Hantavirus

Hantavirus is a type of virus carried by rodents. There are many types of hantavirus infections that infect rodents, and a few that can infect humans as well.


Causes/associated factors
Serious hantavirus infections have been noted for some time in Asia and Europe. This potentially life-threatening illness primarily affects the kidneys.
In 1993, a serious respiratory illness due to a newly recognized type of hantavirus, the Sin Nombre hantavirus, was detected in the United States. That spring, heavy snow and rain helped revive plants and animals after a prolonged drought in the "four corners" area of the southwestern United States. With plenty to eat, the deer mice popu- lation in the area exploded. The increased mouse population led to a sudden outbreak of this serious respiratory illness, now called hantavirus pulmonary syndrome (HPS).

Further investigation determined the illness wasn't new. Tissue samples preserved from people with unexplained respiratory deaths many years ago showed that the virus was present in the United States as early as 1959. Navajo Indians had long before that recognized a similar disease and also associated it with rodents.

It has since been determined that the Sin Nombre hantavirus is responsible for most cases of HPS in the United States, but that other hantaviruses can also cause the infection. You may be exposed to hantavirus when you contact infected rodents through domestic, occupational or leisure activities. Hantavirus is spread mainly by deer mice and cotton rats, both common in rural and semirural areas throughout the United States. Hantavirus may also be found in rice rats and white-footed mice in the United States. The common house mouse hasn't been identified as a carrier of this virus. In the United States, hantavirus has been identified in rodents in at least 31 states.

Sixty percent of all people who've been diagnosed with hantavirus are between ages 20 and 39. The illness is rare in children under age 12.


Transmission
Hantavirus particles are found in the urine, feces and saliva of infected rodents. These particles can get into the air when rodent nests or droppings are disturbed (by sweeping, for example). This process is called aerosolization. Humans are thought to contract hantavirus by breathing air contaminated with these viral particles. Less commonly, the virus may spread through the bite of an infected rodent, by eating contaminated food or by touching an object contaminated with rodent droppings or saliva and then touching your nose or mouth. Person-to-person spread hasn't occurred in the United States, but a few cases have occurred in South America.
Contamination is thought to be most probable inside rodent-infested homes, crawl spaces, garages, barns, storage facilities, shelters or other closed buildings that lack good ventilation. Brief exposure to such an environment may be all it takes to develop a hantavirus infection.

The incubation period (time from exposure until symptoms appear) for humans is about two weeks, but may range from a few days to six weeks.


Signs/symptoms
HPS primarily affects the blood vessels of the lungs, causing changes that allow blood to leak into the surrounding lung tissue. Initial symptoms may resemble the flu, often including fever, muscle aches and fatigue. You may also notice headaches, intestinal problems (such as nausea, vomiting, diarrhea and abdominal pain), dizziness and chills. About two to 15 days after symptoms appear, there's an abrupt change in symptoms as the lungs fill with fluid. In some cases, cough and shortness of breath may progress rapidly to respiratory failure and shock.

Diagnosis
Diagnosis is based on your medical history (especially possible exposure to hantavirus), current symptoms and a physical exam. Blood tests to check for specific antibodies can confirm the diagnosis.

Treatment
If you have HPS, you must be closely monitored in an intensive care unit. Treatment is supportive, focusing on preventing shock and maintaining heart and lung status. The doctor will make sure your heart rate and blood pressure remain stable and your blood has enough oxygen. It often takes about a week after the severe respiratory symptoms appear to recover. These symptoms often subside as quickly as they appeared. Complete recovery may take weeks or months, however.

Complications
Despite intensive care, more than one-third of all people who develop HPS don't survive. Those who do survive usually recover completely, but a few have lasting respiratory problems.

Pregnancy-specific information
Due to the recent identification of this illness, the full effect of HPS during pregnancy isn't known. Based on the few cases that have been observed in pregnant women, the infection doesn't appear to spread to the developing baby.

Senior-specific information
Growing older isn't a risk factor for HPS.

Prevention
To prevent HPS, the Centers for Disease Control and Prevention (CDC) recommends the following rule of thumb: air out, seal up, trap up and clean up. Here are some specific suggestions to help you keep rodents out of your home:
If you have a wooden, earthen or adobe home, create a rodent barrier by placing metal roof flashing around the base of the house. The barrier should run 6 inches underground and 12 inches above ground.

Discourage rodent burrowing by placing 3 inches of gravel under the base of your home, including mobile homes. Cover any openings into your home ¼ inch or larger with steel wool or cement. Use tight-fitting screens on all doors and windows that are left open.

Use raised cement foundations when building sheds, barns or outbuildings.

Keep the grass mowed and eliminate rodent shelters, food sources and woodpiles within 100 feet of your home. Elevate woodpiles at least 12 inches, and don't let debris accumulate.

Store food, pet food, grain and garbage in covered, rodent-proof containers. Don't leave pet food in outdoor dishes.

Avoid placing birdfeeders near your home. If you do have birdfeeders, choose the "squirrel proof" variety and clean up any spilled seed every evening.

Wash dishes and clean up spilled food promptly. Clear up any clutter.

Eliminate rodent access to water. Repair leaks and moisture problems, insulate water pipes to prevent condensation, and make sure rodents can't get to water sources such as aquariums, cleaning equipment and flowerpots.

Place spring-loaded rodent traps within 100 feet of your home, as well as inside. A pea-sized amount of chunky peanut butter can be used as bait.
Tips for cleanup projects


Ventilate closed buildings for at least 30 minutes before beginning work.

When cleaning areas with large numbers of rodents, wear coveralls (disposable if possible); rubber boots; rubber, latex, vinyl or nitrile gloves; protective goggles; and a respiratory protection device with a filter mask. Contact your local health department for tips on disposal methods.

Wear rubber, latex, vinyl or nitrile gloves when cleaning rodent-infested areas and disposing of dead rodents. Before removing the gloves, wash your gloved hands in a household disinfectant and then in soap and water. Thoroughly wash your hands with soap and water after taking off the gloves.

To deactivate the virus and prevent aerosolization, soak all rodent-contaminated areas with a general purpose disinfectant for five minutes. (A solution of 1 1/2 cups of liquid bleach in 1 gallon of water, prepared on the day of use, is effective.)

Don't sweep or use a vacuum. Pick up wet rodent droppings, food piles and nests with a paper towel and then mop the area with disinfectant. Be sure to properly dispose of all towels, droppings, food and nests in the garbage.

If you suspect HPS within 45 days of possible exposure, seek medical attention immediately.
If your work includes handling or exposure to wild rodents, discuss your risk and precautions with your employer.

Hand, foot and mouth disease

Definition
Hand, foot and mouth disease is a viral infection that causes blisters that affect the inside of the mouth and the skin on the hands, fingers, toes, feet and sometimes the buttocks.

Causes/associated factors
Hand, foot and mouth disease is most commonly caused by an enterovirus called coxsackievirus A 16 and sometimes by enterovirus 71 or other enteroviruses. (Enteroviruses are a group of viruses that are found in the gastrointestinal and respiratory tracts.) You can't be infected by the same virus twice, but you can develop hand, foot and mouth disease more than once if you're infected by another virus.
Although adults contract hand, foot and mouth disease, it's most common in young children. Outbreaks may happen among groups of children in child care centers or classrooms, especially during the summer or early fall.

It's important to note that hand, foot and mouth disease is not the same illness as foot and mouth disease, which affects animals.


Transmission
The virus spreads by inhaling infected respiratory droplets or direct contact with infected respiratory secretions, saliva, stool or fluid from the blisters.
The incubation period (time from infection to the appearance of symptoms) is three to seven days. Communicability is greatest while symptoms are present. People who have no symptoms can also spread the virus to others, however. The virus may also be shed in an infected person's stool for several weeks after symptoms disappear. Doctors often recommend that infected children stay home from child care or school if they have mouth blisters and are drooling, or if they have a fever, diarrhea or weeping lesions on their hands. If your child is infected, ask your doctor how long isolation is necessary. You may also want to check with your child's child care provider or school for any individual policies.


Signs/symptoms
For some people symptoms are mild, if they appear at all. For those who develop symptoms, the first may include a mild fever, sore throat, poor appetite and malaise (a general feeling of discomfort or illness). Within one to two days, small blisters can develop in the mouth, often on the inner cheeks, gums or tongue. The blisters in the mouth may ulcerate or become open sores. A rash often appears as small red spots or blisters around the hands, palms, soles of the feet, and between the fingers and toes. The rash may also develop on the buttocks and in the groin, particularly in small children. Some people also develop swollen glands. If symptoms appear, they typically last seven to 10 days.

Diagnosis
Diagnosis is based on your medical history and a physical exam. Although samples to test for the virus can be taken from the throat, stool or any affected site, this isn't routinely necessary. If samples are taken, it may take two to four weeks to receive the test results.

Treatment
There is no specific treatment for hand, foot and mouth disease. If you're severely ill or have a weak immune system, antiviral medication may be prescribed. Self-care includes:
drinking plenty of fluids, especially cool ones
eating a soft, bland diet with nonacidic or cold foods
rinsing your mouth with warm water after eating
taking acetaminophen for fever or discomfort if recommended by the doctor
Sometimes, mouth sores can make swallowing painful. Children who are not eating or drinking normally may become dehydrated. If you're concerned about your child or recovery is not prompt, consult the doctor.


Complications
Hand, foot and mouth disease typically clears up on its own. There are usually no complications associated with the coxsackievirus A 16. Rarely, meningitis (inflammation of the membranes surrounding the brain or spinal cord) may result from an infection with this virus.
Other strains of enterovirus, such as enterovirus 71, may cause complications more often. Although rare, potential complications may include:

meningitis
encephalitis (inflammation of the membranes surrounding the brain or spinal cord)
pneumonia (infection of the lungs)
myocarditis (inflammation of the heart muscle)
paralysis (temporary or permanent loss of voluntary movement)

Pregnancy-specific information
The risk of contracting hand, foot and mouth disease during pregnancy appears to be small. Although a mother's infection is typically mild, some enterovirus infections can lead to a serious infection in the fetus, congenital abnormalities or, rarely, fetal death.

Senior-specific information
The incidence of hand, foot and mouth disease is lower among older adults. Elderly adults with weak immune systems may be at risk for persistent infections, however.

Prevention
To prevent hand, foot and mouth disease, teach children to wash their hands often (especially after going to the bathroom) and to cover their mouths when sneezing. The same rules apply to adults. Also, remember to wash your hands after handling diapers or other soiled materials. Clean all toys, eating utensils, bottle nipples or other objects that have saliva on them. Disinfect contaminated household surfaces and wash soiled clothing. Remember hand, foot and mouth disease can be spread through fluid from the blisters. Be careful to avoid exposure to open sores and break closed blisters. Finally, avoid exposing infants and young children to anyone with a respiratory illness.

Hair loss or thinning

Definition
Human hair originates from individual hair follicles, which are attached to cells that form the outermost layer of skin. Each strand of hair grows for a period of time, rests, sheds and is then replaced. About 100 to 150 hairs are typically shed each day. Alopecia (hair loss or thinning) occurs when the hair follicles are damaged or the natural replacement hair does not balance the shedding hair. Hair loss without associated scarring is often temporary.

Causes/Associated factors
There are many types of hair loss or thinning, each has its own causes, symptoms, prognosis and treatment.
Androgenetic alopecia, also known as male or female pattern baldness or common baldness, is the most common form of hair loss. It's typically noticed as gradual hair thinning. The condition is generally hereditary. For men, this type of hair loss typically begins around age 20 and affects the area above the forehead, over the temples or the crown. In women, it typically begins later in life and affects the area above the forehead or the crown. For some women, it may simply be noticed as diffuse thinning. Treatment success is highly individual.

Alopecia areata produces complete hair loss in small round patches on the scalp, beard, eyebrows, eyelashes and, less commonly, other areas. This type of hair loss develops suddenly and has an unpredictable course that often resolves without treatment. The cause is unknown, but it's thought to be an autoimmune disorder. Recurrences are common.

Telogen effluvium, also known as stress alopecia, is characterized by excessive generalized hair loss. It occurs after a physical stress to the body, such as pregnancy, surgery, a crash diet or stopping birth control pills. It may also be a side effect of many medications, including amphetamines, coumadin, lithium, levodopa and propranolol.

Anagen effluvium results in scattered hair loss that can lead to extensive balding. This type of hair loss is a side effect of certain types of cancer chemotherapy drugs. It's normally reversible.

Traction alopecia occurs when the hair is pulled too tightly for prolonged periods of time, such as when you wear your hair tightly braided or pulled back, you set rolling curlers too tightly, or you twist your hair repeatedly with your fingers. This type of hair loss can result in scarring, which may lead to permanent hair loss.

Alopecia cicatrisata, also known as cicatricial scarring alopecia, results in smooth, shiny, scarred hairless patches of various sizes. This type of hair loss can be caused by a bacterial, viral or fungal infection, as well as certain skin conditions or injuries, such as burns or trauma. Sometimes, no underlying cause is found. Alopecia cicatrisata is usually irreversible.

Trichotillomania is a disorder characterized by the uncontrollable urge to pull your own hair. With this condition, built-up tension results in such excessive hair pulling that the hair is actually pulled out. The act of pulling out the hair provides relief to the mounting tension. The side of the head that corresponds to the dominant hand is most often affected. Trichotillomania is most common in girls under age 10, but it may occur in boys and older children as well. The condition may be a manifestation of depression, anxiety or other psychiatric conditions.

Signs/symptoms
You may notice general hair loss, broken hairs, easily removable hair, thinning hair at the borders of any patch of hair loss or associated skin conditions, such as itching, scaling or inflammation. Any area of the body that has hair can be affected, including the scalp, beard, eyebrows and eyelashes.

Diagnosis
Your doctor will review your medical history and do a physical exam to determine the type of hair loss and its cause. The doctor may assess characteristics of your hair using hair samples, which can help determine what type of hair loss you have. Blood tests may help the doctor identify underlying disorders, and you may need tests to measure your thyroid, hormone or vitamin levels. In some cases, scalp biopsies (taking a sample of cells for further analysis) are recommended. Other tests will depend on your specific condition. In some cases, you may be referred to a dermatologist.

Treatment
Androgenetic alopecia
Standard treatment options for androgenetic alopecia include medication and surgery.

Medication:

Minoxidil (brand name Rogaine) is a topical solution (applied directly to the skin) that can stimulate hair growth.

Benefits of minoxidil: It has been shown to stabilize hair loss and improve new hair growth in some people. Minoxidil can be used by both men and women, and is available without a prescription.

Risks of minoxidil: It may take at least four months to see results. To maintain new hair growth, the medication must be taken indefinitely. Common reactions to minoxidil include burning, itching and redness at the application site.
Finasteride (Propecia) is taken orally. It works by interfering with the production of dihydrotestosterone, a hormone that's elevated in men who have male pattern baldness.

Benefits of finasteride: Finasteride may increase new hair growth and prevent further hair loss in some people.

Risks of finasteride: To maintain new hair growth, finasteride must be taken indefinitely. Side effects may include decreased sex drive and erectile dysfunction. Finasteride is not approved for use in women. Due to the potential harmful effects to a male fetus, crushed or broken tablets should not be handled by women who are or may be pregnant.
Spironolactone is an antiandrogen medication that may be used to treat androgenetic alopecia.

Benefits of spironolactone: If excess androgen (hormones such as testosterone) in the body is causing hair loss in women, spironolactone may lessen the hair loss.

Risks of spironolactone: This medication can only be used by women because of possible breast enlargement and other feminizing effects in men. Pregnant women should not take spironolactone, however, because of a concern for abnormal sexual development in the fetus.
Surgery:

Hair transplantation may be a treatment option for some people who have androgenetic alopecia. Hair plugs are taken from a portion of the scalp that has hair and moved to the area of baldness. The flap technique moves areas of hair rather than hair plugs.

Scalp reduction is a surgical technique that removes an area of balding scalp to lessen the appearance of baldness. Grafts or flaps may be done at the same time. The scalp may also be stretched, increasing the area where hair grows.

Benefits of surgery: Recent refinements in techniques have given more cosmetically pleasing results.

Risks of surgery: People who have very little hair may not be good candidates for surgical treatment. Scarring and infection are possible from surgery, and the transplanted hair may only last a few years.
Alopecia areata
Treatment is often determined by the extent of the hair loss and may include the use of medication or light therapy.

Medication:

Steroid injections or a topical application of steroids may be used to stimulate hair growth for people who have lost less than half of their hair. People who have lost more than half of their hair are often treated with a combination of medications, such as topical anthralin and minoxidil, topical steroids and minoxidil, or a specific topical allergen (any substance that stimulates an immune response or allergic reaction) to force follicle growth. Examples of topical allergens include dinitrochlorobenzene and squaric acid dibutyl ester. Oral steroids may be used alone or in combination with topical or injected steroids, but are usually reserved for extensive or rapidly spreading cases.

Benefits of steroids: Topical steroids may help stimulate new hair growth in mild to moderate cases, but injections may be more effective for more serious cases.

Risks of steroids: Steroid injections may be painful and need to be repeated every four to six weeks. Oral steroids are effective, but are rarely prescribed due to their side effects and need for long-term use (regrown hair may fall out when treatment stops).

Benefits of anthralin: It has been shown to stimulate hair growth and is considered safe.

Risks of anthralin: Scalp irritation may occur.

Benefits of minoxidil: It has been shown to stabilize hair loss and improve new hair growth in some people. Minoxidil can be used by both men and women, and is available without a prescription.

Risks of minoxidil: It may take at least four months to see results. To maintain new hair growth, the medication must be taken indefinitely. Common reactions to minoxidil include burning, itching and redness at the application site.

Benefits of topical allergens: Hair regrowth occurs in about 40 percent of people after six months of treatment.

Risks of topical allergens: These medications produce an itchy rash that may be uncomfortable. They do not permanently prevent further hair loss, and need to be continued to maintain hair regrowth. Topical allergens need to be managed by a dermatologist because of their potency.
Ultraviolet A (PUVA) therapy: Photochemotherapy can be received in your doctor's office. Also known as PUVA, it's a combination of the medication psoralen along with exposure to ultraviolet A (UVA) light. Psoralen, which is available in a pill or topical form, makes the body more sensitive to the light. It is thought PUVA acts on the immune system. Treatments are received two to three times a week, but may require long-term therapy.

Benefits of PUVA therapy: This may be an option if alopecia areata is resistant to other therapy.

Risks of PUVA therapy: This therapy can be effective, though long-term therapy may increase your risk of skin cancer. Hair loss may return when therapy is stopped.
For some people, hair transplantation may be a better treatment option for androgenic alopecia. Recent refinements in techniques have given more cosmetically pleasing results.

Alopecia areata
Standard treatment options for alopecia areata include direct injection of steroids or topical application of steroids, anthralin, minoxidil or a specific topical allergen (any substance that stimulates an immune response or allergic reaction). Controlled exposure to ultraviolet light may also be an option. Oral steroids are rarely prescribed due to their long-term side effects.

Telogen effluvium
Treatment is usually unnecessary because the hair grows back spontaneously. It

Traction alopecia
This type of hair loss can be treated by removing the underlying cause (such as a tight hairstyle or curlers). If scarring is extensive, new hair growth may be limited.

Alopecia cicatrisata
Treatment is typically aimed at the underlying cause. Because new hair growth may be limited, hair transplantation may be an option.

Trichotillomania
Treatment options typically include therapy and medications to treat underlying psychiatric disorders. Behavioral therapy, for example, can help the person address the tension that typically builds before pulling hair and learn healthier methods for releasing the tension.


Considerations
Coping with hair loss can be difficult, and contacting a support group may be beneficial. Learning different ways to style your hair to hide bald areas and wearing hairpieces or wigs are possible ways to cosmetically reduce the appearance of hair loss.

Pregnancy-specific information
The excessive hair loss you may notice two to three months after childbirth is related to the normal hormonal changes of pregnancy. It doesn't lead to baldness, but it's wise to follow a healthy postpartum diet and avoid pulling your hair tightly. Hair loss after childbirth can differ each time you have a baby.

Senior-specific information
Hair loss is often a normal part of the aging process. In fact, most older men and women have some degree of hair loss, although men often experience it to a greater extent than women. If you notice sudden changes in your hair or scalp, consult your doctor.

Prevention
Little can be done to prevent hereditary hair loss. To protect yourself from nonhereditary hair loss, lead a healthy lifestyle, eat healthfully, get regular medical checkups, and control treatable hair conditions. To avoid scalp infections, practice good personal hygiene and avoid sharing hair accessories such as hats, hair brushes or combs. To prevent traction alopecia, avoid tight hairstyles, ponytails, pigtails, braids and tight rollers.

Haemophilus influenzae type B immunization for children

The bacteria Haemophilus influenzae type B (Hib) can cause many serious infections in different parts of the body. Some of these infections may cause permanent disability or even death. The infections include:

meningitis (inflammation of the membrane lining the brain)
epiglottitis (inflammation of the epiglottis, the flap of tissue that covers the voice box and windpipe to protect the airway when you swallow; if left untreated, this inflammation can block the airway and cause respiratory failure.)
pneumonia (a lung infection)
arthritis (inflammation of a joint)
pericarditis (inflammation of the membrane covering the heart)
septicemia (a blood infection)
cellulitis (inflammation of connective tissue)
In the past, these infections were most common in children between ages 6 months and 5 years. Routine immunization dramatically has decreased the incidence of these serious infections in the last decade. In fact, the H. influenzae type B (Hib) vaccine is more than 95 percent effective in preventing Hib. The vaccine is an inactivated vaccine, which means it contains a dead form of the bacteria that causes Hib.


Recommendations/dose
Children routinely are vaccinated between ages 2 months and 15 months. Three or four shots are needed, depending on the brand of vaccine that's used.

Effectiveness/booster
The Hib vaccine is 95 to 100 percent effective in preventing Hib illness, which includes a number of serious infections, some of which can cause permanent disability or death. A booster isn't needed.

Side effects
Side effects are uncommon. When they occur, they're usually mild and can include soreness, redness or swelling at the injection site; mild to moderate fever; and fussiness. Side effects typically begin within 24 hours and usually last less than 48 hours. Allergic reactions are possible, but rare.

Who should wait to receive the vaccine?
Your child's doctor may postpone this vaccine if your child has a moderate to severe acute illness.

Who shouldn't receive the vaccine?
Your child shouldn't receive the vaccine if she or he has had a severe allergic reaction to a prior Hib vaccination or any of its components. The vaccine isn't given to babies younger than age 6 weeks.

Growing pains

Growing pains is a term used to describe intermittent pain, usually in the legs, in otherwise healthy children.


Causes/associated factors
The cause of growing pains is unknown, and it's uncertain whether they're related to the growing process at all. Some experts debate whether the muscle aches or pains common during mild viral illnesses and after strenuous activity, such as running or jumping, are mistaken for growing pains.
Growing pains are most common in school-aged children. They won't affect your child's growth and development, and typically go away on their own by age 12.


Signs/symptoms
Growing pains cause intermittent, deep pain in the legs, thighs, calves, behind the knees or, rarely, in the groin. Although growing pains can occur anytime, they're often noticed late in the evening or while the child is in bed. The nature of the pain can vary and may include:
intermittent pain that doesn't occur on a daily basis
intermittent pain that occurs for weeks or months, disappears and then returns
pain unrelated to daytime physical activity
leg pain that doesn't involve the joints
pain in both legs, never just one
Although growing pains seem to be harmless, an underlying disorder may cause the same type of pain. If your child has swelling, muscle shrinking or wasting, limpness, tenderness, continued pain or other signs of disease, consult his or her doctor.


Diagnosis
The doctor will review your child's health history and do a physical exam. Your child may need lab tests or X-rays of the affected area to rule out more serious conditions. Growing pains may be diagnosed if the evaluation is normal and your child is otherwise healthy.

Treatment
To help your child deal with growing pains, reassure him or her that the pain is temporary and not a sign of a serious problem.
If your child's symptoms last longer than 30 minutes, the doctor may recommended an over-the-counter pain medication, such as children's acetaminophen or ibuprofen. It may help to gently massage the painful area or apply a warm, moist compress. You may want to teach your child muscle-stretching exercises as well.

Group B streptococcus and pregnancy

Group B streptococcus (GBS) is a bacterium that can cause serious infections. (Group A streptococcus is a different bacterium that causes the common strep throat.) For newborns, GBS can cause pneumonia, blood infections, bacterial meningitis (inflammation of the membranes surrounding the brain or spinal cord), and bone or joint infections.


Transmission/associated factors
Many people carry the GBS bacterium temporarily in their intestines, vagina, bladder or throat without being ill. It can cause illness in elderly adults or adults who have a chronic illness, pregnant women and newborns. GBS can be transmitted from mother to baby shortly before or during birth. Other modes of transmission are uncertain. GBS is not considered to be a sexually transmitted disease.
At the time of delivery, up to 30 percent of all mothers have GBS in their vaginas or intestines. About one of every 2,500 babies born in the United States become infected. In fact, group B streptococcus is the most common cause of life-threatening infections in newborns. The presence of GBS before delivery has been associated with premature delivery and premature rupture of the membranes (when your water breaks early).

Without preventive measures, about one of every 200 babies born to women with GBS in the vagina or rectum become infected. The risk of infection is highest for babies whose mothers have:

a previous baby who developed GBS disease
a urinary tract infection caused by GBS
a fever of 100.4°F or higher during labor
preterm labor or rupture of the membranes (before 37 weeks of pregnancy)
rupture of the membranes 18 hours or more before delivery
Early-onset vs. late-onset GBS disease
About 80 percent of infants who contract GBS do so in the first week of life, usually within the first six to 12 hours after birth. Typically acquired from the mother just before or during birth, this is considered early-onset GBS disease. Even with proper treatment, about 25 percent of newborns with early-onset GBS disease do not survive.

Late-onset GBS disease develops one week to several months after birth, with most cases occurring within the first three months. Late-onset GBS disease can be acquired from the mother during delivery or later through other sources, such as poor hand washing by those caring for the infant. The survival rate for late-onset GBS disease is significantly higher than the survival rate for early-onset GBS disease.


Signs/symptoms
For newborns, symptoms of early-onset GBS disease may include:
difficulty regulating temperature
fever of 100.4°F or more, taken rectally
grunting sounds
breathing difficulty
stiffness or limpness
Symptoms of late-onset GBS disease may include:

fever of 100.4°F or higher, taken rectally
stiffness or limpness
decreased appetite
inconsolable crying
Pregnant women who have group B streptococcus in their vaginas or rectums typically have no symptoms and develop no complications. However, some may develop uterine, urinary or C-section incision infections.


Diagnosis
If you or your baby develop any symptoms of GBS disease, consult a doctor immediately. Blood tests, cultures and X-rays may be done to diagnose the problem.

Treatment
If a GBS infection is suspected in a baby, antibiotic treatment begins at once -- even before test results are available. Mothers diagnosed with GBS infections are also given antibiotics. For both mothers and babies, penicillin and ampicillin are the antibiotics of choice. Others, such as clindamycin or erythromycin, may be used if allergies exist.

Complications
About 10 percent of infected babies don't survive, and others have permanent disabilities, such as hearing or vision loss, learning disabilities and mental deficiencies. For pregnant women and new mothers, GBS can cause infections in the uterus, urinary tract and C-section incision. The risk of preterm labor and premature rupture of the membranes is also higher.

Prevention
In 1996, two approaches for identifying high-risk mothers were recommended to prevent GBS disease in infants. Doctors could either screen for the bacteria during pregnancy or give antibiotics to women in labor with certain risk factors for GBS. Recent research, however, has shown the first approach to be most effective. The Centers for Disease Control and Prevention (CDC) now recommends screening all pregnant women for GBS.
For GBS screening, tissue samples are swabbed from the mother's vagina and rectum between 35 and 37 weeks of pregnancy. (Because GBS bacteria can come and go, cultures done earlier in the pregnancy are not as accurate.) Test results are available in 24 to 48 hours. A new test recently approved by the U.S. Food and Drug Administration provides results in one hour. The quick results allow women who go into labor before being tested or women who haven't had prenatal care to be treated if necessary. A positive result indicates GBS bacteria are present, but not that mother or baby are ill. If you test positive, you will then be given penicillin or another antibiotic, such as ampicillin, clindamycin or erythromycin during labor. Giving the medication earlier may not be effective because you may become infected again before the baby is born.

Antibiotics are also recommended if you've had a urinary tract infection caused by GBS during this pregnancy or a previous baby who developed GBS disease. Prior screening isn't necessary in these high-risk situations.

If the one-hour testing isn't available at your facility and you go into labor before GBS screening is done or the results are unknown, antibiotics are given if you have:

rupture of the membranes 18 hours or more before delivery
preterm labor or rupture of membranes (before 37 weeks of pregnancy)
fever of 100.4°F or higher during labor
A mother who receives antibiotics during labor has a one in 4,000 chance of delivering a baby with GBS disease -- significantly lower than the one in 200 chance without antibiotics. Infants born to mothers who receive the antibiotics should be observed in the hospital for any symptoms of GBS infection for at least 48 hours after birth. Discharge after 24 hours of observation may be considered if the mother received at least four hours of antibiotic therapy before delivery and the infant appears healthy and was born at 38 weeks of pregnancy or later. If an infant is born before 35 weeks of pregnancy, a blood test and culture may be done to determine if GBS is present.

On the research front
A vaccine to prevent GBS disease is currently being developed. The vaccine will stimulate the mother's body to produce antibodies that fight the GBS bacteria. Through the placenta, the infant would receive these antibodies and develop immunity to the bacteria.

Grief myths

Myth: Grief moves through stages in a totally predictable pattern.
Fact: Grief is a profoundly personal and individual experience. It does not necessarily follow a set pattern. There are many ways to experience grief. Honor your own mourning process when facing a loss. There is no established time line or deadline.

Myth: The goal when dealing with grief is recovering to your previous status within a specific time period.
Fact: The belief that grief can be resolved quickly and easily is damaging. In truth, your life may never be or feel exactly the same as it did before any significant loss. In some cases, accepting or reconciling the loss is more realistic -- and healthier -- than recovering from it.

Myth: If you don't respond to a significant loss with extreme distress, something is seriously wrong.
Fact: Depression or extreme distress can occur when grieving, but these are not the only responses to a loss. People react to situations in highly personal ways. A lack of extreme distress over a loss does not mean you lack caring or love.

Myth: Eventually, you should be able to find meaning in your loss.
Fact: With time, some people find meaning in loss. This does not happen for everyone, however.

Myth: Grief and mourning are the same thing.
Fact: The thoughts and feelings you experience after a loss are considered grief. Mourning is the outward expression of those thoughts and feelings.

Myth: Tears expressing grief are often a sign of weakness.
Fact: Crying is a way to physiologically mourn a loss.

Grief and loss in children and adolescents

Overview
Grief is a difficult emotion for everyone -- and can certainly be experienced by children and adolescents as well. Sometimes younger people's grief is overlooked when adults are dealing with their own grief. Remember, however, a child or adolescent may need additional support more than ever when he or she is grieving.
Everyone has a unique time line for grieving. Sometimes children or adolescents wait until the adult caregivers have grieved before they begin their own grieving. Children or adolescents tend to grieve, rest for a while, then begin grieving again. Of course, the relationship and the degree of attachment to the situation or person who has passed away affects the intensity of grief, as well as the young person's age and developmental stage. The nature of the loss -- such as death, divorce, a family move, a disaster or trauma, the development of a chronic condition, the discovery of being adopted, older siblings moving out or the loss of a treasured object -- also plays a role. Sometimes children comprehend the loss only as they realize the implications, such as no longer having holiday dinners at Grandma's house.


Characteristics
At any age, a child or adolescent dealing with grief may sense the distress of the parent or other close adults and how it may affect the emotional atmosphere, which can lead to feelings of insecurity. Common age-specific characteristics are discussed below.
Birth to age 2
A child at this age may experience a sense of loss without understanding what has happened. Because he or she has no knowledge of death, reactions are based on the emotions of others and any separation from the primary caregiver. You may notice a change in crying or eating patterns, irritability, clingy or whiny behavior, bowel or bladder disturbances, or a temporary slowing in development.

Ages 3 to 5
A child at this age may also feel a sense of loss without understanding what has happened. The child may consider death reversible for others but have no concept of death for himself or herself. The child may feel personally responsible for the loss. He or she may want to join the deceased loved one or may appear indifferent to the loss. There may also be literal connections to the loss. For example, if a grandparent died of stomach problems, the child may think, "I will die if I get a stomach ache." If a parent has died, the child may seek reassurance that the surviving parent will not die. The child may ask questions openly, even of strangers.

The child may have headaches, stomach aches or rashes. Periods of sadness may be mixed with normal play. The child may regress to earlier behaviors, such as thumb sucking, clinging, temper tantrums, bedwetting or daytime bladder/bowel accidents. Any fears -- such as fear of the dark, going to sleep (especially if death has been compared to a long sleep), abandoment or being taken away -- may intensify.

Ages 6 to 11
At this age, a child's idea of loss expands. The child knows he or she can die and may fear death or his or her own safety. The child may believe death is contagious or a punishment. The child may alternate between approaching and avoiding feelings. Struggling to relate to peers or teachers can occur. The child may also express anger at a religious leader, God or another higher power, nurses, doctors or anyone who may be perceived as having contributed to the loss. The child may also experience the distress of caregivers and the emotional atmosphere at home.

Ages 12 to 18
Teenagers often believe they're invincible. The teenager may be in denial or view death as a natural enemy. Shock, sadness, anger, guilt and fear are common. A teenager may repress his or her emotions or regress to earlier behavior patterns. He or she may appear cynical ("What difference does it make?") or question or degrade the value of life, asking existential questions such as, "What is the meaning of life?" Physical distress is also a possibility.

Behaviorally, the teen may do poorly in school, abruptly change peer groups, or fight with other kids. Some teens turn to substance abuse or sexual promiscuity. Others run away from home or consider suicide.

Developmentally delayed children or adolescents
A child or adolescent who is developmentally delayed may have tremendous difficulty dealing with loss. He or she may not have the reasoning capability to fully understand the loss or his or her own thoughts or feelings. Anger, guilt, fear and regression are common. The child or adolescent may repress his or her emotions or experience physical distress. The child or adolescent may also fight with other kids.

At any age or developmental level, consider potential signs that a child or adolescent's grief has become more complex and may need additional assistance. For example:

absence of grief (showing no emotion)
persistent blame or guilt
aggressive or destructive outbursts
suicidal thoughts or actions
unwillingness to speak about the deceased
stealing or other illegal acts
displaying addictive behaviors (for example, through drugs or food)
adopting a cynical or callous attitude or devaluing life (for example, "Life sucks, so what's the big deal?")
Sometimes grief can be more than a child or adolescent is able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult medical health care provider to rule out a medical condition. If these or any other symptoms cause distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Providing comforting objects already familiar to a child or adolescent at any age can be beneficial. Security and stability are important needs during a loss. Also consider the following suggestions for certain age groups:
For children up to age 5, follow routines and maintain consistency as much as possible. Also, play and interact with the child. State the facts and circumstances without lying about death, using simple words the child can understand. Avoid confusing statements, such as "He went away" or "She passed away." Also avoid references to sleeping. Statements such as "She is sleeping" may cause a child to fear going to sleep.

For children ages 6 to 11, talk about what is happening. Plan and participate in a special activity to mark closure on the event. If the child won't be attending the funeral, have him or her make something that can be taken to the service, such as a drawing. Reassure the child that the death of a loved one does not mean the inevitable loss of another. Similarly, a sibling's death does not mean the child will also die young. Define what "dead" means in biological terms and avoid pairing it with abstract concepts, such as an afterlife. On a practical level, notify the child's teacher or other caregivers of what has happened.

For children ages 12 to 18, encourage writing in a journal, drawing, physical activity or another healthy outlet for grief. You may also want to suggest attending a grief support group for teenagers or contacting a counselor or trusted relative or friend.

For children who are developmentally delayed, provide extra reassurance, understanding and patience. Maintain close ranks, and carry on with family rituals and routines as much as possible.

If a move is involved, be aware that the child may become anxious and develop symptoms of depression. His or her friendships and sense of stability may be interrupted. The older the child, the more difficult the move may be due to the increasing importance of peers. Explain to the child why the move is necessary, describe the advantages of the new location and help familiarize the child with the area and its attractions. Consider a closure ritual or activity for the child with old friends, the home, the neighborhood or the area. In the new place, help the child get involved in community activities through the school or a religious organization. Remind the child that he or she can still call, write or e-mail old friends.

If there has been a disaster or trauma, keep in mind that the amount of destruction the child saw or experienced will affect his or her response. Post-traumatic stress disorder, for example, is a natural response to experiencing, witnessing or participating in an overwhelmingly traumatic event. Honor the frightening parts of the disaster with statements such as, "Anyone would have been scared." Listen carefully to the child's account of the trauma and remember that he or she may need to share it several times. Do not minimize the danger -- it will profoundly affect how the child processes the related grief, trauma and loss. Caring adults should remind the child how they're positively coping with the trauma themselves.

Also consider the following additional coping strategies:

When possible, prepare the young person for loss ahead of time. Tell the child or adolescent about any impending loss as soon as possible. Allow the young person to attend the funeral or memorial service, but do not force attendance.

Offer age-appropriate information that's simple, honest and accurate. Expect and address questions and concerns about grief. Pick a time when you can have each other's undivided attention. Take cues from the young person's words, actions and body language about how much information he or she can handle. Recognize that a child may tune out at times in order to protect himself or herself. Be aware that behavior can be a good indication of feelings. Don't try to talk the child out of his or her feelings, and know that the child may look to adults for permission to express those feelings. The child may need to come back to the same information again and again to seek reassurance and make sure the truth is being told.

Acknowledge the changes associated with the loss. Let the young person talk, ask questions and express emotions. Depending on the circumstances, expect questions such as, "Will this happen to me?" and "Is it my fault?" A child who has lost one parent, sibling or other loved one may ask if he or she will lose another. Do not describe death as going to sleep, and be honest and gentle in your responses.

Remind the child or adolescent that there's no timeline for dealing with grief. He or she doesn't have to feel "better" by any particular date and should take as much time as needed. Share your own experiences and coping strategies, keeping in mind that grieving is an individual process.

Don't hide your own grieving. Showing it openly gives the child or adolescent permission to grieve as well. You may want to discuss options for additional support, such as grief support groups or talking with a school counselor, therapist, friend or relative.

Provide comfort. Hold, hug or make eye contact with the child. A stable, secure environment can also be reassuring. Give the young person space, and don't push him or her into anything. You may also want to help the young person establish rituals of remembrance.

Seek additional support through individual, family or group counseling if symptoms intensify or last for a prolonged amount of time. Restrain well-meaning relatives or friends from expressing pity on the child or adolescent though statements such as, "Poor Mike." This sets the stage for long-term self pity and the belief that the child or adolescent is disabled, disadvantaged or does not need to meet normal expectations. Do not ignore any indications that a child or adolescent might be depressed or suicidal. Also, look for books or videos on grief to help the child or adolescent understand the loss and accept his or her own feelings.


Summary
To help a child or adolescent cope with grief, acknowledge his or her feelings and offer as much comfort and support as possible. Although the pain may never go away completely, assure the young person that he or she is not alone and supportive people care.

Grief and loss

Overview
Grief is a difficult emotion, but a normal and healthy response to loss. It touches nearly everyone at some point -- physically, emotionally, mentally and spiritually. Everyone experiences grief differently, however.
Grief is defined as deep sorrow over a loss, such as a death, divorce, separation, move, disaster or overwhelming trauma. You may also grieve in response to the loss or change of a job, financial status, social standing, security, friendship or treasured object. Changes in ambition, dreams, goals, abilities, health, identity, and freedom or independence, among other things, may have the same effect.

You may experience disenfranchised grief if a loss is not or cannot be openly acknowledged, publicly mourned or socially supported. For example, the loss of a pet, a miscarriage, an abortion, being the target of a crime, experiencing rape, learning of an extramarital affair, losing money in a scam or illegal activity, or having your uterus, breast or testicle removed may all lead to disenfranchised grief.

You may experience ambiguous loss if a loss remains unclear because there is no verification that the person is alive or dead (such as a soldier missing in action). An ambiguous loss may also occur when a loved one is physically present, but psychologically absent (such as a parent with severe dementia due to Alzheimer's disease.) An ambiguous loss can be particularly difficult because grief and coping can become frozen or stuck due to the uncertainty of the loss.


Experiencing grief
The emotional process of grieving a significant loss may cycle several times through various stages. For example:
Stage one: Protest
You may be shocked, confused and angry. You may be in denial over the loss or experience decreased self-esteem. Crying, pain, weakness, nausea, appetite loss and sleep disturbances are common responses in the protest stage.

Stage two: Despair
You may be agonized or anguished over the loss. You may feel grief or depression. During the despair stage, you may have an urge to recover what was lost, slowed thinking and actions, and a continuation of physical symptoms.

Stage three: Detachment
You may feel apathetic and indifferent. You may lose interest in routine activities or simply want to withdraw and "give up." During the detachment stage, you may not socialize as much. You may avoid forming new relationships, develop a "bland" expression and lose your sense of spontaneity.

In Elisabeth Kubler-Ross' classic work on grief, the psychologist identified five stages of grief: denial and isolation, anger, bargaining, depression and acceptance. It's important to note that these stages occur in no particular order and not everyone who faces a loss will experience each stage. The stages can help you identify the possible thoughts, feelings and actions grief may inspire, however.


Understanding the individuality
Grieving is a profoundly individual experience. There is no time limit or universal rule for when you should feel "better." Sometimes a loss brings up memories of previous losses, making the situation seem even more profound. Anniversaries of losses, as well as birthdays and special holidays, can be especially difficult times when feelings and memories are recycled. The nature of the loss (a death, divorce, career upset or loss of physical capability, for example), your age and health, how many other losses you've already sustained, how much the loss changes your life, and how much support is available also impact your grief.
Grief is also shaped by religious beliefs, family values and cultural norms. For example, Western cultures often view death as separate from life, and Eastern cultures typically regard death as part of life. In some parts of the world, a period of mourning is expected when a loved one dies. In the United States, grief is often expected to be processed more quickly.

You may want to defer or consider deferring any major life decisions until your grief has become less acute.


Grief and older adults
With age, the likelihood of losing friends or loved ones through death increases. Logically, these losses can affect many aspects of an older adult's life. Social interaction and companionship may decrease most dramatically when a spouse, partner or close friend dies. Statistically, the impact may be greatest for widowed men -- their mortality rates increase for two years after the wife's death. Widowed women do not seem to be affected in the same way.

Characteristics
Physically, grief may leave a hollow or heavy feeling in your stomach. You may experience headaches, gastrointestinal disturbances or dry mouth. You may also have a decreased resistance to common illnesses or infections, especially if you don't take adequate care of yourself.
Psychologically, you may be angry, sad, numb, nervous, forgetful or confused. Mood swings, denial, disbelief, shock and guilt are also common. You may be lonely, confused about the future or feel detached from the situation. You may have dreams or nightmares about the deceased person, or see, hear or sense his or her presence.

Socially, you may withdraw or isolate yourself from friends or loved ones. You may also express aggressive behavior, or turn to alcohol or drug abuse.

Spiritually, you may have a crisis of faith or become angry. You may attempt to find meaning in the loss and struggle with existential questions about the purpose of life. You may simply ask yourself, "Why?"

Sometimes grief can be more than you are able to handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical health care provider to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Remember that grief is a normal and healthy response to any loss. To help cope with your grief, keep the following suggestions in mind:
Maintain your social connections. Share your feelings with a trusted family member or friend. You may also want to join a support group for people dealing with similar losses.

Give yourself permission to cry. It is OK to feel sad or frustrated or have the need to take some time for yourself.

Set short-term goals for your future. Remember, at first, you may need to take it day by day.

If you're dealing with a loved one's death, it is normal and healthy to want to remember and honor his or her memory. For example, you may choose to care for the grave site, make a memory book, share cherished stories or plant a tree in the person's memory.

Consider individual, family or group counseling if your symptoms intensify or last for a prolonged amount of time. Although grief does not have a specified time frame, you may reach a point when professional assistance would be helpful. Religious, clergy or pastoral counseling may be useful as well.


Summary
Whether grief leaves a knot in your stomach or prompts you to question the meaning of life, remember that your feelings are natural and healthy. Learning to cope with grief is part of being human. Concentrate on finding the coping strategies that work best for you.

Graves' disease

Definition
Graves' disease, also called diffuse thyrotoxic goiter, is the one of the most common forms of hyperthyroidism. Hyperthyroidism develops when the thyroid gland produces too much of the hormones triiodothyronine (T3) and thyroxine (T4). With Graves' disease, the entire thyroid gland may become enlarged.

Anatomy
The thyroid gland is located in the neck, just below the voice box and on top of the windpipe. This butterfly-shaped gland produces thyroid hormones T3 and T4, which help regulate several body systems, including metabolism and the conversion of calories to energy. The thyroid hormones also help control body temperature, growth and skeletal development, heart rate and function, muscle tone and function, nervous system development, mental function and body weight. When the gland produces too much of the thyroid hormones, your metabolism speeds up.

Causes/associated factors
Graves' disease is considered an autoimmune disorder, a condition in which the body produces antibodies (compounds that help neutralize or destroy foreign substances in the blood) to fight against its own tissues. Rheumatoid arthritis, lupus, pernicious anemia, Addison's disease and a variety of other conditions are also classified as autoimmune diseases. These conditions may run in families, but why they occur is unknown.
Graves' disease tends to run in families and is more common in women. The condition most often occurs between ages 20 and 40, but it can develop at any age. Graves' disease is often triggered by an infection, excess consumption of iodine, drug treatment with lithium, pregnancy, or physical or emotional stress. Often, there is no recognizable cause.


Signs/symptoms
Symptoms typically appear gradually, but sometimes they develop suddenly. Since thyroid hormones affect so many body functions, the symptoms associated with Graves' disease are numerous and may include:
goiter (enlarged thyroid gland)
rapid pulse rate and heart palpitations
hair loss
thinning of skin
nervousness
heat intolerance and excessive sweating
weight loss despite increased appetite
tremors
frequent and/or loose bowel movements
red or inflamed eyes
exophthalmos (protruding or bulging eyeballs)
a grainy feeling in the eyes
blurred or double vision
excess tearing
decreased eye movement
visual sensitivity to light
mood swings
muscle weakness
changes in menstrual cycle
red, thickened and lumpy skin over the shins or tops of the feet
swollen skin around the base of the fingernails
for men, enlarged breasts

Diagnosis
The doctor will review your medical history and do a physical exam. You'll probably need blood tests to measure your thyroxine (T4) levels. Other thyroid hormone studies may measure T3 resin uptake, T3, free T3, free T4 and thyroid stimulating hormone (TSH). Depending on the circumstances, you may need a thyroid scan. With this test, you drink (or take in pill form) a radioactive iodine substance and a picture of your thyroid gland is taken. This test indicates the overall level of thyroid functioning by measuring the amount of iodine the thyroid gland takes from the body. (Because this test may not be done if you're pregnant, doctors often give pregnancy tests to women before doing a radioactive iodine uptake test.) Antithyroid antibodies (antibodies that attack the thyroid gland) may also be measured.

Treatment
The goal of treatment is to decrease thyroid hormone production to normal levels. Treatment options may include medication, radioactive iodine, or surgical removal of part or all of the thyroid gland.
If you're being treated for Graves' disease, keep the following self-care measures in mind:

Do not stop taking prescribed medications or adjust dosages without consulting your doctor.
Get adequate rest.
Eat a well-balanced diet and drink plenty of fluids.
Keep follow-up appointments with your doctor, even if you're feeling well.
Ask your doctor if you need regular checkups with an ophthalmologist for eye care.
Medications
Antithyroid medications such as propylthiouracil (PTU) or methimazole (brand name Tapazole) decrease the amount of thyroid hormone produced, which, in turn, eases the symptoms of Graves' disease. Improvement is usually noticed in about two to four weeks. You may need to take the medication for one to two years, and the condition may resolve completely with no further treatment in about 60 to 70 percent of people. Although rare, propylthiouracil or methimazole can cause agranulocytosis (decreased white blood cells), which may lower your resistance to infection. If you take either of these medications and develop a sore throat, fever or rash, contact your doctor immediately for a white blood cell count.

Your doctor may also prescribe beta-adrenergic blocking drugs such as atenolol or propranolol, which control symptoms by blocking the action of thyroxine in the body. This can help reduce the racing heart, shakes and nervousness. These medications may not be prescribed if you have asthma or other lung problems, however.

Radioactive iodine therapy
Radioactive iodine is given orally, usually as a one-time dose. The thyroid absorbs it from the bloodstream and the radiation destroys part or all of the thyroid gland. Symptoms often improve because the partially destroyed gland can't produce as much hormone. An expected side effect of radioactive iodine is hypothyroidism or underactive thyroid. Hypothyroidism requires long-term thyroid replacement medication. Since hypothyroidism from radioactive iodine therapy may take years to develop, you'll need periodic thyroid testing indefinitely. Exophthalmos may worsen after this type of treatment, particularly if you smoke. If you have exophthalmos, discuss your condition thoroughly with your doctor or ophthalmologist before receiving radioactive iodine therapy. You may need to take steroids before receiving radioactive iodine.

Surgery
Surgical removal of part of the thyroid gland decreases the amount of thyroid hormones produced and released into your bloodstream. Complications of surgery are rare, but may include recurrent hyperthyroidism if not enough thyroid tissue is removed or hypothyroidism if too much thyroid tissue is removed. Injury to nerves in the throat may cause cause hoarseness. Injury to the parathyroid glands (the glands that secrete parathyroid hormone, which regulates calcium and phosphorus metabolism) is also possible.


Complications
When properly treated, complications may include continued hyperthyroidism or a new case of hypothyroidism.
If left untreated, Graves' disease can lead to osteoporosis (bone loss), atrophy (shrinking) of the muscles, paralysis, infertility, eye disorders and heart problems (such as an irregular heart rhythm or congestive heart failure). In some cases, it may be fatal.

If there is a severe and sudden overproduction of thyroid hormones, a thyroid crisis or storm may develop. Physically stressful events such as traumatic surgery, a severe blood infection or other serious illness may bring on this life-threatening condition. If the crisis is not treated immediately, overstimulation of the heart and nervous system may lead to high fever, irregular heartbeat, heart failure, collapse or coma. In some cases, a thyroid crisis may be fatal.


Pregnancy-specific information
Graves' disease may affect your menstrual cycle and cause infertility. Sometimes, childbirth triggers Graves' disease. If you have Graves' disease, make sure your obstetrician and endocrinologist (a doctor who specializes in treating disorders of the endocrine glands, such as the thyroid) work together during your pregnancy to manage your condition.
Graves' disease during pregnancy may increase your risk of certain pregnancy-related complications, including premature delivery, abruptio placenta (early separation of the placenta from the uterus), preeclampsia (pregnancy-induced high blood pressure) or eclampsia (a life-threatening condition for pregnant women and/or fetuses that causes convulsions and/or coma). You are also at a higher risk for congestive heart failure and thyroid storm. Certain medications (such as PTU) may be safely used during pregnancy to treat Graves' disease and reduce the risk of these possible complications. If necessary, surgery may be done during the second trimester.

Because radioactive iodine treatment may damage the thyroid of a developing baby, it's inappropriate for pregnant women. This treatment hasn't been shown to affect fertility or cause birth defects in future children, but waiting at least several months after completing this treatment before attempting to conceive is recommended.


Senior-specific information
If you have an existing heart condition and then develop Graves' disease, the heart condition may become considerably more severe. An irregular heartbeat such as atrial fibrillation may occur, which can increase your risk of stroke. Ask your doctor about the need to consult a cardiologist (a doctor who specializes in treating disorders of the heart) to manage your heart disease.

Prevention
Although Graves' disease is usually not preventable, early diagnosis and treatment can help prevent complications. Discuss testing with your doctor if you're at risk for developing thyroid disease.

Grandparents parenting grandchildren

Overview
Grandparents are accepting the responsibility of raising their grandchildren more than ever before. In fact, an estimated 6 percent of children under age 18 are being raised by a grandparent in the United States.
Grandparents may raise their grandchildren for a number of reasons, including abandonment, parental drug or alcohol abuse, mental or physical illness, incarceration, neglect, abuse, divorce, economic factors (such as job loss or poverty), teenage parenthood, or the death of one or both parents. Grandparents raising their grandchildren often experience frustration, feeling great responsibility without commensurate authority. Role reversal is common when the parents remain involved in the situation -- the grandparents assume the role of parents and the childction from doing so.


Characteristics
Becoming a parent again can trigger a variety of physical, emotional and psychological issues. Physically, you may be fatigued and notice stress-related symptoms, such as muscle tension or aches, headaches or digestive distress. Or, you may experience an exacerbation of any existing health problems, such as cardiovascular or gastrointestinal conditions or arthritis.
Psychologically, you may feel angry or resentful toward your son or daughter. Depending on the circumstances, this may trigger feelings of guilt or thoughts that you're to blame for the situation. It's common to have doubts and fears, and you may also be ashamed, worried, disappointed or overwhelmed. If you're married or in an intimate relationship, you may worry how your new parenting role will impact the existing relationship. Of course, positive feelings may surface as well. Many grandparents feel relief, compassion and a sense of good will by caring for their grandchildren.

On a practical level, you may need to make changes in your daily routine or lifestyle. You may have less time for social activities, sense a general lack of freedom, or feel the need to modify your plans for retirement and other future activities.

Financially, returning to parenthood may lead to early or delayed retirement, a return to work or a change in working hours. Depending on the circumstances, there may be a lack of financial support from the child's parents. You may become responsible for the child's medical or legal expenses, sometimes with few suggestions from social workers or court personnel. You may also need to change your living arrangements. In some cases, this may require dipping into your retirement funds or other savings accounts. Some grandparents need to borrow money or take out a second mortgage or reverse mortgage. Again, depending on the circumstances, there may be little money left over for personal pursuits.

Sometimes raising a grandchild can be more than you can handle at the time. Symptoms such as sleep disturbances, decreased energy, changes in appetite, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical health care provider to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Returning to parenthood may be difficult. To cope with your new responsibilities and emotions, consider the following suggestions:
Know that it is common to experience complex emotional dynamics. Expect to have conflicting feelings and loyalties about your new role. You may also wonder how much freedom you have to use your own judgment and parenting skills.

Remain aware of what's happening in your grandchild's life. Take an active role in his or her academic and social development, and make connections in your grandchild's school. Also, find out what issues your grandchild is facing, as well as current issues for today's youth. You may worry about raising a child in today's society. After all, this is a much different world than when you raised your own child. That doesn't reduce your parenting ability, however.

Acknowledge the feelings of grief and loss you may be experiencing. Consider what returning to parenthood means to you and your grandchild in terms of roles, expectations and developmental needs.

Set goals consistent with your new role. Consider your grandchild's needs as well as your own. Support groups, parenting groups or classes, and individual or family counseling may be helpful in this endeavor. Also, be aware of your own needs and establish ways to meet them.

Make sure your authority as a grandparent is equal to your responsibility. For example, it is important to have the authority from your child to discipline your grandchild as you see necessary. If you don't have this authority, you may feel limited in your ability to parent your grandchild. This may also create confusion for your child.

Maintain an optimistic attitude. Be patient as you adjust to your new role. Recognize that change will not happen overnight.

If possible, consider helping your son or daughter develop a cooperative relationship with you and a consistent relationship with the child. Sadly in some cases, however, this may not be possible. Some grandparents may need to assume the unwanted role of protecting a grandchild from his or her parents.

If necessary, seek additional support for you and your grandchild. Depending on the circumstances, you may consider individual or family counseling, support groups, respite care, legal or financial consultation, guardian ad litem (a person who represents and advocates for a child's best interest during the legal process) services or mediation.


Summary
Raising a grandchild is a monumental task. Adjusting to your new role may take time, but eventually the pride, excitement and love you may have felt parenting your own child can return with parenting your grandchild. By making the best of a difficult situation, you may come to enjoy the special bond you're likely to form with your grandchild.

Gout

Definition
Gout is a disorder that causes recurring attacks of painful arthritis (inflammation of a joint).

Causes/associated factors
A condition known as hyperuricemia causes gout. Here's how it develops. Purines, compounds that form naturally in your body and can also be found in certain foods, produce uric acid when they're broken down in your body. This waste product normally dissolves in your blood and is eliminated from your body through urination. If too much uric acid builds up in your blood, however, you may develop hyperuricemia. Eventually, uric acid crystals can form and be deposited in the joints.
The exact cause of hyperuricemia is unknown, but it may be due to an increased production of uric acid in the body or a reduction in the amount of uric acid that's eliminated. Another factor may be the consumption of alcohol or foods high in purine, such as shellfish, organ meats, anchovies, sardines, yeast, beans, dried peas, oatmeal and asparagus.

Ten to 20 percent of people who have gout also develop uric acid kidney stones.

Various factors may increase the risk of developing gout, including being male, obese and/or older than age 30. Having a family history of gout also increases the risk. Other risk factors may include:

diabetes
high blood pressure
vascular disease (involving the blood vessels, veins or arteries), such as artherosclerosis
kidney failure
certain endocrine diseases (affecting glands that produce hormones), such as thyroid problems (the gland that helps, in part, regulate the body's metabolism)
certain skin conditions, such as psoriasis (a chronic skin disease marked by patches of raised, red bumps covered with white, flaking scales on the scalp, knees, elbows or buttocks)
certain blood conditions, such as anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron) and sickle cell anemia (a specific type of anemia in which the hemoglobin is defective, causing the red blood cells to become shaped like a sickle or crescent)
lead poisoning or exposure
Attacks of gout may be precipitated by factors such as:

physical or emotional stress
surgery or trauma
heavy alcohol use
excessive dietary intake of purines
dehydration
fasting, starvation or extremely low-calorie diets
use of certain drugs, such as some diuretics (medications that help the body get rid of fluid through increased urine secretion), antibiotics, low-dose aspirin, niacin and cyclosporin (a medication to prevent organ rejection after a transplant)

Signs/symptoms
When hyperuricemia causes deposits of uric acid crystals in your joints, you may experience a sudden gout attack. These attacks can develop in just 24 hours and often happen at night. The affected joints will become red, painful, swollen and warm. You may have a difficult time using them. You may even get a moderate fever or the chills. Gout usually affects one joint at a time, often the big toe. Other joints can be involved, such as the elbows, knees, ankles, feet, elbows, wrists or hands.
Gout attacks normally last about a week and go away on their own. Other attacks typically follow within the next few months or years. With time, the attacks may occur more often and last longer. Even if the pain goes away, it's important to consult your doctor to prevent damage to your joints.


Diagnosis
The doctor will ask questions about your medical history and do a physical exam. A diagnosis can usually be made after identifying uric acid crystals from fluid removed from the affected joint, which can often be done right in your doctor's office. Blood tests may show elevated uric acid levels, but this is not necessarily an indicator of gout because many people with hyperuricemia never develop gout. Uric acid levels may even be normal during a gout attack. Sometimes X-rays are helpful in diagnosing crystal deposits and bone damage from inflammation.

Treatment
Although there is no cure for gout, the condition can usually be controlled through medication, diet and lifestyle changes. The goal of treatment is to treat sudden attacks, prevent future attacks and joint damage, and control uric acid levels.
During an attack, elevate the affected joint and get plenty of rest. Splinting of the affected joint may also provide some pain relief and protect the area from other trauma. Your doctor may also recommend certain medications to provide pain relief and reduce inflammation, or others to help prevent recurrences. Medications often used during acute attacks include nonsteroidal anti-inflammatories (such as indomethacin, naproxen or ibuprofen), the drug colchicine, and steroidal anti-inflammatories such as oral prednisone or the injection of a corticosteroid into the affected joint. For those who need long-term therapy after an acute attack, urate-lowering drugs (such as allopurinol) and drugs that increase the excretion of uric acid through the kidneys (such as probenecid or sulfinpyrazone) may be considered.


Complications
Gout may become chronic, with persistent pain in your joints and the development of tophi (deposits of uric acid crystals that produce lumps on your fingers, hands, wrists, elbows, ankles, knees, feet or outer ears). Gout may also lead to kidney stones and kidney damage. To prevent complications, seek an early diagnosis and begin treatment as soon as possible.

Pregnancy-specific information
Gout is uncommon in women of childbearing age. Remember to tell your doctor if you have gout. Some medications used to treat the condition may be harmful to the developing fetus. Do not take any medications without your doctor's approval.

Senior-specific information
Older adults have a higher risk of side effects from gout medications. Be sure you understand the potential side effects of any medication your doctor prescribes. Follow the doctor's instructions carefully, and report any new symptoms right away.

Prevention
To help prevent gout attacks, consider the following suggestions:
Avoid or limit alcohol and foods high in purine, such as shellfish, organ meats, anchovies, sardines, yeast, beans, dried peas, oatmeal and asparagus.
Maintain a normal body weight. If you're overweight, keep in mind that it's best to lose weight gradually. Avoid fasting or extremely low-calorie diets.
Drink at least eight to 10 glasses of water a day to flush out uric acid.
Exercise regularly.
Discuss all medication use with your doctor. Your doctor may recommend avoiding aspirin, which prevents uric acid from being eliminated by the body.
Keep all follow-up appointments with your doctor, especially if you're on chronic medication therapy.
It's also helpful to keep a diary of your responses to treatment and self-care measures to track what works best for you.

Gonorrhea

Gonorrhea is a highly contagious sexually transmitted disease (STD).


Causes/associated factors
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It's one of the most common sexually transmitted diseases in the United States. The disease can affect any age group, but most cases occur in teens and young adults. The risk of contracting gonorrhea increases with the number of sexual partners you have.

Transmission
Gonorrhea typically spreads through vaginal, oral or anal sex. If left untreated, gonorrhea is contagious for months even if you don't have symptoms.

Signs/symptoms
If symptoms develop, they usually appear within two to 10 days of exposure to the disease. Symptoms depend on the site of infection, your age, sex and how long you've had the infection.
Many women have no symptoms or symptoms so mild they don't seek treatment. The infection often goes unnoticed. Other women may experience yellowish or bloody vaginal discharge, often after intercourse, and painful urination.

Later symptoms in women may include abdominal pain, bleeding between menstrual periods, vomiting or fever.

Men usually have more noticeable symptoms, including painful urination and thick, yellowish penile discharge.

For both men and women, a gonorrhea infection in the rectum may cause rectal discharge, anal itching or painful bowel movements. An infection in the throat may cause the throat to become painful and red.
To prevent complications, consult your doctor right away if you notice any of these symptoms.


Diagnosis
First, the doctor will ask questions about your medical and sexual history and do a physical exam. Then, lab tests will be done on any abnormal discharge from the affected site. Sometimes urine samples can be used to identify the Neisseria gonorrhoeae bacterium. It's important to identify the bacterium because other STDs may have similar symptoms but require different treatment. Because you can have more than one infection at the same time, the doctor may screen you for other sexually transmitted diseases.

Treatment
Gonorrhea is treated with antibiotics. Your doctor may prescribe ceftriaxone, cefixime, ciprofloxacin or ofloxacin. Other antibiotics may be prescribed if you have medication allergies. While you're being treated for gonorrhea, your doctor may treat you for the STD chlamydia as well because the two conditions often develop together. Medications to treat chlamydia include antibiotics such as doxycycline or azithromycin.
It's important to abstain from all sexual activity until the treatment is complete and all symptoms have resolved. You must also notify your sexual partners from the past two months so they can be tested and treated.


Complications
If left untreated, gonorrhea can cause severe medical problems, especially for women. The most common complication of untreated gonorrhea for women is pelvic inflammatory disease (PID). The condition can irreversibly scar the fallopian tubes, resulting in infertility or ectopic pregnancy (when the fertilized egg develops outside the uterus). Rarely, untreated gonorrhea can cause sterility for men.
For a small percentage of people who have untreated gonorrhea, the infection spreads to other parts of the body and may cause:

joint pain
arthritis with potentially permanent joint damage
tenosynovitis (inflammation of the sheath covering a tendon)
skin lesions
meningitis (inflammation of the membranes surrounding the brain and spinal cord)
endocarditis (inflammation of the lining of the heart, which can be fatal)
perihepatitis (inflammation of the lining of the liver)
Rarely, touching fluid from infected mucous membranes and then touching your eye can result in an eye infection called conjunctivitis. This condition may lead to blindness if not treated quickly.


Pregnancy-specific information
If you're pregnant and have gonorrhea, your baby can be infected with the bacteria when passing through the infected birth canal during delivery. An infected baby may develop a condition called gonococcal ophthalmia neonatorum or other conditions, ranging from minor inflammation to serious bloodstream infections.
To prevent spreading an infection to your baby, good prenatal care is essential. Preventive therapy for ophthalmia neonatorum with silver nitrate eye drops or erythromycin or tetracycline eye ointment is recommended for all babies as soon as possible after delivery.


Senior-specific information
Growing older is not a risk factor for this condition.

Prevention
Abstinence is the most effective way to prevent gonorrhea. If you're sexually active, mutual monogamy will reduce the risk of contracting gonorrhea and other sexually transmitted diseases. If you're not in a monogamous relationship, reduce the risk of contracting gonorrhea and other STDs by:
limiting your number of sexual partners
making sure each sexual partner is tested for STDs and completes proper treatment, if necessary, before you have sexual contact
using a latex or polyurethane condom consistently during any vaginal, oral or anal sexual contact (Keep in mind that a condom doesnt effective in preventing the spread of STDs -- use only water-based lubricants. The chemicals in other lubricants may break down the latex in the condom.)

Glaucoma

Definition
Glaucoma is a group of eye diseases that cause damage to the optic nerve due to a buildup of pressure inside the eyeball.

Anatomy
Normally, a clear fluid called aqueous humor flows into the eye through a space called the anterior chamber, located at the front of the eye. This fluid nourishes tissues in the eye. The fluid leaves the eye through a drain called the trabecular meshwork. This drain is located at the "angle" of the eye, where the cornea (the clear surface covering the eye) and iris (the colored part of the eye) meet



Causes/associated factors
Glaucoma is caused by aqueous humor buildup in the eye, usually due to problems with fluid drainage from the eye. As the fluid builds up, the pressure inside the eye increases, which damages the optic nerve and possibly other eye structures as well. Damage to the optic nerve can result in vision loss.
What causes glaucoma to develop is unknown, but risk factors include:

having high fluid pressure in the eye
a family history of glaucoma
being African American, especially over age 40
diabetes
myopia (nearsightedness)
being over age 60
high blood pressure
steroid use
certain eye injuries

Types of glaucoma
There are more than 40 types of glaucoma. Here are descriptions of four of the most common types.
Open-angle glaucoma
Open-angle glaucoma accounts for nearly 75 percent of all glaucoma cases. It's a slowly progressing chronic condition that can affect both eyes and is most common in nearsighted people. With this type of glaucoma, there's a blockage of the trabecular meshwork. The drain can get smaller with age or become clogged with a gradual deposit buildup. When there's a blockage, fluid can't leave the eye as quickly as it's produced. This buildup of fluid increases intraocular pressure.

Open-angle glaucoma may have vague symptoms or none at all, so you may not realize you're losing your vision until the late stages of the disease. Peripheral vision is lost before central vision. Periodic eye exams are the best way to detect open-angle glaucoma. Once nerve cells are destroyed and vision is lost, the damage is irreversible.

Angle-closure glaucoma
With this type of glaucoma, the iris is pushed against the trabecular meshwork, which blocks the drainage of fluid from the eye and causes high intraocular pressure. Sudden attacks of angle-closure glaucoma (acute angle-closure glaucoma, for example) can be precipitated by stress, dark environments (in which the pupil is fully dilated), and by the use of certain medications, such as antidepressants, antihistamines, and other cold and flu medications.

Angle-closure glaucoma can be chronic or acute (occur suddenly). The chronic type may cause vision damage without symptoms. Periodic eye exams are the best way to detect chronic angle-closure glaucoma.

Acute angle-closure glaucoma is a medical emergency. Unless it's treated quickly, permanent damage and blindness can occur. The following symptoms may indicate this type of glaucoma:

sudden onset of blurred vision
severe pain in or around the eye
colored halos around lights
nausea and vomiting
redness in the eye
headache
Some attacks may subside when the pupils constrict (by entering a well-lit room or sleeping, for example). If you notice any of the symptoms of acute glaucoma, however, seek medical attention right away.

Secondary glaucoma
Secondary glaucoma can develop after events such as an eye injury or trauma, or after the development of certain eye diseases that damage the eye structure. It may also develop as a result of steroid medication side effects or following eye surgery.

Congenital glaucoma
Congenital glaucoma is a rare childhood condition that appears soon after birth. Those with this condition have an abnormality of the drainage system for eye fluids within the eye. Because of this, the child may be sensitive to light and may tear excessively. A child with these symptoms or other eye problems should be taken to an ophthalmologist right away.


Diagnosis
Glaucoma is diagnosed with an eye exam. Using an instrument called an ophthalmoscope, the doctor can check out the optic nerve. The doctor may also do the following tests:
visual acuity, which measures the ability to see to various distances
tonometry, which measures eye pressure
perimetry, which tests visual fields
gonioscopy, which helps the doctor see the angle of the eye directly

Treatment
Although there is no cure for glaucoma, treatment can help prevent vision loss. Eyedrops, ointments, "wafers" (small strips of medication placed in the corner of the eyes) and oral medications can be used to treat open-angle glaucoma. These drugs work by reducing the pressure within the eye. Some commonly used drugs include timolol maleate, betaxolol, brimonidine tartrate (brand name Alphagan) and latanoprost (Xalatan).
If medication is not effective, then laser surgery may help prevent further damage to the optic nerve.

Argon laser trabeculoplasty may be used to treat open-angle glaucoma. This procedure alters the trabecular meshwork to help fluid pass through the blocked drainage system. Steroids may be prescribed for several days after surgery to reduce inflammation. Depending on individual circumstances, this procedure has a high success rate.

Laser iridotomy may be used to treat acute angle-closure glaucoma. An opening is made in the iris to let fluid drain and decrease intraocular pressure.

Cyclophotocoagulation is often used to treat advanced or aggressive cases of glaucoma. This procedure reduces fluid production in the eye by partially destroying the ciliary body or gland with a laser or freezing instrument. The ciliary body is an area just behind the base of the iris that is responsible for fluid production inside the eye.
Most laser procedures are done on an outpatient basis. Eyedrops are often used to numb the eye, so discomfort is minimal. After surgery there may be some eye irritation, but normal activities can usually be resumed in a day or two. Many people need to continue using glaucoma medications even after successful laser surgery.

If vision loss is rapid or medication or laser surgery doesn't help the condition, other types of surgery may be recommended.

Surgical procedures
To give fluid another way to leave the eye, the doctor may recommend a trabeculectomy. This procedure creates an alternate drainage system for the eye fluids to leave the inside of the eye. The procedure may be done in a hospital or on an outpatient basis. First, the doctor makes a space (called a filtering bleb) between the conjunctiva (outer lining of the eyelids and eyeball) and sclera (tough tissue that covers the white part of the eye). Next, a small hole may be cut in the iris to keep it from blocking the perforated sclera (a peripheral iridectomy). Finally, the scleral flap and the filtering bleb are sewn shut. The fluid that drains out of the new space is absorbed by the blood vessels in the conjunctiva.

Benefits of surgery: The surgery has a high success rate. If there is too much or too little fluid flow in the eye, an adjustment may be necessary. After surgery, anti-inflammatory eyedrops can help prevent scarring and cataract formation. Some people may need long-term drug therapy to keep the intraocular pressure low.

Risks of surgery: Complications of surgery are rare, but may include infection, bleeding, cataracts, changes in intraocular pressure or vision loss.

Recovery is often quick. To protect the eye, most people wear an eye patch for a few days after surgery. Your doctor may want you to avoid showering, swimming, driving or strenuous exercise for a short time. Contact your doctor right away if you notice redness or swelling in the eye or other side effects after surgery.


Complications
If glaucoma is left untreated, tunnel vision and blindness may develop within a few years. In fact, glaucoma is a leading cause of adult blindness in the United States. Once vision loss occurs, it cannot be reversed.

Pregnancy-specific information
Pregnancy is not considered a risk factor for glaucoma.

Senior-specific information
Conditions such as diabetes, eye surgery or cataracts may predispose older adults to glaucoma. Regular eye exams are recommended for older adults to detect eye disorders. Some experts recommend eye exams yearly or every two years beginning at age 60 or 65. Earlier or more frequent exams may be recommended for people at high risk of developing glaucoma.

Prevention
Early detection and treatment can prevent vision damage. Periodic eye exams are recommended by most health care professionals. If you're at high risk (you're African American, take corticosteroid medication on a long-term basis, have a parent or sibling with glaucoma, or have other factors that increase the risk of glaucoma), earlier or more frequent eye exams may be recommended. Consult your doctor about the best screening schedule for you.
If you have glaucoma, careful management of the condition can help preserve your vision. Here are a few tips.

Take any medications exactly as prescribed by your doctor.
If your condition changes or you experience side effects or new symptoms, call your doctor immediately.
Know what kind of glaucoma you have. Wear a medical ID bracelet or carry a medical emergency ID card to alert others of your condition.
Keep appointments for regularly scheduled exams and follow-up care.
You may also want to check out community support groups for people who have glaucoma.

Giardiasis

Giardiasis is an infectious bowel disease caused by Giardia lamblia, a one-celled parasite.


Causes/associated factors
G. lamblia infects people and certain animals, including dogs, cats, cattle, sheep, rodents and beavers. It's found worldwide, including all parts of the United States. Itater from contaminated mountain streams, lakes, rivers, etc. while traveling, camping or hiking
people who ingest contaminated recreational water (from lakes, swimming pools, hot tubs or wading pools, for example)
people who drink from shallow wells
international travelers and people who live in areas where drinking water comes from streams or rivers with inadequate water treatment
children in child care settings (the parasite can easily spread from caregivers who diaper infected children), as well as child care workers and family members who care for infected children
people living in a custodial institutional setting
people who engage in anal sex

Transmission
The parasite's active form, known as a trophozoite, lives inside the small intestine of the host. Its inactive form, known as a cyst, survives well in the environment, especially in cold water. The cysts may enter your body through contaminated food or water or through direct contact with infected feces. For example, the parasite may spread if you don't wash your hands after touching contaminated material (such as diaper pails, changing tables, bathroom fixtures or toys) or through anal sex.
As few as 10 to 25 cysts can cause an infection. Once the cysts are in your body, your stomach acid activates them, which releases the trophozoites. The trophozoites multiply in the small intestine. Before passing out of the body in your stool, they develop into more resistant cysts, which can survive for several months in water.

You're considered contagious as long as the parasite is in your system, even if you don't develop symptoms. If left untreated, this means you can pass G. lamblia in your stool for months. Also, developing giardiasis once does not completely protect you from another infection. In some cases, the infection can become chronic, causing recurrent symptoms for months or even years.

The incubation period (time from exposure until symptoms appear) averages from one to two weeks, but may last from three to 25 days. Giardiasis occurs more often during the summer in the United States, when water recreation is most common.


Signs/symptoms
Symptoms are often mild, if they even appear at all, and many people are unaware they've been infected. When present, symptoms can last from two to six weeks and may include:
sudden, explosive, watery, foul-smelling diarrhea
appetite loss
nausea
vomiting
gas or bloating
abdominal cramping or pain
rarely, mild fever
If the condition becomes chronic, loss of appetite and poor absorption of nutrients can lead to fatigue, weakness, weight loss and dehydration.


Diagnosis
The doctor will review your medical history and do a physical exam. The parasite can be identified through stool samples. Several samples taken over the course of a few days may be needed because the parasite can be difficult to diagnose. G. lamblia can also be detected through a sample of small intestine fluid, which may be taken through a tube that's passed from the nose into the stomach and upper intestine or by swallowing a specially designed string. Rarely, a biopsy of the intestines (taking a tissue sample for further evaluation in the lab) is done to identify the parasite.

Treatment
If you have no symptoms, treatment is not typically necessary. In most cases, your body will rid itself of the parasite within six weeks. However, your doctor may recommend treatment if you risk passing the infection to a pregnant woman or someone with a weak immune system. If you have symptoms, your doctor may prescribe a drug such as metronidazole, albendazole or furazolidone. If you have diarrhea, remember to drink plenty of fluids to prevent dehydration.

Complications
Children who have severe cases of giardiasis may experience impaired growth and development, especially if they were undernourished before the infection. For people who have weak immune systems, giardiasis may cause complications such as malabsorption, dehydration, weakness and electrolyte imbalances. (Electrolytes are substances that assist with the conduction of electrical impulses when dissolved in body fluids.) Chronic giardiasis is more likely to develop in people who have weak immune systems. Recently, severe giardiasis that's difficult to treat has been observed in people who have AIDS.

Pregnancy-specific information
Some of the more common drugs used to treat giardiasis are unsafe for the developing fetus, especially during the first trimester of pregnancy. If your symptoms are mild, your doctor may recommend delaying treatment until after delivery or at least until after the first trimester. If you need treatment, your doctor may prescribe a drug such as paromomycin or metronidazole. Be sure to remind the doctor you're pregnant before taking any medications.

Senior-specific information
Older adults are at higher risk for complications of diarrhea, such as dehydration. If you experience prolonged diarrhea, consult your doctor.

Prevention
To prevent infection, avoid contact with feces and potentially contaminated food and water. Remember that contaminated water may not look, smell or taste bad, including lake water, river water or other potentially contaminated water sources. Ensure safety of potentially contaminated drinking water by boiling it vigorously for one minute, filtering it or treating it with iodine or chlorine, which can be found in sporting goods stores or pharmacies. Carefully follow the package directions. Three minutes of vigorous boiling or disinfection with iodine after boiling for one minute is recommended at altitudes higher than 6,562 feet. (Water reaches its boiling point sooner at higher altitudes.) To filter water, use a filter with an absolute pore size of at least 1 micron or one that has been rated for cyst removal by the National Safety Foundation. Have well water tested for fecal substances if you suspect it may be contaminated.
In areas with potentially contaminated water, canned or bottled carbonated beverages (including water and soft drinks), beer, wine and beverages made from boiled water are considered safe. Be sure to avoid using ice cubes made from potentially contaminated water and drinking from unclean glasses or wet or dirty cans or bottles. (Drink straight from the can or bottle after wiping it clean and dry.)

Other preventive measures include washing your hands with soap and water before handling food and after using the toilet or changing diapers. Always wash and peel raw fruits and vegetables before eating. Finally, don't brush your teeth in potentially contaminated tap water or swallow bath or recreational water.