Alzheimer’s Disease

Overview

What is Alzheimer’s disease?

Alzheimer’s disease is a type of dementia. Dementia is a word that doctors use to describe a wide range of symptoms linked to physical and functional changes in the brain. Dementia usually affects a person’s memory, thinking abilities, and behavior. These mental changes make it hard for a person who has dementia to care for him- or herself.
Alzheimer’s disease is the most common cause of dementia, but many other things can also cause dementia.

How common is Alzheimer’s disease?

Alzheimer’s disease is common in people older than 65 years of age. About 1 out of every 8 people who are 65 years of age or older have the disease. Nearly half of people 85 years of age and older have Alzheimer’s.
People who are younger than 65 years of age can also have Alzheimer’s disease. This is called early onset Alzheimer’s. Early onset Alzheimer’s is not very common. Approximately 200,000 people in the United States have early onset Alzheimer’s.
This content has been supported by Forest Laboratories Inc.

Symptoms

Why is Alzheimer’s disease called a “progressive” disease?

“Progressive” means that the symptoms of Alzheimer’s disease usually start slowly and are mild, then get worse over time. The process of symptoms getting worse over time is called “cognitive decline.” In the late stages of the disease, a person who has Alzheimer’s is no longer able to communicate and depends entirely on other people for care.

How long does a person usually live with Alzheimer’s disease?

It’s different for each person. Alzheimer’s disease is the fifth leading cause of death for Americans older than 65 years of age and the sixth leading cause of death for all people in the United States. Most people live 4 to 8 years after being diagnosed with Alzheimer’s disease. Some live with the disease for up to 20 years.

What are the warning signs and symptoms of Alzheimer’s disease?

The Alzheimer’s Association has identified 10 warning signs and symptoms of Alzheimer’s disease (see the list below). It’s important to remember that every person is different and may not have all or even most of these warning signs. Talk to your family doctor if you notice 1 or more of these signs in yourself or a loved one.

10 Alzheimer’s Disease Warning Signs

1. Memory loss that affects daily life: Examples include forgetting important dates or things you just learned; asking the same question over and over; or relying heavily on reminder notes, technology, or other family members to remember things.
2. Changes in the ability to follow a plan or solve a problem: This may include having trouble concentrating on a problem, such as a math problem; following a plan, such as a recipe; or keeping track of regularly scheduled tasks, such as paying monthly bills.
3. Changes in the ability to complete familiar tasks: Alzheimer’s disease can make it hard to do the things that you used to do all the time. For example, it might be hard to do chores at home, run errands, or finish a routine task at work.
4. Becoming confused about time or place: Examples include losing track of how much time has passed or the date or the day of the week and forgetting where you are and how you got there.
5. Problems with vision or understanding visual information: Examples include trouble reading, identifying colors or judging distances, or getting confused about what you see.
6. Problems with words: Examples include forgetting words in the middle of a conversation, repeating parts of a conversation, or problems with vocabulary, such as calling things by the wrong names.
7. Misplacing things: Examples include putting things in unusual places, losing things often, being unable to retrace steps in order to find a lost object, and even accusing others of stealing.
8. Poor judgment: Examples include paying less attention to appearance or cleanliness and using poor judgment with money, such as giving large amounts of money to solicitors.
9. Withdrawal from activities: Examples include withdrawing from social activities, work projects, or family gatherings, or abandoning a hobby, sport, or favorite activity.
10. Changes in mood and personality: Examples include becoming unusually confused, suspicious, upset, depressed, fearful, or anxious, especially when in new or unfamiliar places.

Causes & Risk Factors

What causes Alzheimer’s disease?

Doctors don’t know exactly what causes Alzheimer’s disease. It appears that Alzheimer’s disease develops when clumps of abnormal proteins grow in the brain. This growth likely begins with a series of many small changes in the brain that start long before any symptoms are noticeable. Over time, these changes add up. Eventually, brain cells become damaged and die.

What are the risk factors for Alzheimer’s disease?

The risk factors for Alzheimer’s disease include the following:

• Age: The older you are, the greater your risk of developing Alzheimer’s disease. After age 65, your chance of developing Alzheimer’s doubles every 5 years. People who are 85 years of age or older have a nearly 50% chance of having the disease.
• Genetics and family history: You are more likely to get Alzheimer’s disease if you have a family history of Alzheimer’s disease, meaning that one or more of your parents, siblings, or children has the disease. Scientists also think that certain genes in your DNA may increase your risk for Alzheimer’s disease.
• Down syndrome: People who have Down syndrome have a much higher risk for Alzheimer’s disease than the general population.
• Environmental/lifestyle factors: It is likely that your environment and your lifestyle habits also affect your risk for Alzheimer’s disease. A history of head trauma, cardiovascular or heart problems, diabetes, and obesity appear to increase your risk for Alzheimer’s disease. To help prevent these health problems, wear a helmet when riding a bicycle, always buckle your seat belt when in the car, establish a regular exercise routine, eat right, and avoid tobacco products.

Alzheimer’s disease also appears to be more common in women than in men. Nearly two-thirds of people who have Alzheimer’s disease are women.

Diagnosis & Tests

When should I see my doctor?

If you are worried that you or a loved one might have some of the warning signs of Alzheimer’s disease, talk to your family doctor right away. Getting an early diagnosis of Alzheimer’s will help you get treatment earlier and will give you time to address questions of care, finances, and legal issues with your family.

How does my doctor determine whether I have Alzheimer’s disease?

The diagnosis of Alzheimer’s disease may take some time. There is no test that can tell your doctor whether you have Alzheimer’s disease. So, to make sure your doctor has plenty of information to help determine the cause of your symptoms, he or she may:

• Ask you questions about your current health and your medical history.
• Ask you questions about your daily routine and any changes in your behavior.
• Perform a mental exam to test your memory, problem-solving, attention, and language abilities.
• Perform medical tests, such as blood or urine tests.
• Perform brain scans to look for problems, such as stroke, that may be causing your symptoms.

Based on this information, your doctor can almost always tell whether you have dementia. Your doctor can tell whether Alzheimer’s disease is the cause of your dementia about 90% of the time. But Alzheimer’s disease can only be diagnosed with 100% accuracy after death, when the brain is examined under a microscope. The brain of a person who had Alzheimer’s disease will show very distinct changes that only happen when Alzheimer’s is the cause of dementia.

Treatment

Is there a cure for Alzheimer’s disease?

No, there is no cure for Alzheimer’s disease. Instead, treatment may focus on the following:

• Slowing the progression of symptoms such as memory loss.
• Addressing behavior changes such as depression and aggression.
• Helping to relieve other symptoms, such as sleep problems.

What medicines are used to treat the symptoms of Alzheimer’s disease?

The different medicines your doctor may prescribe to treat Alzheimer’s disease symptoms are listed below. It’s important to remember that these medicines do not stop the disease. They may not work for every person or may help for only a short time.

Medicines for memory

• Cholinesterase inhibitors have been approved by the Food and Drug Administration (FDA) to treat all stages of Alzheimer’s disease. Rivastigmine and galantamine can treat mild to moderate Alzheimer’s. Donepezil is approved to treat mild to severe Alzheimer’s. Typical side effects of these drugs include diarrhea, nausea, and vomiting. The FDA has also approved another cholinesterase inhibitor, tacrine, to treat Alzheimer’s disease, but doctors don’t often prescribe it because it can cause more serious side effects.
• Memantine is approved to treat moderate to severe Alzheimer’s disease. It may be used alone or in addition to one of the cholinesterase inhibitors listed above. It may cause side effects such as dizziness and headaches.

Medicines for behavior

• Depending on the behavioral problems and the severity of the problems, your doctor may also choose to prescribe drugs such as pain relievers, antidepressants, anti-anxiety medicines, sleep medicines, or antipsychotics.

What should I know about clinical trials?

Clinical trials are research studies that help doctors and scientists determine whether a new drug or treatment is safe and effective. During a clinical trial, patients volunteer to receive the new treatment and give the researchers permission to study them. Right now, researchers are trying hard to find new ways to treat or cure Alzheimer’s disease. If you think you might want to volunteer to be part of a clinical trial for Alzheimer’s disease treatments, talk to your family doctor.

What about non-drug treatments?

Drugs don’t always help relieve the symptoms of Alzheimer’s disease. Non-drug treatments for a person who has Alzheimer’s disease often include managing your loved one’s environment and establishing a routine to help reduce stress and anxiety. Read “Caring for a Relative Who Has Dementia” to learn more.

Complications

What are the complications of Alzheimer’s disease?

Complications of Alzheimer’s disease usually are a result of the changes that take place in the brain as the disease progresses. These changes can cause additional health problems, including:

• Depression: Depression is common in people who have Alzheimer’s disease. Many people become depressed when they recognize that their memories and abilities to function are getting worse. It can be hard to tell whether a person who has Alzheimer’s is depressed. Many of the symptoms of depression are very similar to the symptoms of Alzheimer’s disease, including withdrawal from daily activities, changes in mood, and sleeping problems.
• Unreported pain, illness, or medicine side effects: Alzheimer’s disease may make it hard for a person to communicate. As such, a person who has Alzheimer’s may not be able to tell caregivers if they’re in pain, are sick, or are experiencing side effects from a medicine.
• Falling: Alzheimer’s disease can cause changes in balance and coordination. This may cause an increased risk of broken bones, head trauma, or other injuries from falls.
• Pneumonia or other infections: Alzheimer’s disease may cause a loss of control of certain body functions, such as swallowing or bladder control. Problems swallowing may cause the person to accidentally inhale food or drink. This can lead to pneumonia. If the person has problems with bladder control, he or she may need to have a urinary catheter. A catheter is a tube placed in the bladder to drain and collect urine. Having a catheter increases the risk of urinary tract and other serious infections.
• Malnutrition or dehydration: People who have Alzheimer’s disease may not get enough food or water because they refuse food when they are confused or upset; they don’t recognize or are unable to communicate that they are hungry or thirsty; or because it is difficult for them to swallow. It’s important to watch for signs of malnutrition.

If you think that a loved one might be experiencing any of the complications listed above, talk to your loved one’s doctor. He or she can provide medicine or other treatments to help keep your loved one comfortable.

Questions to Ask Your Doctor

• Is it possible that my/my loved one’s mental or behavioral changes are just a normal part of aging, not a symptom of disease?
• Do I/Does my loved one have dementia? How can you tell?
• Do you think that my/my loved one’s symptoms might be caused by Alzheimer’s disease?
• What tests do I/does my loved one need?
• If it is Alzheimer’s disease, what kind of care will I/my loved one need, now and in the future?
• What treatments do you recommend now? As the disease progresses?
• Should I/we think about participating in any clinical trials? What are the pros and cons of participating in a clinical trial?
• What lifestyle changes can I/my loved one make at home to help relieve symptoms?
• What can I, as a caregiver, do to make my loved one more comfortable?

Amblyopia

Overview

What is amblyopia?

Amblyopia (say this: “am-blee-oh-pee-ah”) is an eye problem that causes loss of or poor vision in one or both of a child’s eyes. Amblyopia usually affects only one of the eyes, but sometimes it can affect both. Amblyopia is the most common cause of vision problems in children.

Causes & Risk Factors

What causes amblyopia?

Anything that happens to blur a child’s vision or cause the eyes to become crossed may cause amblyopia. For example, children who have strabismus (also called “crossed eyes”), cataracts, a droopy eyelid or who need glasses to see better may get amblyopia.
All babies are born with poor eyesight. As babies grow, their eyesight gets better. In order to develop good eyesight, both eyes needs to provide a clear, focused image that is the same in both eyes. If the image isn’t clear in one eye or if the image isn’t the same in both eyes, the child gets a different picture from each eye. The child’s brain naturally tries to fix this problem by blocking out the picture from the weaker eye. If the problem is not fixed when the child is young, the child’s brain will always ignore pictures from the weak eye, causing amblyopia.

Treatment

How is amblyopia treated?

The treatment for amblyopia depends on what is causing it. After the cause of the amblyopia is found, the child will need to use the weaker eye most of the time, so it will get stronger. To make the child use the weaker eye, a patch can be put over the stronger eye. Sometimes, eye drops or special glasses are used to blur the vision in the stronger eye. This makes the weaker eye become stronger. Patches may be used all day or part of the day, depending on the child’s age and vision.
Glasses or contact lenses fix some problems. Surgery may be needed for cataracts, droopy eyelids or crossed eyes.
Treatment usually lasts until vision is normal, or until vision stops getting better. For most children, this takes several weeks. A few children need to use eye patches until they are 8 years to 10 years of age.

Why is early treatment important?

The first few years of life are the most important for eyesight. After a child is 8 years to 10 years of age, the brain’s vision system is complete. It can’t develop anymore. If the amblyopia hasn’t been treated by this age, the child will have poor vision for life. It won’t be possible to fix it with glasses, patching or any other treatment.
There’s a small chance that using an eye patch for too long can hurt the strong eye. For this reason, children who are wearing eye patches should see their doctor often during the treatment.

Questions to Ask Your Doctor

• Will my child always have vision problems?
• What is the best way to treat amblyopia?
• Will my child need glasses or contacts?
• My child needs to wear an eye patch. How long will he or she wear it?
• Are there any long-term problems from amblyopia?

Amenorrhea

Overview

What is amenorrhea?

Amenorrhea (say: “ay-men-or-ee-uh”) is when you don’t have menstrual periods. There are two types of amenorrhea. Primary amenorrhea is when you haven’t ever had a period and you are 16 years of age or older. Secondary amenorrhea is when you have had normal periods but then you don’t have one for 3 or more months in a row.

Causes & Risk Factors

What causes amenorrhea?

Primary amenorrhea can be caused by the following:
You may develop secondary amenorrhea due to:

• Problems with the hypothalamus, which is an area in your brain that interacts with your pituitary gland to regulate your menstrual cycle
• Abnormal chromosomes
• Pituitary disease, which affects the pituitary gland. The pituitary gland is located just under the brain and helps regulate your menstrual cycle.
• An obstruction of the vagina, such as a membrane that is blocking menstrual flow
• Pregnancy
• Use of oral or injected contraceptives, such as birth control pills or Depo-Provera
• Stress
• Certain types of medicine, such as antidepressants, chemotherapy medicine and antipsychotics
• Extremely low body weight
• A problem with the thyroid, which is another gland that produces hormones that have an effect on menstruation
• Regular strenuous exercise, like long distance running, especially if body fat is low

Treatment

What should I do if I think I have amenorrhea?

You should see your doctor if you think you have amenorrhea. The following things may help you and your doctor figure out the cause of your amenorrhea:

• If you could be pregnant, take a home pregnancy test.
• If your periods aren’t the same every month, write down when they start and how long they last. Then give this information to your doctor.
• Find out if you have any family members with similar menstrual problems.
• Remember that it is still possible to get pregnant even if you aren’t having regular periods every month.

How is amenorrhea treated?

Treatment depends on what is causing your amenorrhea. It may be as simple as changing your diet and exercise program to help you maintain a healthy weight. You may need medicine. Rarely, surgery is needed.

Questions to Ask Your Doctor

• What is the likely cause of my amenorrhea?
• I take birth control pills or get injections. If I stop, will my periods return?
• Do I need any tests?
• Will lifestyle changes, such as to my diet or exercise, help?
• Can I still get pregnant?

Anaphylaxis

Overview

What is anaphylaxis?

Anaphylaxis (say: “anna-full-ax-iss”) is a life-threatening allergic reaction. It starts soon after you are exposed to something you are severely allergic to. You may have swelling, itching or a rash with itchy bumps (hives). Some people have trouble breathing, a tight feeling in their chest or dizziness. Some people feel anxious. Other people have stomach cramps, nausea or diarrhea. Some people lose consciousness (pass out). A person who has anaphylaxis needs immediate medical attention

Symptoms

What are the symptoms of anaphylaxis?

Anaphylaxis symptoms may include one or more of the following:
These symptoms usually show up right after you are exposed to an allergen (see Causes & Risk Factors to learn more about allergens). The symptoms can be mild or severe. Be sure to tell your doctor if you think you’ve ever had a severe allergic reaction or symptoms of anaphylaxis, even if your symptoms were mild.

• Hives, rash, or itchy skin
• Pale skin, or skin that is red and warm (flushed)
• Swelling in the mouth or throat, or of another body part
• Wheezing or trouble breathing
• A tight feeling in the chest
• Dizziness
• Fainting
• A feeling of anxiety
• Nausea, vomiting, or diarrhea

Causes & Risk Factors

What causes anaphylaxis?

Anaphylaxis is most often caused by exposure to an allergen. Normally, when you are exposed to an allergen, your immune system produces antibodies to help you “fight” the allergen. These antibodies are the cause of normal allergy symptoms—normal allergy symptoms aren’t life threatening. However, sometimes your immune system can overreact to an allergen and cause a very severe allergic reaction—this can lead to anaphylaxis and is very dangerous.
Allergens and substances that may lead to anaphylaxis include the following:

• Foods such as shellfish, nuts, peanuts, eggs, and fruits
• Medicines such as antibiotics, aspirin, over-the-counter pain relievers (such as ibuprofen), allergy shots, and contrast dye for imaging procedures
• Latex or rubber found in surgical gloves, medical supplies, and many products in your home
• Insect stings, especially from bees, wasps, hornets, yellow jackets, sawflies, and fire ants

Prevention

How do I prevent anaphylaxis?

The following are some ways to help prevent a reaction:
If you are at risk of anaphylaxis, keep an emergency anaphylaxis kit with you at all times. Make sure the people around you, such as your family and friends, know how to use it.

• If you have had anaphylaxis, make sure your doctor and dentist know so that it is recorded on your medical chart. Tell them what you are allergic to, if you know.
• If you are allergic to insect stings, wear protective clothing and insect repellent when you’re outside.
• Avoid handling or eating foods you are allergic to. Even tiny amounts mixed by accident into your food can cause a reaction. Read the ingredient list on any packaged foods you are going to eat.
• Wear or carry a medical alert bracelet, necklace or keychain that warns emergency medical technicians (EMTs) and doctors that you are at risk for anaphylaxis.
• Ask your doctor if you need desensitization shots. If you have had anaphylaxis because of a bee or wasp sting, desensitization shots are almost always a good idea.
• Ask your doctor if there are other things you also might be allergic to.

Treatment

What do I do if I have or someone I know has a severe allergic reaction?

Call 911 to get emergency medical help right away.
If the person having an attack has an emergency anaphylaxis kit with an EpiPen (epinephrine injector), give him or her the epinephrine injection right away. Then, make sure he or she still goes to the emergency room for follow-up. Epinephrine just buys the victim some time to get to emergency care.

What is in an emergency anaphylaxis kit?

An emergency anaphylaxis kit contains medicine to counteract your allergic reaction. This medicine is usually a drug called epinephrine that you inject into your arm or leg (or have a friend inject). Your doctor will prescribe a kit with the right dose of medicine and will teach you how to use it. Make sure your family, friends, and coworkers also know how to use the kit. Sometimes your doctor will tell you to keep an antihistamine, such as diphenhydramine (one brand name: Benadryl), in the kit too.

What can I expect after anaphylaxis?

You should recover completely with treatment. Most people live a normal, full life. You can get back to your normal activities once you are feeling better. However, you should have someone stay with you for 24 hours after anaphylaxis to make sure another attack does not happen.
If you’ve had anaphylaxis, you need to be prepared for the possibility that you will have anaphylaxis again in the future. Talk to your doctor about how to minimize your risk for anaphylaxis in the future, and how to use your emergency medical kit.

Questions to Ask Your Doctor

• I have an allergy. Could I be at riskfor anaphylaxis?
• What should I have in my anaphylaxiskit?
• Do I need to wear a medical alertbracelet? Where do I get one?
• If I’ve had one anaphylactic reaction,am I at greater risk for another one?
• How do I make sure that all members ofmy health care team know about my risk for anaphylaxis?

Angina

What is angina?

Angina (say: “ann-jie-na”) is a squeezing pain or a pressing feeling in the chest. It is most often caused by blockages in the arteries that supply blood to your heart. This is called coronary artery disease, or heart disease.

Symptoms

How do I know if my pain is angina?

Angina can bother you when you are doing activities like walking, climbing stairs, exercising or cleaning. The pain of angina may make you sweat or make it hard to catch your breath. You may feel pain in your arm, neck, jaw or shoulder as well as in your chest. If the pain is mild, it may go away after a minute or so of rest. If the pain is more severe, medicine may be needed. Often, a medicine called nitroglycerin is used to treat severe angina.
Some people have angina that comes on with a certain level of activity and goes away easily. They may have this kind of angina for a long time. This is called stable angina.
When the pattern of angina changes a lot, it’s called unstable angina. This is a sign of danger. More episodes of angina with less exertion, angina that comes on while you’re resting, or angina in someone who hasn’t had it before are also danger signs.
Unstable angina may be the first sign of a heart attack. If you get angina, you should call your doctor or go to the nearest emergency room right away. Another sign of danger is chest pain that doesn’t go away with rest or after taking medicine. If you have chest pain that doesn’t go away, go to the emergency room right away.

Causes & Risk Factors

What causes angina?

Angina is most often caused by blockages in the arteries that supply blood to your heart. This is called coronary artery disease, or heart disease. Your doctor will test you for heart disease and also will check for any conditions that can increase your chance of heart disease. These conditions include:

• High blood pressure
• Diabetes
• Smoking
• High cholesterol level
• Menopause in women
• Family members who have had heart disease at a young age

Diagnosis & Tests

What tests might my doctor do?

An electrocardiogram, sometimes called an EKG or ECG, is a simple test that can show if your heart or arteries have been damaged. If the EKG is done while you are having angina, it can also show if your pain is caused by a problem with your heart.
The next step after an EKG may be a stress test. Often, this test is done while you walk on a treadmill. Your doctor will look at how your heart handles work to see if it’s abnormal when you exercise. Your doctor may also have X-rays of your heart taken before and after you exercise. These pictures can show if an area of the heart is not getting enough blood during exercise. If this is so, it may mean that the arteries supplying blood to your heart are blocked.
Another important test is cardiac catheterization (say: “kath-a-ter-a-zay-shun”). In this test, a very long and very thin tube is inserted through an artery in the arm or leg and then guided into the heart. Dye is injected into the arteries around the heart and X-rays are taken. The X-rays will show if any of the arteries that supply the heart are blocked.

Treatment

How is angina treated?

If you have heart disease, your angina can be treated by treating the heart disease. If something other than heart disease is causing your chest pain, your doctor will recommend treatment for that condition.

Prevention

How can I prevent angina?

The best way to prevent angina is to prevent heart disease. Keep your blood pressure, diabetes and cholesterol levels under control and, if you smoke, stop. Maintaining a healthy diet, a healthy weight and a regular exercise program can help you avoid heart disease.
If you already have heart disease, the steps listed above are important to help keep the problem from getting worse.

Questions to Ask Your Doctor

• What is the likely cause of my chest pain?
• What lifestyle changes do I need to make at home to help relieve my symptoms?
• Is it safe for me to exercise? How do I get started?
• What treatment option is best for me? Will I need medicine? Surgery?
• Will the medicine you’re prescribing interact with medicine(s) I already take?
• What symptoms will indicate that my condition is getting worse?
• Does angina put me at risk for any long-term problems?

Anemia

Overview

What is anemia?

Anemia is a condition that affects your red blood cells. Your red blood cells carry oxygen from your lungs to the rest of your body. Hemoglobin is the protein in red blood cells that allows them to carry oxygen. Your body needs iron in order to make hemoglobin.People who have anemia don’t have enough hemoglobin. The most common cause of anemia is when your body doesn’t make enough hemoglobin because it doesn’t have enough iron. This is called iron deficiency anemia.
Another common type of anemia is when your body doesn’t have enough red blood cells, but the red blood cells you do have are normal in size. This is called normocytic (say: “normo-sit-tic”) anemia.

Symptoms

What are the symptoms of anemia?

• Often, no symptoms
• Paleness
• Feeling tired
• Unusual shortness of breath during exercise
• Unusual food cravings (known as pica)
• Fast heartbeat
• Cold hands and feet
• Brittle nails or hair loss
• Headaches
• Dizziness or lightheadedness

Causes & Risk Factors

What can cause low iron levels?

A number of things can cause low iron levels in your body:

Diet.

You may have low iron levels if you don’t eat enough foods high in iron. This is mostly a problem for children, young women who follow “fad” diets and people who don’t eat meat.

Inability to absorb iron.

The iron in your food is absorbed by the body in the small intestine. Diseases that affect your small intestine’s ability to absorb nutrients, such as Crohn’s disease or celiac disease, may cause low iron levels in your body. Some foods or medicines, including milk, antacids or stomach acid-lowering medicines, also can prevent your body from absorbing iron.

Growth spurts.

Children younger than 3 years of age grow so fast that their bodies may have a hard time keeping up with the amount of iron they need.
Infants who drink cow’s milk in the first year of life are at risk for iron deficiency anemia. It’s the most common dietary cause of iron deficiency in infants. Cow’s milk does not have enough of the iron infants need to grow and develop. Do not give cow’s milk to your infant in the first year of life. Breastfed infants who do not eat iron-rich foods like iron-fortified cereal or take an iron supplement after the fourth month of life are also at risk of iron deficiency anemia.
Toddlers (12 to 24 months of age) who drink a lot of cow’s milk, have a diet low in iron, or already had iron deficiency as an infant are also at risk.

Pregnancy.

Women who are pregnant or who are breastfeeding need more iron than women who are not pregnant or breastfeeding. That’s why pregnant women often are tested for anemia and why they need to eat more iron-rich foods or take a daily iron pill.
When you’re pregnant, your body makes more blood to share with your baby. You may have up to 30% more blood than when you’re not pregnant. If you don’t have enough iron, your body can’t make the red blood cells that it needs to make this extra blood.
The following may increase your risk of anemia during pregnancy:

• Vomiting a lot from morning sickness
• Not getting enough iron-rich foods
• Having heavy periods before pregnancy
• Having 2 pregnancies close together
• Being pregnant with twins, triplets or more
• Becoming pregnant as a teenager
• Losing a lot of blood (for example, from an injury or during surgery).

If you are pregnant and are not getting enough iron, you are at risk of developing iron-deficiency anemia.

Blood loss.

Heavy periods may cause low iron levels in women. Internal bleeding, usually in the digestive tract, also can cause blood loss. A stomach ulcer, ulcerative colitis, cancer, or taking aspirin or similar medicine for a long time can cause bleeding in your stomach or intestines.

Genetic diseases.

If you have sickle cell disease or thalassemia, your body has trouble producing healthy red blood cells, which can lead to anemia. You’re also at risk of passing these diseases on to your unborn baby. If you or someone in your family has one of these diseases, talk to your doctor about how to prevent or treat anemia while you’re pregnant.

What causes normocytic anemia?

Normocytic anemia can be a problem you were born with (called congenital) or it can be caused by an infection or disease (called acquired).The most common cause of the acquired form of normocytic anemia is a chronic (long-term) disease. Chronic diseases that can cause normocytic anemia include kidney disease, cancer, rheumatoid arthritis and thyroiditis. Some medicines can cause you to have normocytic anemia, but this does not happen often.

Diagnosis & Tests

How is anemia diagnosed?

Talk to your doctor if you think you might have anemia. To diagnose anemia, your doctor will probably test your blood. If you have anemia, your doctor may need to do other tests to find out what’s causing it.
Normocytic anemia is most often found by routine tests that are part of a physical exam. It might be found by a blood test you get for some other reason. A complete blood count (also called a CBC) can show if you have normocytic anemia.If your CBC shows a low number of normal-sized red blood cells, your doctor might want you to get more tests to see what is causing the anemia. If you were born with it, other family members may also need to be tested.

Should my child be tested for iron deficiency?

If you’re worried and think your child might have iron deficiency anemia, talk to your doctor. Infants at risk for iron deficiency should be checked with a blood test at 9 to 12 months of age. Toddlers should be checked 6 months later and at 24 months.

Should I be tested for anemia if I’m pregnant?

During your first prenatal visit, you’ll have a blood test to check for anemia. Even if you don’t have anemia during your early pregnancy, your doctor will probably want to check you again in your second or third trimester.

Treatment

How is anemia treated?

Treatment depends on what’s causing your anemia. For example, if anemia results from losing too much blood, your doctor will need to treat the cause of your blood loss. If anemia results from your diet being too low in iron, your doctor may recommend a change in your diet or iron pills.

How is normocytic anemia treated?

Managing the condition that is causing the anemia is the most important part of treating it. This might mean you would stop taking a particular medicine, or your doctor might treat a chronic illness or look for something that is causing you to lose blood cells.If your normocytic anemia is very bad, you might get shots of erythropoietin. Erythropoietin (say: “air-rith-ro-po-et-in”) helps your bone marrow make more red blood cells.

How is anemia treated in children?

If your child is breastfed, talk to your doctor about adding some form of iron, such as iron-fortified cereal or vitamin drops with iron, to your child’s diet starting at 4 to 6 months of age.

Tips on taking iron pills

• Take the pills with food.
• Start slowly. Try taking 1 pill a day for 3 to 5 days, then 2 pills a day until you aren’t bothered by that amount. Increase the number of pills until you’re taking the amount your doctor recommended.
• Increase the fiber in your diet if you have constipation. This is worth trying, even though fiber may get in the way of how well your body can absorb iron. You’ll still be able to absorb some iron, and it’s better than not taking any iron if you need it.
• Don’t take iron pills at bedtime if they upset your stomach.
• If one type of iron pill causes problems, talk to your doctor about trying a different formula or brand.

Warning:

Keep all products with iron stored out of the reach of your child because they can be poisonous if taken in large amounts.

Complications

What problems can iron deficiency anemia cause in my child?

Iron deficiency anemia can cause your infant or toddler to have mental, motor or behavior problems. These problems can be long lasting even after treatment fixes the anemia.

What problems does anemia cause during pregnancy?

If anemia isn’t treated, it can increase your risk of having your baby too early or having a baby who doesn’t weigh enough. You’ll also be at risk of needing a blood transfusion if you lose a lot of blood during delivery. Anemia may also be associated with postpartum depression (depression after delivery) in new mothers.Rarely, mothers who have severe iron-deficiency anemia may pass along problems associated with low iron to their babies. This can lead to growth problems and mental delays. However, developing babies usually take as much iron as they need from their mothers. Getting treatment for your iron-deficiency anemia can almost always prevent these problems.

Can iron pills cause problems?

Iron pills can cause stomach upset, heartburn and constipation. Be sure to talk to your doctor before you take extra iron pills or vitamins. Lack of iron in your diet may not be the cause of your anemia and too much iron is not good for you. If your doctor prescribes iron supplements, be sure to tell your doctor about any discomfort you notice.

Prevention

Can anemia be prevented?

Some types of anemia can be prevented, such as those caused by diet. You can help prevent this type of anemia by increasing the amount of iron in your diet.

How can I increase the iron in my diet?

Eat more foods that are high in iron. Your body best absorbs iron that comes from meat. Eating a small amount of meat along with other sources of iron, such as certain vegetables, can help you get even more iron out of these foods. Taking vitamin C pills or eating foods high in vitamin C, such as citrus fruits or juice, at the same time you eat iron-rich foods or take your iron pill can also help your body absorb the iron.
Some foods prevent your body from absorbing iron, including coffee, tea, egg whites, milk, fiber and soy protein. Try to avoid these foods when you’re eating food high in iron.

Foods high in iron

• Liver
• Red meat
• Seafood
• Dried fruits such as apricots, prunes and raisins
• Nuts
• Beans, especially lima beans
• Green leafy vegetables, such as spinach and broccoli
• Blackstrap molasses
• Whole grains
• Iron-fortified foods like many breads and cereals (check the label)

How can I prevent iron-deficiency anemia during pregnancy?

You can’t always prevent anemia during pregnancy, but eating foods rich in iron can help. Doctors recommend that pregnant women eat at least 27 mg of iron daily. Most doctors also recommend that pregnant women take a supplement that contains 30 mg of iron each day. (Most prenatal vitamins contain at least this amount.)
Foods with vitamin C—such as strawberries and citrus fruits—help your body absorb iron. Eat these foods with foods that are high in iron to help with absorption. For example, if you’re taking an iron pill, take it with orange juice or another food high in vitamin C. Some foods can block iron absorption. These include milk, soy protein, egg yolks, coffee and tea. Avoid these foods when eating iron-rich foods. Antacids and some other medicines that contain calcium also block iron absorption. Your doctor can tell you more about which medicines to avoid if you’re trying to boost your iron levels.

How do I prevent iron-deficiency anemia in my child?

If you use iron-fortified formula, do not give your child vitamin drops with iron. This combination provides too much iron and is not healthy. If you decide to stop breastfeeding before your infant is 12 months of age, use iron-fortified formula. Do not use low-iron formula. After your child is 12 months old, if you stop breastfeeding or using iron-fortified formula, you should feed your toddler meat, chicken, fish, whole grains, enriched bread and cereal, dark green vegetables, and beans. Vitamin C is also important because it helps the body absorb iron. You should limit your child to less than 24 oz of cow’s milk per day. (That’s 3 cups of milk.) You might try giving your child yogurt and cheese. Ask your doctor if you should continue to give your child vitamins with iron.

Questions to Ask Your Doctor

• How do I know if I have anemia? Is it dangerous?
• I’m pregnant. Should I be tested for anemia?
• How is anemia treated?
• I’ve had anemia before. How can I prevent getting it again?
• Should I be taking an iron supplement?
• Do iron pills treat all kinds of anemia?
• Can I pass anemia on to my child?
• Will I always have anemia?

Anal Fistulas

Overview

An anal fistula is an abnormal tube-like connection, which forms between the inside of the anus (anal gland) and the skin right outside the anus.

Symptoms

The abscess causes intense pain and swelling around the anus that gets worse with bowel movements. Sometimes there’s discharge from an opening around the anus.

Causes

An anal fistula is usually caused from a previous abscess (a swollen area where pus gathers). As the pus drains, it can leave a channel between the bowel and the skin.

Diagnosis

An anal fistula can be diagnosed with a physical exam of the area. If your doctor sees a fistula, he or she will usually try to determine the depth and direction of the fistula. In some cases, further tests may be required.

Prevention

Almost all anal fistulas develop as a result of an abscess in the area. Sometimes abscesses are caused by Crohn’s disease, trauma, or STDs.

Treatment

Most anal abscesses can be drained in a doctor’s office under local anesthesia. If a fistula has developed, the doctor will need to surgically remove it.

Everyday Life

After the fistula has been removed, you’ll need to take antibiotics. You may want to wear a pad over your anal area until you’re healed. Sitz baths can help you feel better. Fill the tub with enough lukewarm water to cover your hips and buttocks. Don’t use soap or bubbles or any other products unless prescribed by your doctor. Relax in the sitz bath 3 to 4 times a day for about 10 minutes at a time.

Questions

• When will I be able to resume normal activities after fistula surgery?
• Should I change my diet?
• Should I use a stool softener while healing from fistula surgery?
• Should I use a laxative while healing from fistula surgery?

Anal Fissures

What are anal fissures?

An anal fissure is a small crack or tear in the thin, moist lining of the lower rectum.

Symptoms of anal fissures

The most common symptom of an anal fissure is a shooting pain in the anal and surrounding area. Anal fissures often cause painful bowel movements and bleeding.

What causes anal fissures?

Anal fissures are usually a result of straining during a bowel movement, causing injury to the anal canal. They can also be caused by repeated diarrhea, when blood flow to the area is decreased (in older adults), after childbirth, or in people with Crohn’s disease.

How are anal fissures diagnosed?

Your doctor will perform a rectal exam. Usually, a visual exam is all that’s necessary to see the fissure. Your doctor might have to insert a lubricated, gloved finger into the anal canal.

Can anal fissures be prevented or avoided?

Keeping bowel movements regular and avoiding constipation can help. Add more fruits, vegetables, and whole grains to your daily plate to get enough fiber. Drink plenty of fluids and get some exercise in every day to help keep your digestive system moving.

Anal fissures treatment

About half of all fissures heal by themselves and need no treatment at all. If fissures don’t heal on their own, other treatments may involve prescription creams such as nitrates or calcium channel blockers. You may even need Botox injections into the muscle in the anus (called the anal sphincter). Minor surgery to relax the anal muscle can be used as a last resort.

Living with anal fissures

Your doctor may prescribe stool softeners to make going to the bathroom easier and less painful while the fissure heals. Numbing cream can also make bowel movements less painful. Petroleum jelly, zinc oxide, 1% hydrocortisone cream and products like Preparation H can help soothe the area. Instead of toilet paper, use alcohol-free baby wipes that are gentler on the area.
Sitz baths can help heal fissures and make you feel better. Fill the tub with enough lukewarm water to cover your hips and buttocks. Don’t use soap or bubbles or any other products unless prescribed by your doctor. Relax in the sitz bath 2 to 3 times a day for about 10 minutes at a time.
People who develop fissures once are more likely to have them in the future, so it’s important to keep bowel movements regular. If you’re worried about pain during a bowel movement, you might be tempted to hold it in. But that will only cause the stools to become harder, making the fissure worse. Continue with a high-fiber diet and plenty of liquids.

Questions to ask your doctor

• How can I add more fiber into my diet?
• Should I use laxatives?
• Should I use fiber supplements?
• What products do you recommend I use while I have the fissure?

Allergic Rhinitis

Overview

What is an allergy?

You have an allergy when your body overreacts to things that don’t cause problems for most people. These things are called allergens. Your body’s overreaction to the allergens is what causes symptoms.

What is hay fever?

Hay fever, also known as allergic rhinitis (say:”rine-EYE-tis”), is an allergic reaction to pollen. Symptoms of hay fever are seasonal, meaning you will feel worse when the pollens that affect you are at their highest levels. Hay fever is the most common form of allergy. It affects 1 in 5 people.

Symptoms

What are common allergy symptoms?

Symptoms vary depending on the severity of your allergies. Symptoms can include:

• Sneezing
• Coughing
• Itching (mostly eyes, nose, mouth, throat and skin)
• Runny nose
• Stuffy nose
• Headache
• Pressure in the nose and cheeks
• Ear fullness and popping
• Sore throat
• Watery, red or swollen eyes
• Dark circles under your eyes
• Trouble smelling
• Hives

How does hay fever differ from a cold or the flu?

Hay fever lasts longer than a cold or the flu—up to several weeks—and does not cause fever. The nasal discharge from hay fever is thin, watery and clear, while nasal discharge from a cold or the flu tends to be thicker. Itching (mostly eyes, nose, mouth, throat and skin) is common with hay fever but not with a cold or the flu. Sneezing is more prominent with hay fever and can occur in rather violent bouts.

When should I see a doctor?

If your symptoms interfere with your life, consider seeing your family doctor. Your doctor will probably do a physical exam and ask you questions about your symptoms. Keeping a record of your symptoms over a period of time can help your doctor determine what triggers your allergies.

Causes & Risk Factors

What causes allergies?

You have an allergy when your body overreacts to things that don’t cause problems for most people. These things are called allergens. If you have allergies, when you are exposed to an allergen, your body releases chemicals. One type of chemical that your body releases is called histamine. Histamine is your body’s defense against the allergen. The release of histamine causes your symptoms.

What are the most common allergens?

Pollen from trees, grass and weeds. Allergies that occur in the spring (late April and May) are often due to tree pollen. Allergies that occur in the summer (late May to mid-July) are often due to grass and weed pollen. Allergies that occur in the fall (late August to the first frost) are often due to ragweed. If you are allergic to pollen, you will notice your symptoms are worse on hot, dry days when wind carries the pollen. On rainy days, pollen often is washed to the ground, which means you are less likely to breathe it.
Mold. Mold is common where water tends to collect, such as shower curtains, window moldings and damp basements. It can also be found in rotting logs, hay, mulches, commercial peat moss, compost piles and leaf litter. This allergy is usually worse during humid and rainy weather.
Animal dander. Proteins found in the skin, saliva, and urine of furry pets such as cats and dogs are allergens. You can be exposed to dander when handling an animal or from house dust that contains dander.
Dust. Many allergens, including dust mites, are in dust. Dust mites are tiny living creatures found in bedding, mattresses, carpeting and upholstered furniture. They live on dead skin cells and other things found in house dust.

Diagnosis & Tests

How do I know what I’m allergic to?

Your doctor will do a physical exam and will ask you about your symptoms and when they occur. Your doctor may also want to do an allergy skin test to help determine exactly what is causing your allergy. An allergy skin test puts tiny amounts of allergens onto your skin to see which ones you react to. Once you know which allergens you are allergic to, you and your doctor can decide the best treatment. Your doctor may also decide to do a blood test, such as the radio allergo sorbent test (called RAST).

Prevention

How can I avoid allergens?

Pollens. Shower or bathe before bedtime to wash off pollen and other allergens in your hair and on your skin. Avoid going outside, especially on dry, windy days. Keep windows and doors shut, and use an air conditioner at home and in your car.
Mold. You can reduce the amount of mold in your home by removing houseplants and by frequently cleaning shower curtains, bathroom windows, damp walls, areas with dry rot and indoor trash cans. Use a mix of water and chlorine bleach to kill mold. Open doors and windows and use fans to increase air movement and help prevent mold.
Don’t carpet bathrooms or other damp rooms and use mold-proof paint instead of wallpaper. Reducing the humidity in your home to 50% or less can also help. You can control your home air quality by using a dehumidifier, keeping the temperature set at 70 degrees, and cleaning or replacing small-particle filters in your central air system.
Petdander. If your allergies are severe, you may need to give your pets away or at least keep them outside. Cat or dog dander often collects in house dust and takes 4 weeks or more to die down.
However, there are ways to reduce the amounts of pet dander in your home. Using allergen-resistant bedding, bathing your pet frequently,and using an air filter can help reduce pet dander. Ask your veterinarian forother ways to reduce pet dander in your home.
Dust and dust mites. To reduce dust mites in your home,remove drapes, feather pillows, upholstered furniture, non-washable comforters and soft toys. Replace carpets with linoleum or wood. Polished floors are best.Mop the floor often with a damp mop and wipe surfaces with a damp cloth. Vacuum regularly with a machine that has a high-efficiency particulate air (HEPA)filter. Vacuum soft furniture and curtains as well as floors. Install an air cleaner with a high-efficiency particulate or electrostatic filter. Wash carpets and upholstery with special cleaners, such as benzyl benzoate or tannic acid spray. Wash all bedding in hot water (hotter than 130°F) every 7 to 10days. Don’t use mattress pads. Cover mattress and pillows with plastic covers. Lower the humidity in your home using a dehumidifier.

Treatment

How are allergies treated?

Several medicines can be used to treat allergies. Your doctor will help you determine what medicine is best for you depending on your symptoms, age and overall health. These medicines are more useful if you use them before you’re exposed to allergens.
Antihistamines help reduce the sneezing, runny nose and itchiness of allergies. They’re more useful if you use them before you’re exposed to allergens. Some antihistamines come in pill form (some brand names: Zyrtec, Claritin) and some are nasal sprays (brand names: Astelin and Patanase). Some antihistamines can cause drowsiness and dry mouth. Others are less likely to cause these side effects, but some of these require a prescription. Ask your doctor which kind is best for you.
Decongestants, such as pseudoephedrine and phenylephrine, help temporarily relieve the stuffy nose of allergies. Decongestants are found in many medicines and come as pills, nose sprays and nose drops (some brand names: Sudafed, Afrin, Sinex). They are best used only for a short time.
Nose sprays and drops shouldn’t be used for more than 3 days because you can become dependent on them. This causes you to feel even more stopped-up when you try to quit using them.
You can buy decongestants without a doctor’s prescription. However, decongestants can raise your blood pressure, so it’s a good idea to talk to your family doctor before using them, especially if you have high blood pressure.
Cromolyn sodium is a nasal spray (one brand name: NasalCrom) that helps prevent the body’s reaction to allergens. Cromolyn sodium is more helpful if you use it before you’re exposed to allergens. This medicine may take 2 to 4 weeks to start working. It is available without a prescription.
Nasal steroid sprays reduce the reaction of the nasal tissues to inhaled allergens. This helps relieve the swelling in your nose so that you feel less stopped-up. They are the most effective at treating patients who have chronic symptoms. Nasal steroid sprays are available with a prescription from your doctor. You won’t notice their benefits for up to 2 weeks after starting them.
Eye drops. If your other medicines are not helping enough with your itchy, watery eyes, your doctor may prescribe eye drops for you.
Allergy shots or sublingual tablets (also called immunotherapy) are an option for people who try other treatments but still have allergy symptoms. These shots or dissolvable tablets contain a very small amount of the allergen you are allergic to. They’re given on a regular schedule so that your body gets used to the allergens and no longer overreacts to them. This helps decrease your body’s sensitivity to the allergen. Over time, your allergy symptoms will become less severe.
Allergy shots or sublingual tablets are only used when the allergens you’re sensitive to can be identified and when you can’t avoid them. It takes a few months to years to finish treatment, and you may need to have treatments throughout your life.

Questions to Ask Your Doctor

• Could anything else, such as a cold or the flu, be causing my symptoms?
• How do I figure out what I’m allergic to?
• Is my allergy seasonal?
• I am allergic to _____. Am I at risk for any other allergies?
• What changes can I make at home to help relieve my symptoms?
• Will any over-the counter medicines help relieve my symptoms?
• What should I do if my symptoms get worse or don’t respond to the treatment you’ve prescribed?
• Do I need to see an allergy specialist (called an allergist or immunologist)?

Things that can make your allergy symptoms worse

• Aerosol sprays
• Air pollution
• Cold temperatures
• Humidity
• Irritating fumes
• Tobacco smoke
• Wind
• Wood smoke