grow in the brain. A tumor is an abnormal growth caused by cells reproducing themselves in an uncontrolled manner. Brain tumors typically are categorized as either primary or secondary. Primary brain tumors originate in your brain and can be noncancerous (benign) or cancerous (malignant). Secondary brain tumors result from cancer that began elsewhere and spread to your brain. Primary brain tumors are less common than secondary brain tumors. Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, benign or malignant tendencies of the tumor, and other factors. Primary brain tumors can arise from the brain cells, the meninges (membranes around the brain), nerves, or glands. Each year approximately 190,000 people in the United States and 10,000 people in Canada will be diagnosed with a primary or metastatic brain tumor. Symptoms of brain tumors may depend on two factors: tumor size (volume) and tumor location. The time point of symptom onset in the course of disease correlates in many cases with the nature of the tumor.

Brain tumor patients, including those with certain “benign” brain tumors, have poorer survival rates than breast cancer patients. In children under 2, about 70% of brain tumors are medulloblastoma, ependymoma, and low-grade glioma. Less commonly, and seen usually in infants, are teratoma and atypical teratoid rhabdoid tumor. Brain tumors are the leading cause of Solid tumor  death in children under age 20 now surpassing acute lymphoblastic leukemia (ALL), and are the third leading cause of cancer death in young adults ages 20-39. Tumors may occur at any age, but many specific tumors have a particular age group in which they are most common. In adults, gliomas and meningiomas are most common. There are over 120 different types of brain tumors. Specific tumor types is   Astrocytic tumors include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant). Astrocytomas can progress over time more malignant forms, including glioblastoma.

Photodynamic therapy uses a special drug (Photofrin) that is absorbed by the tumor. Retinoids are vitamin A derivatives and act as differentiating drugs in cancer Treatments. Oligodendroglial tumors also can vary from low grade to very malignant.  Surgery is necessary for most primary brain tumors. Some tumors may be completely removed. A biopsy is a surgical procedure used to remove a small amount of tumor tissue. Radiation therapy (also called radiotherapy) is the use of high-powered rays to damage cancer cells and stop them from growing. Stereotactic radiosurgery is another way to treat brain tumors. Chemotherapy is the use of drugs to kill cancer cells. Conventional radiation therapy delivers radiation to an entire region of the brain. Immunotherapy aims at using modalities that boost the patient’s own immune system’s ability to seek out and destroy cancerous cells. Steroids may be used temporarily following surgery or during radiation because these treatments often cause edema. 

Brain Tumors Treatment Tips

1. Surgery is the treatment of choice for accessible brain tumors.

2. Conventional radiation therapy uses external beams of either x or gamma rays aimed at the tumor.

3. Chemotherapy may be used before, during, or after surgery and radiation therapy.

4. Steroids control the swelling due to accumulation of fluids (edema) often associated with brain tumors.

5. Immunotherapy uses biological response modifiers (BRMs)to fight tumor cells.

6. Anti-convulsants such as phenytoin to reduce seizures.

7. Antacids or histamine blockers to control stress ulcers.

Varicose veins are gnarled, enlarged veins. Varicose veins are swollen, twisted, painful veins that have filled with an abnormal collection of blood.   Large varicose veins can cause aching and feelings of fatigue as well as skin changes like rashes, redness, and sores. As many as 40 million Americans, most of them women, have varicose veins. Varicose veins, in the legs, affect about 30% of adults at some point in their life. They tend to be more common in older women. Varicose veins usually develop gradually, and may run in families. Although varicose veins can appear unsightly, and are sometimes painful, they do not usually cause any serious health problems.  Causes include congenitally defective valves, thrombophlebitis, and pregnancy. Prolonged standing and increased pressure within the abdomen may increase susceptibility to the development of varicose veins or aggravate the condition. Varicose veins may sometimes be an important pathway for venous return, as when they provide a bypass pathway for venous return in patients with acute blockage of the deep venous system from any cause.

Varicose veins are a common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women. Varicose veins affect 1 out of 2 people over age 50. They are more common in women than men. Hemorrhoids are a type of varicose vein. Spider veins are like varicose veins, but they are smaller. Primary varicose veins occur because of congenitally defective valves, or without a known cause. Secondary varicose veins occur because of another condition, such as occurs when a pregnant woman develops varicose veins. Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins. Varicose veins of pregnancy most often are caused by hormonal changes that render vein walls and the valves themselves more pliable.  Symptoms that are commonly associated with varicose veins including is aching, throbbing.

The presence and size of visible varicosities are not reliable indicators of the volume or pressure of venous reflux. Support stockings and bandages to support the veins and muscles in the legs to prevent blood pooling and also hide the veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. Sclerotherapy is used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.  Surgery is usually performed under general anaesthesia, a spinal anaesthetic is an alternative. For treatment of the greater saphenous vein and the saphenofemoral junction, ultrasonography is used to confirm and map all areas of reflux and to trace the path of the refluxing greater saphenous trunk from the saphenofemoral junction down the leg to the upper calf.

Varicose Veins Treatment Tips

1. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear.

2. Local anesthesia is used in this outpatient procedure. 

3. Support stockings and bandages to support the veins and muscles in the legs to prevent blood pooling and also hide the veins.

4. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear.

5. Sclerotherapy is used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping.

6. Avoid prolonged standing if personal or family history indicates you are at risk of developing varicose veins.

Mitral valve is part of the heart. Mitral valve prolapse  is the most common heart valve abnormality. It has two flaps that open and close together like a pair of swinging doors. It  is affected five to ten percent of the world population. The mitral valve controls the flow of blood between 2 chambers  of  heart called the left atrium and the left ventricle. About 1 in 20 Americans has mitral valve prolapse. People are usually born with it. The condition is most common in women, although men are also affected. MVP tends to run in families, so those with blood relatives with MVP have a greater chance of also having the condition. The mitral valve prolapse syndrome is sometimes called dysautonomia. MVP occurs when the left ventricular (LV) size is small in comparison to an enlarged mitral annulus, leaflets, or chordae tendineae, and it can be induced in healthy women with typical body habitus following dehydration that is reversed with rehydration. Some forms of mitral valve prolapse seem to be passed down through families (inherited). Mitral valve prolapse has been associated with Marfan syndrome (a disorder present from birth) and Graves disease.

MVP can result in cerebrovascular ischemia, which may be related to abnormal platelet activity or protein C or S deficiencies. Many MVPers believe chest pains signal a heart attack.  In general, severe narrowing and blockage of a coronary artery that supplies an area of heart muscle with blood causes a heart attack. Chest pain and dyspnea previously were considered part of the MVP syndrome, but they are now felt to be no more common in cases of MVP than they are in the general population. Mitral regurgitation can lead to the thickening or enlargement of the heart wall, caused by the extra pumping the heart must do to make up for the backflow of blood. It sometimes causes people to feel tired or short of breath. Palpitations (awareness of the heart beating) is also very common in the population as a whole, as well as frequently seen in persons with MVP. There are also some even rarer conditions in which MVP may be associated with sudden death. This exceedingly unusual association is not well understood since it happens so very rarely.

MVP patients should have a mid-afternoon high-protein snack, such as cheese or peanut butter crackers, instead of sugary food. Mitral valve prolapse usually requires  specific treatment, except reassurance.  Mitral valve prolapse can be treated with surgical replacement of the mitral valve. Antibiotics used include oral amoxicillin and erythromycin as well as intramuscular or intravenous ampicillin, gentamycin, and vancomycin. Regular exercise is necessary to improve fitness and reduce MVP symptoms. Exercise should be aerobic, such as walking, running, bicycling, swimming, etc. Many symptoms of MVP (such as dizziness, weakness, light-headedness, etc.) are due to low blood pressure and low blood volume that can be helped through drinking adequate amounts of water. MVP patients should have a mid-afternoon high-protein snack, such as cheese or peanut butter crackers, instead of sugary food.

Mitral Valve Prolapse Treatment Tips

1. Anti-arrhythmics drugs help control irregular heart beats.

2. Vasodilators dilate (widen) blood vessels, which makes it easier for the heart to work.

3. Digitalis is used to strengthen the heartbeat.

4. Regular exercise is necessary to improve fitness and reduce MVP symptoms.

5. Medication may be required to improve symptoms of MVP.

Electrical injury can occur to the skin or internal organs when a person is directly exposed to an electrical current.  These injuries encompass various diagnostic and treatment modalities. Generally, they may be classified as lightning, low voltage, and high voltage. Further, each of these may be subclassified depending on whether the person with the injury required cardiopulmonary resuscitation (CPR). The human body is a good conductor of electricity. Direct contact with electrical current can be fatal. While some electrical burns look minor, there still may be serious internal damage, especially to the heart, muscles, or brain. Analysis of the human-machine interface. Extensive federal and state testimony experience. Publication on electrical injury. Accident reconstruction based on burn injury pattern and other physical evidence. Analysis of pain and suffering.  Human factors associated with electrical contact.   Diffuse electrical injury (DEI).  Both high and low voltage contacts.Ordinary household current in the United States is 110 to 220 volts. Anything over 500 volts is considered high voltage. Electrical burns from high-voltage circuits generally are much worse than they appear in the ED.

Electric shocks from static electricity such as those experienced when getting out of a car or walking across a man-made carpet can be at more than 10,000 volts. High voltage can jump (arc) through the air anywhere from an inch up to several feet, depending on the voltage. Thus a person may be injured simply by coming too close to a high-voltage line. High voltage causes more severe injuries than low voltage and is more likely to cause internal damage. Kidney damage may result when high voltage burns large amounts of muscle, which releases a chemical into the blood.  More than 500 lightning deaths and generated electrical deaths per year are estimated to occur. Between 3-5% of burn unit admissions are associated with electrical burns.  About 1,000 people die annually of electric shock in the United States.  High-voltage injury: Generally, patients who have been in high-voltage circuits do not arrest but have extensive injuries from burns and are at risk of acute and chronic problems from myoglobinuria.

Electrical injuries are most frequent in young adult men aged 20-40 years. Electric shock is sometimes used as a punishment in novelty games such as Lightning Reaction, Shocking Roulette, Shocking Liar, Laser Shock Guns, and Shocking Tanks. In addition to these games, there are some prank toys like a fake pen, chocolate candy, or cigarette lighter which give out a mild shock. The nerves and brain can be injured in various ways, causing seizures, brain hemorrhages, poor short-term memory, personality changes, irritability, or difficulty sleeping. Damage to the nerves in the body or spinal cord may cause weakness, paralysis, numbness, tingling, uncontrollable loss of urine (incontinence), and chronic pain. Severe shocks can also trigger powerful muscle contractions sufficient to throw a person to the ground or to cause joint dislocations, bone fractures, and other blunt injuries. Electric shock delivered by an electric chair is sometimes used as a means of capital punishment, although its use has become rare in recent times.

Electrical Injury  Treatment Tips

1. Remove the patient from the circuit.

2. Use child safety plugs in all outlets.

3. Keep electrical cords out of children’s reach.

4. Teach your children about the dangers of electricity.

5. Avoid electrical hazards at home and at work

6. Parents of small children should put safety guards on all electrical outlets, and keep children away from electrical devices.

7. Avoid using electrical appliances while showering or wet.

8. Never touch electrical appliances while touching faucets or cold water pipes.

Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria.  Osteomyelitis  is a bone infection often caused by a bacteria called Staphylococcus aureus. Osteomyelitis does not occur more commonly in a particular race or gender. The infection associated with osteomyelitis may be localized or it may spread through the periosteum, cortex, marrow, and cancellous tissue. The bacterial pathogen varies on the basis of the patient’s age and the mechanism of infection. Osteomyelitis affects about two out of every 10,000 people. Osteomyelitis can affect both adults and children. The bacteria or fungus that can cause osteomyelitis, however, differs among age groups. In adults, osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the adjacent ends of long bones. Long bones are large, dense bones that provide strength, structure, and mobility. They include the femur and tibia in the legs and the humerus and radius in the arms. Chronic osteomyelitis results when bone tissue dies as a result of the lost blood supply.

Chronic infection can persist intermittently for years. Fever, usually the most obvious sign of an infection, is often absent. Risk factors are recent trauma, diabetes, hemodialysis, and intravenous drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.More commonly, chronic osteomyelitis causes bone pain, recurring infections in the soft tissue over the bone, and constant or intermittent drainage of pus through the skin. Osteomyelitis is an infective process which encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic it can lead to bone sclerosis and deformity.  Treatment of osteomyelitis depends on the severity of the infection and whether it is acute (recent) or chronic (has been present for a longer period of time).  Surgery may be needed to drain abscesses or to stabilize affected vertebrae (to prevent the vertebrae from collapsing and thereby damaging nearby nerves or blood vessels).
 
The treatment generally consists of surgical debridement (cleaning) of the infected bony and soft tissue structures, and the prolonged use of antibiotics. Antibiotic therapy is continued for at least 3 weeks after surgery.   Treatment for chronic osteomyelitis may require several operations to remove all the infected bone and other tissue, completely draining the abscess and repairing the bone when possible. Bracing is recommended to provide stability for the spine while the infection is healing. It is usually continued for 6 to 12 weeks, until either a bony fusion is seen on x-ray, or until the patient’s pain subsides. Treatment with free ciprofloxacin or vancomycin for 14 days was ineffective in eradicating osteomyelitis. Surgical decompression is necessary if an epidural abscess places pressure on the neural elements. The goal of surgical treatment is to convert an infection with dead bone to a situation with well-vascularized tissues that are readily penetrated by blood-borne antibiotics.

Osteomyelitis  Treatment Tips

1. Antibiotic therapy is continued for at least 3 weeks after surgery.

2. Bracing is recommended to provide stability for the spine while the infection is healing. It is usually continued for 6 to 12 weeks.

3. Treatment with free ciprofloxacin or vancomycin for 14 days was ineffective in eradicating osteomyelitis.

4. Surgical decompression is necessary if an epidural abscess places pressure on the neural elements.