ADHD in Adults

Image result for adhd symptoms in adults checklist

ADHD Symptom Snapshot

There are 3 core symptoms of ADHD: inattention, impulsivity, and hyperactivity. The following are examples of how ADHD symptoms may appear in adults.

Only a doctor or other health care professional can diagnose ADHD.

ONLY A DOCTOR OR OTHER HEALTH CARE PROFESSIONAL CAN DIAGNOSE ADHD

Symptoms of Inattention

  • Often makes careless mistakes and lacks attention to details
    (Examples: overlooking or missing details or handing in work that is inaccurate)
  • Often has difficulty paying attention to tasks
    (Example: difficulty remaining focused during lectures, conversations, or lengthy readings)
  • Often seems to not listen when spoken to directly
    (Example: mind seems elsewhere, even in the absence of obvious distraction)
  • Often fails to follow through on instructions, chores, or duties in the workplace
    (Example: starts tasks but quickly loses focus and is easily sidetracked)
  • Often has difficulty organizing tasks and activities
    (Examples: messy, disorganized work; poor time management; fails to meet deadlines)
  • Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort, like preparing reports, completing forms, or reviewing lengthy papers 
  • Often loses things like tools, wallets, keys, paperwork, eyeglasses, and mobile phones
  • Often easily distracted by other things, including unrelated thoughts
  • Often forgetful in daily activities, such as running errands, returning calls, paying bills, and keeping appointments

Symptoms of Hyperactivity and Impulsivity

  • Often fidgets with or taps hands and feet or squirms in seat
  • Often leaves seat when remaining seated is expected
    (Example: leaves their place in the office or other workplace setting or in other situations that require remaining seated)
  • Often runs or climbs where it is inappropriate or feels restless (in adults, may be limited to feeling restless)
  • Often unable to participate in leisure activities quietly
  • Often acts as if “on the go” or “driven by a motor”
    (Example: is unable to be or uncomfortable being still for an extended time, as in meetings or restaurants)
  • Often talks excessively
  • Often blurts out an answer before a question has been fully asked
    (Examples: completes people’s sentences; cannot wait for next turn in conversation)
  • Often has difficulty waiting his or her turn, for example, while waiting in line
  • Often interrupts or intrudes on others
    (Examples: butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; may intrude into or take over what others are doing)

Europe’s most dangerous pathogens: Climate change increasing risks

Image result for lyme disease

Europe’s most dangerous pathogens: Climate change increasing risks

Date:
August 2, 2017
Source:
University of Liverpool
Summary:
The impact of climate change on the emergence and spread of infectious diseases could be greater than previously thought, according to new research.

The impact of climate change on the emergence and spread of infectious diseases could be greater than previously thought, according to new research by the University of Liverpool.

The study, published in Scientific Reports, is the first large-scale assessment of how climate affects bacterium, viruses or other microorganisms and parasites (pathogens) that can cause disease in humans or animals in Europe.

The results will help policy makers prioritise the surveillance for pathogens that may respond to climate change and, in turn, contribute to strengthening climate change resilience for infectious diseases.

Epidemics

There is growing evidence that climate change is altering the distribution of some diseases, in some cases causing epidemics or making diseases spread within their natural range, for example, Zika virus in South America, or bluetongue and Schmallenberg disease in livestock in Europe.

Dr Marie McIntyre, who led the project at the University’s Institute of Infection and Global Health, explained: “Although there is a well-established link between climate change and infectious disease, we did not previously understand how big the effects will be and which diseases will be most affected.

“Climate sensitivity of pathogens is a key indicator that diseases might respond to climate change, so assessing which pathogens are most climate-sensitive, and their characteristics, is vital information if we are to prepare for the future.”

Largest effects

The researchers carried out a systematic review of published literature on one hundred human and one hundred domestic animal pathogens present in Europe that have the largest impact on health.

Nearly two-thirds of the pathogens examined were found to be sensitive to climate; and two-thirds of these have more than one climate driver, meaning that the impact of climate change upon them will likely be multifaceted and complex.

Diseases spread by insects and ticks (vector-borne diseases) were found to be the most climate sensitive, followed by those transmitted in soil, water and food. The diseases with the largest number of different climate drivers were Vibrio cholerae (cause of cholera), Fasciola hepatica (cause of liver fluke), Bacillus anthracis (cause of anthrax) and Borrelia burgdorferi (cause of tickborne Lyme disease).

Future effects

Dr Marie McIntyre, commented: “Currently, most models examining climate effects only consider a single or at most two climate drivers, so our results suggest that this should change if we really want to understand future impacts of climate change on health.”

Zoonotic pathogens — those that spread from animals to humans — were also found to be more climate sensitive than those that affect only humans or only animals. As 75% of emerging diseases are zoonotic, emerging diseases may be particularly likely to be impacted by climate change.

However, the researchers stress that their response to climate change will also be dependent on the impacts of other drivers, such as changes to travel and trade, land-use, deforestation, new control measures and the development of antimicrobial resistance.

Big Data

The top 100 human and animals list was compiled using the Enhanced Infectious Disease Database (EID2), — a comprehensive and open-access ‘Big Data’ record of over 60 million scientific papers, electronic sources and textbooks associated with infectious diseases that was developed in Liverpool.


Story Source:

Materials provided by University of LiverpoolNote: Content may be edited for style and length.

New light shed on Lyme disease-causing bacteria

Image result for lyme disease infections 2017Prompt removal of ticks can help prevent transmission of Borrelia mayonii

Date:
august 13, 2017
Source:
Entomological Society of America
Summary:
A new species of bacteria that causes Lyme disease needs the same amount of time for transmission after a tick bite compared to previously implicated bacteria, according to new research. Existing guidelines for frequent tick checks and prompt removal of attached ticks remain the same.

A new species of bacteria that causes Lyme disease needs the same amount of time for transmission after a tick bite compared to previously implicated bacteria, according to new research by the Centers for Disease Control and Prevention (CDC). Existing guidelines for frequent tick checks and prompt removal of attached ticks remain the same.

The duration of attachment of a single nymphal blacklegged tick (Ixodes scapularis) needed for the tick to be likely to transmit the bacterial species Borrelia mayonii, identified in 2016, is 48 hours or more, according to the study. By 72 hours, however, likelihood of transmission has risen significantly. This timeframe aligns with existing research on Borrelia burgdorferi, previously the sole bacteria species known to cause Lyme disease in the United States. The research is published in the Entomological Society of America’s Journal of Medical Entomology.

“Our findings show that recommendations for regular tick checks and prompt tick removal as a way to prevent transmission of Lyme disease spirochetes to humans via the bites of infected ticks applies to the newly recognized B. mayonii as well as B. burgdorferi, for which these recommendations originally were developed,” says Lars Eisen, Ph.D., CDC research entomologist and senior author of the study.

The study authors tested transmission rates of B. mayonii from ticks to mice at four time intervals: 24, 48, and 72 hours after attachment and after the tick’s full feed. Their experiment focused on nymphal-stage ticks (the more common source of pathogen transmission, compared to larval or adult ticks) and exposed the mice to a single infected tick each. They found no evidence of transmission by single nymphs infected with B. mayonii in the first 24 or 48 hours, but 31 percent of mice examined after 72 hours were found to be infected. In mice examined after a tick’s complete feed (4-5 days), the infection rate was 57 percent.

“Our findings underscore the importance of finding and removing ticks as soon as possible after they bite,” says Eisen.

Lyme disease is the most commonly reported vector-borne illness in the United States, with around 300,000 people estimated to be diagnosed each year, mostly in the Northeast and upper Midwest regions. The blacklegged tick is the primary vector of Lyme disease as well as at least a dozen other illnesses.

To reduce the risk of tick bites and tickborne diseases, CDC recommendations include:

  • Avoid wooded and brushy areas with high grass and leaf litter.
  • Use insect repellent when outdoors.
  • Use products that contain permethrin on clothing.
  • Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks.
  • Conduct a full-body tick check after spending time outdoors.
  • Examine gear and pets, as ticks can come into the home on these and later attach to people.

The bacterial species B. mayonii was discovered when six patients exhibiting symptoms of Lyme disease at the Mayo Clinic in Rochester, Minnesota, in 2013 showed unusual blood-test results. The discovery of the new species was confirmed in 2016.

“There is much still to discover about B. mayonii, including to clarify the geographic range of this emerging human pathogen in the U.S., to determine how commonly different life stages of the blacklegged tick are infected with B. mayonii, and to find out whether the same vertebrate animals that serve as natural reservoirs for B. burgdorferi play the same role also for B. mayonii,” says Eisen.


Story Source:

Materials provided by Entomological Society of AmericaNote: Content may be edited for style and length.

Boy with autism attacked by bullies, left with nail embedded in his head

 

A boy with autism has been attacked by bullies after falling behind his family during a walk home.

Romeo Smith, nine, was with his family as they returned home from a visit with his grandmother when he was confronted by older boys waving sticks, The Mirrorreports.

The incident happened at Mansfield in Nottinghamshire in the UK.

Romeo was left with a nail embedded in his head after being attacked by bullies. Image: The Mega Agency

Terrified of being attacked, Romeo climbed a tree to try and escape.

When his parents noticed he’d fallen behind, father Craig, 35, went to find him and bring him home.

It was then that one of the boys threw an eight-inch piece of wood with a nail protruding from it, embedding it in his skull.

“It was terrible, mother Natasha Smith, 30, told The Mirror. “He was sat there waiting with a plank of wood sticking out of his head, like something out of a horror film.”

Romeo told The Mirror the experience was “scary”.

“When they threw the plank I could feel it stick in the back of my head.”

His mother said it’s hard for Romeo to talk about his feelings due to his autism but she can tell that the experience affected him, although he has tried to open up about this.

“I thought the worst and thought that I was dying,” he said.

“I have no idea how long the bullying has been going on but it is worrying that they have done this in front of an adult,” Smith told The Mirror.

“You wonder what else they are capable of?”

The boy is now recovering at home.

Nottinghamshire Police are still searching for the offenders however told the parents due to their age, they are unlikely to be prosecuted.

Typhoid fever

Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world, especially for children.

Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.

Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications. Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Symptoms

Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease.

Early illness

Once signs and symptoms do appear, you’re likely to experience:

  • Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
  • Headache
  • Weakness and fatigue
  • Muscle aches
  • Sweating
  • Dry cough
  • Loss of appetite and weight loss
  • Abdominal pain
  • Diarrhea or constipation
  • Rash
  • Extremely swollen abdomen

Later illness

If you don’t receive treatment, you may:

  • Become delirious
  • Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state

In addition, life-threatening complications often develop at this time.

In some people, signs and symptoms may return up to two weeks after the fever has subsided.

When to see a doctor

See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you’ll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.

If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn’t familiar with these areas.

Causes

Typhoid fever is caused by virulent bacteria called Salmonella typhi (S. typhi). Although they’re related, S. typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, aren’t the same.

Fecal-oral transmission route

The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid fever is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up typhoid bacteria while traveling and spread it to others through the fecal-oral route.

This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the toilet. You can also become infected by drinking water contaminated with the bacteria.

Typhoid carriers

Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

Risk factors

Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 26 million or more people each year. The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you’re at increased risk if you:

  • Work in or travel to areas where typhoid fever is endemic
  • Work as a clinical microbiologist handling Salmonella typhi bacteria
  • Have close contact with someone who is infected or has recently been infected with typhoid fever
  • Drink water contaminated by sewage that contains S.
  • Complications

    Intestinal bleeding or holes

    The most serious complications of typhoid fever — intestinal bleeding or holes (perforations) in the intestine — may develop in the third week of illness. A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms, such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care.

    Other, less common complications

    Other possible complications include:

    • Inflammation of the heart muscle (myocarditis)
    • Inflammation of the lining of the heart and valves (endocarditis)
    • Pneumonia
    • Inflammation of the pancreas (pancreatitis)
    • Kidney or bladder infections
    • Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
    • Psychiatric problems, such as delirium, hallucinations and paranoid psychosis

    With prompt treatment, nearly all people in industrialized nations recover from typhoid fever. Without treatment, some people may not survive complications of the disease.

  • Preparing for your appointment

    Call your doctor if you’ve recently returned from travel abroad and develop mild symptoms similar to those that occur with typhoid fever. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.

    Here’s some information to help you get ready and know what to expect from your doctor.

    Information to gather in advance

    • Pre-appointment restrictions. At the time you make your appointment, ask if there are restrictions you need to follow in the time leading up to your visit. Your doctor will not be able to confirm typhoid fever without a blood test, and may recommend taking steps to reduce the risk of passing a possible contagious illness to others.
    • Symptom history. Write down any symptoms you’re experiencing and for how long.
    • Recent exposure to possible sources of infection. Be prepared to describe international trips in detail, including the countries you visited and the dates you traveled.
    • Medical history. Make a list of your key medical information, including other conditions for which you’re being treated and any medications, vitamins or supplements you’re taking. Your doctor will also need to know your vaccination history.
    • Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.

    For typhoid fever, possible questions to ask your doctor include:

    • What are the possible causes for my symptoms?
    • What kinds of tests do I need?
    • Are treatments available to help me recover?
    • I have other health problems. How can I best manage these conditions together?
    • How long do you expect a full recovery will take?
    • When can I return to work or school?
    • Am I at risk of any long-term complications from typhoid fever?

    Don’t hesitate to ask any other related questions you have.

    What to expect from your doctor

    Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

    • What are your symptoms and when did they begin?
    • Have your symptoms gotten better or worse?
    • Did your symptoms briefly get better and then come back?
    • Have you recently traveled abroad? Where?
    • Did you update your vaccinations before traveling?
    • Are you being treated for any other medical conditions?
    • Are you currently taking any medications?
    • Tests and diagnosis

      Medical and travel history

      Your doctor is likely to suspect typhoid fever based on your symptoms and your medical and travel history. But the diagnosis is usually confirmed by identifying S. typhi in a culture of your blood or other body fluid or tissue.

      Body fluid or tissue culture

      For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. The culture is checked under a microscope for the presence of typhoid bacteria. A bone marrow culture often is the most sensitive test for S. typhi.

      Although performing a culture test is the mainstay for diagnosis, in some instances other testing may be used to confirm a suspected typhoid fever infection, such as a test to detect antibodies to typhoid bacteria in your blood or a test that checks for typhoid DNA in your blood.

    • Treatments and drugs

      Antibiotic therapy is the only effective treatment for typhoid fever.

      Commonly prescribed antibiotics

      • Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for nonpregnant adults.
      • Ceftriaxone (Rocephin). This injectable antibiotic is an alternative for people who may not be candidates for ciprofloxacin, such as children.

      These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

      Problems with antibiotic resistance

      In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of side effects, a high rate of health deterioration after a period of improvement (relapse) and widespread bacterial resistance.

      In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid fever, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin.

      Other treatments

      Other treatments include:

      • Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein (intravenously).
      • Surgery. If your intestines become perforated, you’ll need surgery to repair the hole.
      • Prevention

        In many developing nations, the public health goals that can help prevent and control typhoid fever — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.

        A vaccine is recommended if you’re traveling to areas where the risk of getting typhoid fever is high.

        Vaccines

        Two vaccines are available.

        • One is injected in a single dose at least one week before travel.
        • One is given orally in four capsules, with one capsule to be taken every other day.

        Neither vaccine is 100 percent effective, and both require repeat immunizations, as vaccine effectiveness diminishes over time.

        Because the vaccine won’t provide complete protection, follow these guidelines when traveling to high-risk areas:

        • Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.
        • Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is.

          Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.

        • Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
        • Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.

        Prevent infecting others

        If you’re recovering from typhoid fever, these measures can help keep others safe:

        • Take your antibiotics. Follow your doctor’s instructions for taking your antibiotics, and be sure to finish the entire prescription.
        • Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
        • Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.

What are kidney stones?

kidney stones on x-ray

The cause of most stones is unknown, but they can be associated with a high concentration of calcium in the urine or occasionally in the blood.

They can also be caused by Dehydration, infection, obstruction of urine and various kidney disorders.

Crystals of salts found normally in the urine aggregate together and gradually enlarge in size to form stones, which may vary greatly in size. Some are as small as a grain of sand whereas others are so big they fill the entire renal pelvis.

Kidney stones typically occur in healthy men aged between 30 and 50. The male to female ratio for kidney stone disease is 4:1.

Patients who have had stones before are more at risk of further stones and sometimes the problem runs in families.

What are the symptoms of kidney stones?

  • Kidney stones may cause sudden, intense pain. If the stone travels down the ureter (the tube leading from the kidney to the bladder) it may get stuck at one of several points. The pain that this causes is usually concentrated on one side of the back but may also move into the stomach or down to the groin where it can result in colicky pains. The same type of pain may also be caused by bleeding or infection in the urinary system.
  • Kidney stone attacks can be so painful they cause great distress to the sufferer. The pain is often accompanied by nausea and vomiting.
  • They may cause scratches in the lining (mucosa) of the renal pelvis or the ureter. This leads to blood in the urine. There is not always enough to be seen with the naked eye but a diagnostic test can detect it.
  • Frequent infections in the urinary system may be a sign of kidney stones.

What should you do if you have an attack?

If you have a kidney stone attack, you may need medical help to ease the pain if simple painkillers (for example ibuprofen) are not helpful.

If you have never had a stone before, investigations will be necessary to make a diagnosis because other serious abdominal problems may cause similar pain.

Stones less than 5mm are very likely to pass out of the ureter spontaneously.

Once the stone reaches the bladder, it normally passes out of the body in the urine without further problems and often without you even being aware of it.

Larger stones may not pass on their own and may need an operation to remove them.

The doctor may want to see the stones. They are obviously difficult to catch but one solution is to try urinating through a sieve or through a coffee filter paper.

Will you need to go to hospital?

If the kidney stone is so big that it cannot come out by itself or the pain continues, it will be necessary to go to hospital.

In the past X-ray or ultrasound were used but it is becoming more common to use a CT scan to diagnose the problem.

CT is very good at showing the size of the stone and where it is situated. This is important because it helps doctors decide how, and when, the stone should be removed. If the stone is small and lying close to the bladder, it may be left to pass on its own.

There are many modern methods of removing stones that involve passing a small telescope via the bladder through which a variety of stone disintegrators can be used. Most commonly lasers are now used to fragment the stone.

Occasionally, a small opening is made directly into the kidney for large stones. It is very rare nowadays for patients to need open surgery.

What is lithotripsy?

Lithotripsy uses shockwave therapy to break up kidney stones. The treatment is performed in hospital using special equipment and is becoming more and more common.

The stone is fragmented into pieces by the treatment and these smaller pieces can then pass out of the body unaided in the urine.

If the stone is larger than 1 cm, then more than one treatment session may be required.

7 Natural Remedies For Joint Pain

Natural Remedies For Joint Pain

When joint pain flares up, you want relief—fast. But you might not want to pop a pain reliever, especially if you’re concerned about side effects or interactions with other drugs. Or maybe meds alone aren’t doing enough, so you’re looking to add a drug-free remedy to your arsenal. Ice and heat are great, but they’re not your only options. Here are 7 more natural ways to fight inflammation and ease your ache. (The Power Nutrient Solution is the first-ever plan that tackles the root cause of virtually every major ailment and health condition today; get your copy now!)

Stick a pin in it

The scientific proof that acupuncture improves osteoarthritis pain is a little iffy. (Studies have been mixed, and it’s hard to rule out the placebo effect.) But a 2013 research review did conclude that there’s some evidence that this alternative treatment improves pain and stiffness in people with fibromyalgia(an arthritis-like condition characterized by widespread musculoskeletal pain). So if you’re not averse to needles, book a few sessions. Just remember that frequent visits may be needed before you see results, and most insurance plans won’t cover it, says Sheryl Mascarenhas, MD, an assistant professor of rheumatology at The Ohio State University. (See what else acupuncture can treat.)

MORE: 11 Effective Solutions For Sciatic Nerve Pain

Take to the water.
Take to the water

Swimming, water aerobics, and other aquatic activities “promote flexibility and strength without high impact,” says Mark Karadsheh, MD, an orthopedic surgeon at the William Beaumont Hospital in Royal Oak, MI. A 2014 review in the journal Physical Therapy found that exercising in water reduces pain and improves physical functioning in people with osteoarthritis of the lower limbs. Meanwhile, a 2015 study from The Netherlands found that a 45-minute aquatic circuit training session helped relieve the pain of knee osteoarthritis.

Spice things up.
Spice things up

Capsaicin, a substance responsible for the heat in hot peppers, is also used in topical pain-relieving creams and ointments. “It temporarily uses up substance P [a brain chemical that stimulates pain receptors], which redirects nerves so you don’t feel pain in the joint,” explains Mascarenhas, who notes that it can provide significant relief. In fact, a study from Case Western Reserve University found that 80% of people with osteo or rheumatoid arthritis had less pain after applying capsaicin cream four times a day for 2 weeks.

Consider supplements.
Consider supplements
Consider supplements.

Glucosamine and chondroitin sulfate (both found in human cartilage) are popular for treating the pain and swelling associated with osteoarthritis. Studies on their effectiveness have been mixed, but a 2015 research review determined that this combo significantly reduces pain and improves functioning in people with osteoarthritis of the knee. “There’s no risk associated with taking them so they’re worth a shot,” says Karadsheh.

Go fish.
Go fish

It’s no secret that omega-3 fatty acids, including fish oil supplements, have anti-inflammatory properties. It turns out these supplements also could help aching joints feel better. A 2015 study from Thailand found that when people with osteoarthritis of the knee took 1,000 mg of fish oil supplements (a combination of EPA, or eicosapentaenoic acid, and DHA, or docosahexaenoic acid) once a day for 8 weeks, their pain decreased and their functioning improved significantly. Other research has found that getting more omega-3s enabled people with rheumatoid arthritis to reduce their reliance on NSAIDs.

Embrace an ancient martial art.
Embrace an ancient martial art

Practicing tai chi is a low-impact way to strengthen the muscles around your joints and increase your range of motion, says Karadsheh. A 2013 review of seven randomized controlled trials found that a 12-week tai chi program improves symptoms of pain, stiffness, and physical function in peopl

Lower abdominal pain in women

All women will experience pain in the lower abdomen from time to time. Most commonly this can occur due to their periods or menstruation.

In many cases it is difficult to diagnose the exact cause of the pain, but noting certain features will help your doctor come to a diagnosis.

The most common causes are a urinary disorder, such as bladder or kidneyproblems, a bowel problem or a problem with the reproductive system – the uterus, Fallopian tubes and ovaries.

Abdominal pain arising from the urinary system

Urine infections are common and present symptoms, such as burning when you pass urine and going to the toilet more often.

Infection can spread to the kidneys (pyelonephritis) and can make you feel unwell with a high temperature and back pain.

If you have pain that spreads from your back down to your groin and is severe – your doctor may be more concerned that you have kidney stones. The doctor will test your urine if you have any of the above symptoms.

If you have any blood in your urine, it’s important to tell the doctor because this always needs investigation.

Tumours of the urinary system are not common, and the doctor will certainly take into account the duration of your symptoms first.

Abdominal pain arising from the digestive system

Pain arising from the large intestine is a particularly common cause of lower abdominal pain in both men and women. Features suggesting your pain may be to do with the bowel are:

  • Pain associated with pooing
  • A change in bowel habit
  • Loss of blood when you poo
  • Bloating with wind

Both constipation and diarrhoea can give you pain.

The pain they are often associated with is described as crampy or ‘colicky.’ This means that it comes and goes in waves. Large bowel pain is characteristically relieved on opening the bowels. Potential causes of pain arising from the bowel include irritable bowel syndrome (IBS), which can give you alternating diarrhoea, constipation and bloating. Other conditions include diverticular disease and it’s complications which are more frequent in older patients. Inflammatory bowel disease (ulcerative colitis or Crohn’s). A rare but important diagnosis is colorectal cancer.

Bloating and swelling is also a common symptom that people report and can be due to a problem affecting the bowels.

If you have any fresh bleeding from your back passage or you notice that your poo is black in colour then your should alert your doctor. These symptoms require investigation.Woman having her stomach examined by doctor

Abdominal pain arising from the reproductive organs

Pain can originate from your uterus (womb), Fallopian tubes or ovaries. It’s usually felt in the middle of the lower abdomen.

Pain that is felt more to the side can be more typical of a pain coming from the ovary.

Pain coming from the uterus is often worse during your period and is called dysmenorrhoea.

Some conditions affecting the reproductive system can also cause pain during intercourse. This is called dyspareunia and it is important to let your doctor know if you are troubled by it.

Examples of conditions of the reproductive organs include endometriosis, fibroids, pelvic inflammatory disease, ovarian cysts and problems related to the early stage of pregnancy such as a miscarriage or ectopic pregnancy.

What will the doctor do?

The doctor will ask lots of questions regarding your periods, passing of urine and bowel movements. They may also ask about general symptoms such as fever, nausea and vomiting.

If appropriate, they may ask questions about a person’s emotional life-family, home, work and sex life.

Next the doctor will examine you. They will examine your abdomen and may examine you internally also (vaginal, rectal or sometimes both) may be necessary.

Often the doctor will ask for you to give a urine sample, which can be tested for infection.

If you have symptoms of vaginal discharge or other related symptoms the doctor may take some vaginal swabs.

Depending on your symptoms and their duration the doctor may decide to arrange for further investigations.

These may include:

  • Gynaecological causes may require vaginal swabs, cervical smears or pelvic ultrasound examination. Ultrasound may also be performed from within the vagina. Specialised blood test for ovarian cancer, CA-125, are usually performed. More invasive tests will depend upon the doctor’s suspicion of the cause of the pain.
  • Urinary causes can be investigated by urine culture, ultrasound or CT scan.
  • Colonic causes may require internal endoscopic examination of the bowel by Flexible Sigmoidoscopy or Colonoscopy.
  • A CT (Computerised Tomography Scan) may be appropriate for all three major sites of pain.

To determine how far to investigate lower abdominal pain takes skill and judgement. Pain can even arise outside the abdomen, for example from the back. Depending on the exact symptoms and duration, possible referral to the appropriate specialist is often required.

Other people also read:

Irritable bowel syndrome (IBS): what are the symptoms of IBS?

Lumbago (lower back pain): what are the danger signs?

Vaginal discharge: what can the doctor do?

Based on a text by Dr Erik Fangel Poulsen, specialist

Female Foot Pain

Anatomical illustration of human foot

The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections:

  • The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals).
  • The midfoot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone.
  • The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.

Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes.

Feet Conditions

  • Plantar fasciitis: Inflammation in the plantar fascia ligament along the bottom of the foot. Pain in the heel and arch, worst in the morning, are symptoms.
  • Osteoarthritis of the feet: Age and wear and tear cause the cartilage in the feet to wear out. Pain, swelling, and deformity in the feet are symptoms of osteoarthritis.
  • Gout: An inflammatory condition in which crystals periodically deposit in joints, causing severe pain and swelling. The big toe is often affected by gout.
  • Athlete’s foot: A fungal infection of the feet, causing dry, flaking, red, and irritated skin. Daily washing and keeping the feet dry can prevent athlete’s foot.
  • Rheumatoid arthritis: An autoimmune form of arthritis that causes inflammation and joint damage. Joints in the feet, ankle, and toes may be affected by rheumatoid arthritis.
  • Bunions (hallux valgus): A bony prominence next to the base of the big toe that may cause the big toe to turn inward. Bunions may occur in anyone, but are often caused by heredity or ill-fitting footwear.
  • Achilles tendon injury: Pain in the back of the heel may suggest a problem with the Achilles tendon. The injury can be sudden or a nagging daily pain (tendinitis).
  • Diabetic foot infection: People with diabetes are vulnerable to infections of the feet, which can be more severe than they appear. People with diabetes should examine their feet daily for any injury or signs of developing infection such as redness, warmth, swelling, and pain.
  • Swollen feet (edema): A small amount of swelling in the feet can be normal after prolonged standing and common in people with varicose veins. Feet edema can also be a sign of heart, kidney, or liver problems.
  • Calluses: A buildup of tough skin over an area of frequent friction or pressure on the feet. Calluses usually develop on the balls of the feet or the heels and may be uncomfortable or painful.
  • Corns: Like calluses, corns consist of excessive tough skin buildup at areas of excessive pressure on the feet. Corns typically have a cone shape with a point, and can be painful.
  • Heel spurs: An abnormal growth of bone in the heel, which may cause severe pain during walking or standing. People with plantar fasciitis, flat feet, or high arches are more likely to develop heel spurs.
  • Ingrown toenails: One or both sides of a toenail may grow into the skin. Ingrown toenails may be painful or lead to infections.
  • Fallen arches (flat feet): The arches of the feet flatten during standing or walking, potentially causing other feet problems. Flat feet can be corrected with shoe inserts (orthotics), if necessary.
  • Nail fungal infection (onychomycosis): Fungus creates discoloration or a crumbling texture in the fingernails or toenails. Nail infections can be difficult to treat.
  • Mallet toes: The joint in the middle of a toe may become unable to straighten, causing the toe to point down. Irritation and other feet problems may develop without special footwear to accommodate the mallet toe.
  • Metatarsalgia: Pain and inflammation in the ball of the foot. Strenuous activity or ill-fitting shoes are the usual causes.
  • Claw toes: Abnormal contraction of the toe joints, causing a claw-like appearance. Claw toe can be painful and usually requires a change in footwear.
  • Fracture: The metatarsal bones are the most frequently broken bones in the feet, either from injury or repetitive use. Pain, swelling, redness, and bruising may be signs of a fracture.
  • Plantar wart:  A viral infection in the sole of the foot that can form a callus with a central dark spot.  Plantar warts can be painful and difficult to treat.
  • Morton’s neuroma: A growth consisting of nerve tissue often between the third and fourth toes. A neuroma may cause pain, numbness, and burning and often improves with a change in footwear.

    Feet Tests

    • Physical exam: A doctor may look for swelling, deformity, pain, discoloration, or skin changes to help diagnose a foot problem.
    • Feet X-ray: A plain X-ray film of the feet can detect fractures or damage from arthritis.
    • Magnetic resonance imaging (MRI scan): An MRI scanner uses a high-powered magnet and a computer to construct detailed images of the foot and ankle.
    • Computed tomography (CT scan): A CT scanner takes multiple X-rays, and a computer constructs detailed images of the foot and ankle.

    Feet Treatments

    • Orthotics: Inserts worn in the shoes can improve many foot problems. Orthotics may be custom-made or standard-sized.
    • Physical therapy: A variety of exercises can improve flexibility, strength, and support of the feet and ankles.
    • Feet surgery: In some cases, fractures or other problems with the feet require surgical repair.
    • Pain medicines: Over-the-counter or prescription pain relievers such as acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) can treat most foot pain.
    • Antibiotics: Bacterial infections of the feet may require antibacterial drugs given orally or intravenously.
    • Antifungal medicines: Athlete’s foot and other fungal infections of the feet can be treated with topical or oral antifungal medicines.
    • Cortisone injection: An injection of a steroid may be helpful in reducing pain and swelling in certain foot problems.

Anal Canal Anatomy

The anal canal is the most terminal part of the lower GI tract/large intestine, which lies between the anal verge (anal orifice, anus) in the perineum below and the rectum above. The description in this topic is from below upwards, as that is how this region is usually examined in clinical practice. Images depicting the anal canal can be seen below. [1, 2]

Coronal section of rectum and anal canal. Coronal section of rectum and anal canal.
Coronal section through the anal canal. Coronal section through the anal canal.

The pigmented, keratinized perianal skin of the buttocks (around the anal verge) has skin appendages (eg, hair, sweat glands, sebaceous glands); compare this with the anal canal skin above the anal verge, which is also pigmented and keratinized but does not have skin appendages. [3, 4]

The demarcation between the rectum above and the anal canal below is the anorectal ring or anorectal flexure, where the puborectalis muscle forms a sling around the posterior aspect of the anorectal junction, kinking it anteriorly.

The anal canal is completely extraperitoneal. The length of the anal canal is about 4 cm (range, 3-5 cm), with two thirds of this being above the pectinate line (also known as the dentate line) and one third below the pectinate line.

The epithelium of the anal canal between the anal verge below and the pectinate line above is variously described as anal mucosa or anal skin. The author believes that it should be called anal skin (anoderm), as it looks like (pigmented) skin, is sensitive like skin (why a fissure-in-ano is very painful), and is keratinized (but does not have skin appendages).

The pectinate line is the site of transition of the proctodeum below and the postallantoic gut above. It is a scalloped demarcation formed by the anal valves (transverse folds of mucosa) at the inferior-most ends of the anal columns. Anal glands open above the anal valves into the anal sinuses. The pectinate line is not seen on inspection in clinical practice, but under anesthesia the anal canal descends down, and the pectinate line can be seen on slight retraction of the anal canal skin.

The anal canal just above the pectinate line for about 1-2 cm is called the anal pecten or transitional zone. Above this transitional zone, the anal canal is lined with columnar epithelium (which is insensitive to cutting). Anal columns (of Morgagni) are 6-10 longitudinal (vertical) mucosal folds in the upper part of the anal canal.

At the bottom of these columns are anal sinuses or crypts, into which open the anal glands and anal papillae. Infection of the anal glands is likely the initial event in causation of perianal abscess and fistula-in-ano. Three of these columns (left lateral, right posterior, and right anterior, at 3-, 7-, and 11-o’clock positions in supine position) are prominent; they are called anal cushions and contain branches and tributaries of superior rectal (hemorrhoidal) artery and vein. When prominent, veins in these cushions form the internal hemorrhoids.

The anorectal junction or anorectal ring is situated about 5 cm from the anus. At the anorectal flexure or angle, the anorectal junction is pulled anterosuperiorly by the puborectal sling to continue below as the anal canal.

Levator ani and coccygeus muscles form the pelvic diaphragm. Lateral to the anal canal are the pyramidal ischioanal (ischiorectal) fossae (1 on either side), below the pelvic diaphragm and above the perianal skin. The paired ischioanal fossae communicate with each other behind the anal canal. The anterior relations of the anal canal are, in males, the seminal vesicles, prostate, and urethra, and, in females, the cervix and vagina with perineal body in between. In front of (anterior to) the anal canal is the rectovesical fascia (of Denonvilliers), and behind (posterior) is the presacral endopelvic fascia (of Waldeyer), under which lie a rich presacral plexus of veins. Posterior to the anal canal lie the tip of the coccyx (joined to it by the anococcygeal ligament) and lower sacrum.

The anal canal is surrounded by several perianal spaces: subcutaneous, submucosal, intersphincteric, ischioanal (rectal) and pelvirectal.

Blood supply and lymphatics

The anal canal above the pectinate line is supplied by the terminal branches of the superior rectal (hemorrhoidal) artery, which is the terminal branch of the inferior mesenteric artery. The middle rectal artery (a branch of the internal iliac artery) and the inferior rectal artery (a branch of the internal pudendal artery) supply the lower anal canal.

Beneath the anal canal skin (below the pectinate line) lies the external hemorrhoidal plexus of veins, which drains into systemic veins. Beneath the anal canal mucosa (above the pectinate line) lies the internal hemorrhoidal plexus of veins, which drains into the portal system of veins. The anal canal is, therefore, an important area of portosystemic venous connection (the other being the esophagogastric junction). Lymphatics from the anal canal drain into the superficial inguinal group of lymph nodes.

Physiology

Anorectal sphincter tone can be assessed during digital rectal examination (DRE) when the patient is asked to squeeze the examining finger. Anorectal manometry measures the pressures: resting and squeezing.

Embryology

The anal canal below the pectinate line develops from the proctodeum (ectoderm), while that above the pectinate line develops from the endoderm of the hindgut.