MyMedExpert Health Articles

What is Orthostatic Hypotension?

Orthostatic hypotension is a sudden fall in blood pressure that occurs when a person assumes a standing position. It may be caused by hypovolemia (a decreased amount of blood in the body), resulting from the excessive use of diuretics, vasodilators, or other types of drugs, dehydration, or prolonged bed rest. The disorder may be associated with Addison’s disease, atherosclerosis (build-up of fatty deposits in the arteries), diabetes, and certain neurological disorders including Shy-Drager syndrome and other dysautonomias. Symptoms, which generally occur after sudden standing, include dizziness, lightheadedness, blurred vision, and syncope (temporary loss of consciousness).

What is the prognosis?

The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition.
Is there any treatment?

When orthostatic hypotension is caused by hypovolemia due to medications, the disorder may be reversed by adjusting the dosage or by discontinuing the medication. When the condition is caused by prolonged bed rest, improvement may occur by sitting up with increasing frequency each day. In some cases, physical counterpressure such as elastic hose or whole-body inflatable suits may be required. Dehydration is treated with salt and fluids.
Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health
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What are the adrenal glands?
The adrenal glands are the part of the body responsible for releasing three different classes of hormones. These hormones control many important functions in the body, such as:
Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation
Regulating the balance of salt and water
Controlling the “fight or flight” response to stress
Maintaining pregnancy
Initiating and controlling sexual maturation during childhood and puberty
The adrenal glands are also an important source of sex steroids, such as estrogen and testosterone.

What are adrenal gland disorders?
Adrenal gland disorders occur when the adrenal glands don’t work properly.  Sometimes, the cause is a problem in another gland that helps to regulate the adrenal gland.  In other cases, the adrenal gland itself may have the problem.  The NICHD conducts and supports research on many adrenal gland disorders. 

Some examples include:
Cushing’s Syndrome - Cushing’s syndrome happens when a person’s body is exposed to too much of the hormone cortisol. In this syndrome, a person’s body makes more cortisol than it needs. For example, adrenal tumors can cause the body to produce too much cortisol. In some cases, children are born with a form of adrenal hyperplasia that leads to Cushing syndrome. Or, in some cases, certain medications can cause the body to make too much cortisol

Congenital Adrenal Hyperplasia - Congenital adrenal hyperplasia is a genetic disorder of adrenal gland deficiency.  In this disorder, the body doesn’t make enough of the hormone cortisol. The bodies of people with congenital adrenal hyperplasia may also have other hormone imbalances, such as not making enough aldosterone, but making too much androgen.
 

Pituitary Tumors - The pituitary gland is located in the brain and helps to regulate the activity of most other glands in the body, including the adrenal glands. In rare cases, benign (non-cancerous) tumors may grow on the pituitary gland, which may restrict the hormones it releases.  
In some cases, tumors on the pituitary can lead to Cushing’s syndrome – this is called Cushing disease.  In other cases, the tumors reduce the adrenal gland’s release of hormones needed for the “fight or flight” response to stress.  If the body is unable to handle physiological stress—a condition called Addison’s disease—it can be fatal.

 
What are the treatments for adrenal gland disorders?
The treatment for adrenal gland disorders depends on the specific disorder or the specific cause of the disorder.  For example:

The treatment for Cushing’s syndrome depends on the cause. If the excess cortisol is caused by medication, your health care provider can change dosages or try a different medication to correct the problem.  If the Cushing’s syndrome is caused by the body making too much cortisol, treatments may include oral medication, surgery, radiation, or a combination of these treatments.

Congenital adrenal hyperplasia can’t be cured, but it can be treated and controlled.  People with congenital adrenal hyperplasia can take medication to help replace the hormones their bodies are not making.  Some people with congenital adrenal hyperplasia only need these medications when they are sick, but others may need to take them every day.

Doctors can successfully treat most pituitary tumors with microsurgery, radiation therapy, surgery, drugs, or a combination of these treatments. Surgery is currently the treatment of choice for tumors that grow rapidly, especially if they threaten or affect vision.  The treatment plan for other pituitary tumors differs according to the type and size of the tumor.

Source: National Institute of Child Health and Human Development, NIH, DHHS

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What is Myoclonus?
Myoclonus refers to a sudden, involuntary jerking of a muscle or group of muscles. In its simplest form, myoclonus consists of a muscle twitch followed by relaxation. A hiccup is an example of this type of myoclonus. Other familiar examples of myoclonus are the jerks or “sleep starts” that some people experience while drifting off to sleep.  These simple forms of myoclonus occur in normal, healthy persons and cause no difficulties. When more widespread, myoclonus may involve persistent, shock-like contractions in a group of muscles.  Myoclonic jerking may develop in people with multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, or Creutzfeldt-Jakob disease. Myoclonic jerks commonly occur in persons with epilepsy, a disorder in which the electrical activity in the brain becomes disordered and leads to seizures.
Is there any treatment?
Treatment of myoclonus focuses on medications that may help reduce symptoms. The drug of first choice is clonazepam, a type of tranquilizer.  Many of the drugs used for myoclonus, such as barbiturates, phenytoin, and primidone, are also used to treat epilepsy.  Sodium valproate is an alternative therapy for myoclonus and can be used either alone or in combination with clonazepam. Myoclonus may require the use of multiple drugs for effective treatment.

What is the prognosis?

Simple forms of myoclonus occur in normal, healthy persons and cause no difficulties. In some cases, myoclonus begins in one region of the body and spreads to muscles in other areas. More severe cases of myoclonus can distort movement and severely limit a person’s ability to eat, talk, or walk. These types of myoclonus may indicate an underlying disorder in the brain or nerves. Although clonazepam and sodium valproate are effective in the majority of people with myoclonus, some people have adverse reactions to these drugs.  The beneficial effects of clonazepam may diminish over time if the individual develops a tolerance for the drug.

What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts research relating to myoclonus in its laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country.  Scientists are seeking to understand the underlying biochemical basis of involuntary movements and to find the most effective treatment for myoclonus and other movement disorders.  Researchers may be able to develop drug treatments that target specific biochemical changes involved in myoclonus.  By combining several of these drugs, scientists hope to achieve greater control of myoclonic symptoms

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Attention deficit hyperactivity disorder is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.¹⁶

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender, Frederick Reimherr, and David Wood. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers’ interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors.¹⁷ Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with ADHD are unaware that they have this disorder—they often just feel that it’s impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day’s work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.

Diagnosing ADHD in an Adult

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms.¹⁸ The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient’s childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

Treatment of ADHD in an Adult

Medications. As with children, if adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.¹⁹

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer “half-life” in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and psychotherapy. Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both “psychoeducation” and individual psychotherapy can be helpful. A professional coach can help the ADHD adult learn how to organize his life by using “props”—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.

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Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest. It usually starts in the chest behind the breastbone.

Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion.

Some people say that angina discomfort is hard to describe or that they can’t tell exactly where the pain is coming from.

Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur. Women are more likely to feel discomfort in their back, shoulders, and abdomen.

Symptoms vary based on the type of angina.

Stable Angina
The pain or discomfort:

Occurs when the heart must work harder, usually during physical exertion
Doesn’t come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina
The pain or discomfort:

Often occurs at rest, while sleeping at night, or with little physical exertion
Comes as a surprise
Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
Is usually not relieved with rest or medicine
May get continually worse
May mean that a heart attack will happen soon
Variant Angina
The pain or discomfort:

Usually occurs at rest and during the night or early morning hours
Tends to be severe
Is relieved by medicine
Lasting Chest Pain
Chest pain that lasts longer than a few minutes and isn’t relieved by rest or angina medicine may mean you’re having (or are about to have) a heart attack. Call 9–1–1 or emergency right away.

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Cryosurgery is used to treat several types of cancer, and some precancerous or noncancerous conditions. In addition to prostate and liver tumors, cryosurgery can be an effective treatment for the following:

* Retinoblastoma (a childhood cancer that affects the retina of the eye). Doctors have found that cryosurgery is most effective when the tumor is small and only in certain parts of the retina.
* Early-stage skin cancers (both basal cell and squamous cell carcinomas).
* Precancerous skin growths known as actinic keratosis.
* Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal cell changes in the cervix that can develop into cervical cancer).

Cryosurgery is also used to treat some types of low-grade cancerous and noncancerous tumors of the bone. It may reduce the risk of joint damage when compared with more extensive surgery, and help lessen the need for amputation. The treatment is also used to treat AIDS-related Kaposi’s sarcoma when the skin lesions are small and localized.

Researchers are evaluating cryosurgery as a treatment for a number of cancers, including breast, colon, and kidney cancer. They are also exploring cryotherapy in combination with other cancer treatments, such as hormone therapy, chemotherapy, radiation therapy, or surgery.

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# What is cryosurgery?

Cryosurgery (also called cryotherapy) is the use of extreme cold produced by liquid nitrogen (or argon gas) to destroy abnormal tissue. Cryosurgery is used to treat external tumors, such as those on the skin. For external tumors, liquid nitrogen is applied directly to the cancer cells with a cotton swab or spraying device.

Cryosurgery is also used to treat tumors inside the body (internal tumors and tumors in the bone). For internal tumors, liquid nitrogen or argon gas is circulated through a hollow instrument called a cryoprobe, which is placed in contact with the tumor. The doctor uses ultrasound or MRI to guide the cryoprobe and monitor the freezing of the cells, thus limiting damage to nearby healthy tissue. (In ultrasound, sound waves are bounced off organs and other tissues to create a picture called a sonogram.) A ball of ice crystals forms around the probe, freezing nearby cells. Sometimes more than one probe is used to deliver the liquid nitrogen to various parts of the tumor. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the frozen tissue thaws and is either naturally absorbed by the body (for internal tumors), or it dissolves and forms a scab (for external tumors).

Why RadioFrequency Ablation (RFA)?
Recent developments in radiofrequency ablation technology make large volume tissue ablation more effective and safer for local control of neoplastic disease than ever before. Local tumor control is an attractive option for some patients who are not ideal surgical candidates, have failed conventional therapies, or have contraindications to surgery or recurrent tumors. Percutaneous radiofrequency ablation may also expand surgical options. For example, RFA may convert an inoperable patient into a surgical candidate by treating small liver lesions that are too difficult or too spread out to surgically resect. RFA may treat multiple liver tumors, if any one tumor is not too large. RFA may be repeated for tumor recurrence, regrowth, or incomplete treatments. RFA can also be added to any other treatment, like surgery, radiation therapy, chemotherapy, or hepatic arterial infusion therapy, alcohol ablation, or chemoembolization.
Needle-based tissue ablation techniques may provide alternatives to open surgical procedures in certain patients, and may augment conventional therapies. No long-term, prospective, randomized clinical trials using RFA have been reported, so the expected benefit is speculative, and not definite. However, early results are optimistic and suggest that RFA provides safe and effective local treatment of neoplastic disease, with very low complication rates. Reported preliminary survival curves for small, solitary colorectal carcinoma liver metastases (<3cm), and hepatocellular carcinomas (<4cm) are similar to those from surgery, but there is no long-term data yet .

How Does it Work?
The procedure may be performed on an outpatient basis under general anesthesia or conscious sedation. The patient can be awake, but drowsy, for the entire procedure, or alternatively may be put to sleep by an anesthesiologist. The patient receives pain medicine and sedation through an IV and skin-numbing medicine. Routine cardiovascular and respiratory monitoring ensures patient safety during the procedure. Most patients feel little or no pain during the procedure and go home the same day or the day after the procedures, usually with no pain or soreness.
The patient is made into an electrical circuit by placing grounding pads on the thighs. A very small needle-electrode with an insulated shaft, and an uninsulated distal tip is inserted through the skin and directly into the tumor. Ultrasound, CT scan, or MRI guide the needles to the correct spot and monitor treatment. Each treatment session has about 10 to 15 minutes of active ablation. The energy at the needle tip causes ionic agitation and frictional heat in the surrounding tissue, which, when hot enough, leads to cell death and coagulation necrosis. This results in a 3 cm to 7 cm sphere of dead tissue per treatment session. In large tumors, the physician may create more than one sphere next to each other to try to turn the tumor edges in three dimensions. A small margin of normal tissue next to tumors is also burned, to try to leave no single tumor cell behind.
The killed tumor cells are not removed, but are gradually replaced by fibrosis and scar tissue. Over the coming months, the treated tissue shrinks. If there is local recurrence, it occurs at the edge, and in some cases may be retreated. For this reason, a treatment margin free of tumor will be the goal of this local therapy.

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Digestion involves mixing food with digestive juices, moving it through the digestive tract, and breaking down large molecules of food into smaller molecules. Digestion begins in the mouth, when you chew and swallow, and is completed in the small intestine.

Movement of Food Through the System

The large, hollow organs of the digestive tract contain a layer of muscle that enables their walls to move. The movement of organ walls can propel food and liquid through the system and also can mix the contents within each organ. Food moves from one organ to the next through muscle action called peristalsis. Peristalsis looks like an ocean wave traveling through the muscle. The muscle of the organ contracts to create a narrowing and then propels the narrowed portion slowly down the length of the organ. These waves of narrowing push the food and fluid in front of them through each hollow organ.

The first major muscle movement occurs when food or liquid is swallowed. Although you are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the nerves.

Swallowed food is pushed into the esophagus, which connects the throat above with the stomach below. At the junction of the esophagus and stomach, there is a ringlike muscle, called the lower esophageal sphincter, closing the passage between the two organs. As food approaches the closed sphincter, the sphincter relaxes and allows the food to pass through to the stomach.

The stomach has three mechanical tasks. First, it stores the swallowed food and liquid. To do this, the muscle of the upper part of the stomach relaxes to accept large volumes of swallowed material. The second job is to mix up the food, liquid, and digestive juice produced by the stomach. The lower part of the stomach mixes these materials by its muscle action. The third task of the stomach is to empty its contents slowly into the small intestine.

Several factors affect emptying of the stomach, including the kind of food and the degree of muscle action of the emptying stomach and the small intestine. Carbohydrates, for example, spend the least amount of time in the stomach, while protein stays in the stomach longer, and fats the longest. As the food dissolves into the juices from the pancreas, liver, and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion.

Finally, the digested nutrients are absorbed through the intestinal walls and transported throughout the body. The waste products of this process include undigested parts of the food, known as fiber, and older cells that have been shed from the mucosa. These materials are pushed into the colon, where they remain until the feces are expelled by a bowel movement.

Production of Digestive Juices

The digestive glands that act first are in the mouth—the salivary glands. Saliva produced by these glands contains an enzyme that begins to digest the starch from food into smaller molecules. An enzyme is a substance that speeds up chemical reactions in the body.

The next set of digestive glands is in the stomach lining. They produce stomach acid and an enzyme that digests protein. A thick mucus layer coats the mucosa and helps keep the acidic digestive juice from dissolving the tissue of the stomach itself. In most people, the stomach mucosa is able to resist the juice, although food and other tissues of the body cannot.

After the stomach empties the food and juice mixture into the small intestine, the juices of two other digestive organs mix with the food. One of these organs, the pancreas, produces a juice that contains a wide array of enzymes to break down the carbohydrate, fat, and protein in food. Other enzymes that are active in the process come from glands in the wall of the intestine.

The second organ, the liver, produces yet another digestive juice—bile. Bile is stored between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder, through the bile ducts, and into the intestine to mix with the fat in food. The bile acids dissolve fat into the watery contents of the intestine, much like detergents that dissolve grease from a frying pan. After fat is dissolved, it is digested by enzymes from the pancreas and the lining of the intestine.

Absorption and Transport of Nutrients

Most digested molecules of food, as well as water and minerals, are absorbed through the small intestine. The mucosa of the small intestine contains many folds that are covered with tiny fingerlike projections called villi. In turn, the villi are covered with microscopic projections called microvilli. These structures create a vast surface area through which nutrients can be absorbed. Specialized cells allow absorbed materials to cross the mucosa into the blood, where they are carried off in the bloodstream to other parts of the body for storage or further chemical change. This part of the process varies with different types of nutrients.

Carbohydrates. The Dietary Guidelines for Americans 2005 recommend that 45 to 65 percent of total daily calories be from carbohydrates. Foods rich in carbohydrates include bread, potatoes, dried peas and beans, rice, pasta, fruits, and vegetables. Many of these foods contain both starch and fiber.

The digestible carbohydrates—starch and sugar—are broken into simpler molecules by enzymes in the saliva, in juice produced by the pancreas, and in the lining of the small intestine. Starch is digested in two steps. First, an enzyme in the saliva and pancreatic juice breaks the starch into molecules called maltose. Then an enzyme in the lining of the small intestine splits the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried through the bloodstream to the liver, where it is stored or used to provide energy for the work of the body.

Sugars are digested in one step. An enzyme in the lining of the small intestine digests sucrose, also known as table sugar, into glucose and fructose, which are absorbed through the intestine into the blood. Milk contains another type of sugar, lactose, which is changed into absorbable molecules by another enzyme in the intestinal lining.

Fiber is undigestible and moves through the digestive tract without being broken down by enzymes. Many foods contain both soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines.

Protein. Foods such as meat, eggs, and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. An enzyme in the juice of the stomach starts the digestion of swallowed protein. Then in the small intestine, several enzymes from the pancreatic juice and the lining of the intestine complete the breakdown of huge protein molecules into small molecules called amino acids. These small molecules can be absorbed through the small intestine into the blood and then be carried to all parts of the body to build the walls and other parts of cells.

Fats. Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestine. The bile acids produced by the liver dissolve fat into tiny droplets and allow pancreatic and intestinal enzymes to break the large fat molecules into smaller ones. Some of these small molecules are fatty acids and cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules move into the cells of the mucosa. In these cells the small molecules are formed back into large ones, most of which pass into vessels called lymphatics near the intestine. These small vessels carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body.

Vitamins. Another vital part of food that is absorbed through the small intestine are vitamins. The two types of vitamins are classified by the fluid in which they can be dissolved: water-soluble vitamins (all the B vitamins and vitamin C) and fat-soluble vitamins (vitamins A, D, E, and K). Fat-soluble vitamins are stored in the liver and fatty tissue of the body, whereas water-soluble vitamins are not easily stored and excess amounts are flushed out in the urine.

Water and salt. Most of the material absorbed through the small intestine is water in which salt is dissolved. The salt and water come from the food and liquid you swallow and the juices secreted by the many digestive glands.

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1. What is alcoholism?

Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:

* Craving–A strong need, or urge, to drink.
* Loss of control–Not being able to stop drinking once drinking has begun.
* Physical dependence–Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
* Tolerance–The need to drink greater amounts of alcohol to get “high.”

For clinical and research purposes, formal diagnostic criteria for alcoholism also have been developed. Such criteria are included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, as well as in the International Classification Diseases, published by the World Health Organization. (See also “Publications,” Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)

2. Is alcoholism a disease?

Yes, alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems.

Like many other diseases, alcoholism is chronic, meaning that it lasts a person’s lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person’s genes and by his or her lifestyle. (See also “Publications,” Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)

3. Is alcoholism inherited?

Research shows that the risk for developing alcoholism does indeed run in families. The genes a person inherits partially explain this pattern, but lifestyle is also a factor. Currently, researchers are working to discover the actual genes that put people at risk for alcoholism. Your friends, the amount of stress in your life, and how readily available alcohol is also are factors that may increase your risk for alcoholism.

But remember: Risk is not destiny. Just because alcoholism tends to run in families doesn’t mean that a child of an alcoholic parent will automatically become an alcoholic too. Some people develop alcoholism even though no one in their family has a drinking problem. By the same token, not all children of alcoholic families get into trouble with alcohol. Knowing you are at risk is important, though, because then you can take steps to protect yourself from developing problems with alcohol. (See also “Publications,” A Family History of Alcoholism - Are You at Risk?; Alcohol Alert No. 18: The Genetics of Alcoholism.)

4. Can alcoholism be cured?

No, alcoholism cannot be cured at this time. Even if an alcoholic hasn’t been drinking for a long time, he or she can still suffer a relapse. Not drinking is the safest course for most people with alcoholism.

5. Can alcoholism be treated?

Yes, alcoholism can be treated. Alcoholism treatment programs use both counseling and medications to help a person stop drinking. Treatment has helped many people stop drinking and rebuild their lives. (See also “Publication,” Alcohol Alert No. 49: New Advances in Alcoholism Treatment.)

6. Which medications treat alcoholism?

Three oral medications–disulfiram (Antabuse®), naltrexone (Depade®, ReVia®), and acamprosate (Campral®)–are currently approved to treat alcohol dependence. In addition, an injectable, long-acting form of naltrexone (Vivitrol®) is available. These medications have been shown to help people with dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence. Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking. Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia. Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.

Other types of drugs are available to help manage symptoms of withdrawal (such as shakiness, nausea, and sweating) if they occur after someone with alcohol dependence stops drinking.

Although medications are available to help treat alcoholism, there is no “magic bullet.” In other words, no single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers. (See also “News Releases,” Jan. 17, 1995: Naltrexone Approved for Alcoholism Treatment and “Publication,” Alcohol Alert No. 61: Neuroscience Research and Therapeutic Targets.)

7. Does alcoholism treatment work?

Alcoholism treatment works for many people. But like other chronic illnesses, such as diabetes, high blood pressure, and asthma, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person abstains from alcohol, the more likely he or she will be able to stay sober.

8. Do you have to be an alcoholic to experience problems?

No. Alcoholism is only one type of an alcohol problem. Alcohol abuse can be just as harmful. A person can abuse alcohol without actually being an alcoholic–that is, he or she may drink too much and too often but still not be dependent on alcohol. Some of the problems linked to alcohol abuse include not being able to meet work, school, or family responsibilities; drunk-driving arrests and car crashes; and drinking-related medical conditions. Under some circumstances, even social or moderate drinking is dangerous–for example, when driving, during pregnancy, or when taking certain medications.

9. Are specific groups of people more likely to have problems?

Alcohol abuse and alcoholism cut across gender, race, and nationality. In the United States, 17.6 million people–about l in every 12 adults–abuse alcohol or are alcohol dependent. In general, more men than women are alcohol dependent or have alcohol problems. And alcohol problems are highest among young adults ages 18-29 and lowest among adults ages 65 and older. We also know that people who start drinking at an early age–for example, at age 14 or younger–are at much higher risk of developing alcohol problems at some point in their lives compared to someone who starts drinking at age 21 or after. (See also “News Releases,” June 10, 2004 “Alcohol Abuse Increases, Dependence Declines Across Decade: Young Adult Minorities Emerge As High-Risk Subgroups” and July 3, 2006 “Early Drinking Linked to Higher Lifetime Alcoholism Risk. See also Alcohol Alert No. 55: Alcohol and Minorities: An Update.)

10. How can you tell if someone has a problem?

Answering the following four questions can help you find out if you or a loved one has a drinking problem:

* Have you ever felt you should cut down on your drinking?
* Have people annoyed you by criticizing your drinking?
* Have you ever felt bad or guilty about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One “yes” answer suggests a possible alcohol problem. More than one “yes” answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of action.

11. Can a problem drinker simply cut down?

It depends. If that person has been diagnosed as an alcoholic, the answer is “no.” Alcoholics who try to cut down on drinking rarely succeed. Cutting out alcohol–that is, abstaining–is usually the best course for recovery. People who are not alcohol dependent but who have experienced alcohol-related problems may be able to limit the amount they drink. If they can’t stay within those limits, they need to stop drinking altogether. (See the question 13, “What is a safe level of drinking?”) (See also “Publications/Pamphlets and Brochures,” How to Cut Down on Your Drinking.)

12. If an alcoholic is unwilling to get help, what can you do about it?

This can be a challenge. An alcoholic can’t be forced to get help except under certain circumstances, such as a traffic violation dor arrest that results in court-ordered treatment. But you don’t have to wait for someone to “hit rock bottom” to act. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment:

Stop all “cover ups.” Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.

Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred–like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.

Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.

State the results. Explain to the drinker what you will do if he or she doesn’t go for help–not to punish the drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.

Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.

Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.

Find strength in numbers. With the help of a health care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional who is experienced in this kind of group intervention.

Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic’s life, and Alateen, which is geared to children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic’s drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help. (See the question 19, “How can a person get help for an alcohol problem” for referral to support groups.)

You can call the National Drug and Alcohol Treatment Referral Routing Service (Center for Substance Abuse Treatment) at 1-800-662-HELP (4357) for information about treatment programs in your local community and to speak to someone about an alcohol problem.

13. What is a safe level of drinking?

For most adults, moderate alcohol use–up to two drinks per day for men and one drink per day for women and older people–causes few if any problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)

Certain people should not drink at all, however:

* Women who are pregnant or trying to become pregnant
* People who plan to drive or engage in other activities that require alertness and skill (such as driving a car)
* People taking certain over-the-counter or prescription medications
* People with medical conditions that can be made worse by drinking
* Recovering alcoholics
* People younger than age 21.

(See also “Publications” Harmful Interactions: Mixing Alcohol With Medicines and Drinking and Your Pregnancy; Alcohol Alert No. 27: Alcohol-Medication Interactions; Alcohol Alert No 50: Fetal Alcohol Exposure and the Brain; and Alcohol Alert No. 52: Alcohol and Transportation Safety)

14. Is it safe to drink during pregnancy?

No, alcohol can harm the baby of a mother who drinks during pregnancy. Although the highest risk is to babies whose mothers drink heavily, it is not clear yet whether there is any completely safe level of alcohol during pregnancy. For this reason, the U.S. Surgeon General released advisories in 1981 and again in 2005 urging women who are pregnant or may become pregnant to abstain from alcohol (http://www.lhvpn.net/hhspress.html). The damage caused by prenatal alcohol includes a range of physical, behavioral, and learning problems in babies Babies most severely affected have what is called Fetal Alcohol Syndrome (FAS). These babies may have abnormal facial features and severe learning disabilities. Babies can also be born with mild disabilities without the facial changes typical of FAS.

(See also “Publications” Alcohol Alert No.50: Fetal Alcohol Syndrome and the Brain; “Pamphlets and Brochures,” Drinking and Your Pregnancy.)

15. Does alcohol affect older people differently?

Alcohol’s effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol’s effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking.

Older people also tend to take more medicines than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous, even fatal. (See the question 18,  “When taking medications, must you stop drinking?” for more information.) In addition, alcohol can make many of the medical conditions common in older people, including high blood pressure and ulcers, more serious. Physical changes associated with aging can make older people feel “high” even after drinking only small amounts of alcohol. So even if there is no medical reason to avoid alcohol, older men and women should limit themselves to one drink per day. (See also “Publications/Pamphlets and Brochures” Age Page: Alcohol Use and Abuse.)

16. Does alcohol affect women differently?

Yes, alcohol affects women differently than men. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women’s bodies have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman’s body than in a man’s. In other words, it would be like dropping the same amount of alcohol into a much smaller pail of water. That is why the recommended drinking limit for women is lower than for men. (See the question 13, “What is a safe level of drinking?” for recommended limits.)

In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men. (See also “Publications,” Alcohol Alert No. 62: Alcohol-An Important Women’s Health Issue.)

17. Is alcohol good for your heart?

Studies have shown that moderate drinkers are less likely to die from one form of heart disease than are people who do not drink any alcohol or who drink more.

If you are a nondrinker, however, you should not start drinking solely to benefit your heart. You can guard against heart disease by exercising and eating foods that are low in fat. And if you are pregnant, planning to become pregnant, have been diagnosed as alcoholic, or have another medical condition that could make alcohol use harmful, you should not drink.

If you can safely drink alcohol and you choose to drink, do so in moderation. Heavy drinking can actually increase the risk of heart failure, stroke, and high blood pressure, as well as cause many other medical problems, such as liver cirrhosis. (See also “Publications,” Alcohol Alert No. 16: Moderate Drinking and Alcohol Alert No. 45: Alcohol Coronary Heart Disease.)

18. When taking medications, must you stop drinking?

Possibly. More than 150 medications interact harmfully with alcohol. These interactions may result in increased risk of illness, injury, and even death. Alcohol’s effects are heightened by medicines that depress the central nervous system, such as sleeping pills, antihistamines, antidepressants, anti-anxiety drugs, and some painkillers. In addition, medicines for certain disorders, including diabetes, high blood pressure, and heart disease, can have harmful interactions with alcohol. If you are taking any over-the-counter or prescription medications, ask your doctor or pharmacist if you can safely drink alcohol. (See also “Publications,” Harmful Interactions; Mixing Alcohol with Medicines; Alcohol Alert No. 27: Alcohol-Medication Interactions.)

19. How can a person get help for an alcohol problem?

There are many national and local resources that can help. The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), offering various resource information. Through this service you can speak directly to a representative concerning substance abuse treatment, request printed material on alcohol or other drugs, or obtain local substance abuse treatment referral information in your State (see Treatment Referral Information).

Many people also find support groups a helpful aid to recovery. The following list includes a variety of resources:

Al-Anon/Alateen
Alcoholics Anonymous (AA)
National Association for Children of Alcoholics (NACOA)
National Clearinghouse for Alcohol and Drug Information (NCADI)

If you have any specific question, you can ask the doctors at www.mymedexpert.com