GERD: Gastroesophageal reflux disease

Your esophagus is the tube that carries food from your mouth to your stomach. Gastroesophageal reflux disease (GERD) happens when a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it.

You may feel a burning in the chest or throat called heartburn. Sometimes, you can taste stomach fluid in the back of the mouth. If you have these symptoms more than twice a week, you may have GERD. You can also have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.

Anyone, including infants and children, can have GERD. If not treated, it can lead to more serious health problems. In some cases, you might need medicines or surgery. However, many people can improve their symptoms by

• Avoiding alcohol and spicy, fatty or acidic foods that trigger heartburn
• Eating smaller meals
• Not eating close to bedtime
• Losing weight if needed
• Wearing loose-fitting clothes

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Skin Cancer

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands, and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

Anyone can get skin cancer, but it is more common in people who

• Spend a lot of time in the sun or have been sunburned
• Have light-colored skin, hair and eyes
• Have a family member with skin cancer
• Are over age 50

You should have your doctor check any suspicious skin markings and any changes in the way your skin looks. Treatment is more likely to work well when cancer is found early. If not treated, some types of skin cancer cells can spread to other tissues and organs. Treatments include surgery, radiation therapy, chemotherapy, photodynamic therapy (PDT), and biologic therapy. PDT uses a drug and a type of laser light to kill cancer cells. Biologic therapy boosts your body's own ability to fight cancer.

New treatments may prolong health after breast cancer

Promising advances in research could mean longer, healthier lives for women with breast cancer, the number one cancer in women worldwide, experts said Saturday at a major US cancer conference.

A new targeted therapy that appears to double the amount of time cancer can be held in check, a drug that offers more women a chance at healthy lives post-diagnosis and a surgical option to remove extra tissue in order to reduce the likelihood of cancer's return were among the findings presented at the American Society of Clinical Oncology annual meeting in Chicago.

The targeted drug, palbociclib, is made by Pfizer and was granted accelerated approval by the US Food and Drug Administration earlier this year for use in women with the most common form of advanced breast cancer, known as estrogen receptor positive (ER+), human epidermal growth factor receptor 2 negative (HER2-).

According to the findings of a phase III trial presented at the ASCO meeting, the drug -- when used in combination with an anti-estrogen agent called Fulvestrant -- was able to double the time women spent without having their cancer advance.

The combination delayed disease progression for just over nine months, compared to nearly four months in women taking Fulvestrant alone, according to a randomized study of 521 women, most of whom were post-menopausal.

Those results led investigators to stop the trial early because it was so effective.

"After initial hormonal therapy stops working in metastatic breast cancer, the next step is typically chemotherapy, which can be effective, but the side effects are often very difficult for women," said lead study author Nicholas C. Turner, a consultant medical oncologist at The Royal Marsden and a team leader at The Institute of Cancer Research, London, United Kingdom.

"This relatively easy-to-take new drug can substantially delay the point when women need to start chemotherapy, making this an exciting new approach for women."

Palbociclib works by blocking a key protein that fuels the growth of hormone receptor-positive breast tumors.

Researchers said that comparable benefits were seen in both pre- and postmenopausal women, but more long term research is needed to determine whether or not the drug helps women live longer.

- Post-diagnosis survival -

Another study released at ASCO involved more than 3,100 postmenopausal women with a localized form of breast cancer, known as ductal carcinoma in situ (DCIS), which is typically treated by surgically removing the cancerous lump from the breast, followed by radiation.

Women with this kind of breast cancer face a higher risk of invasive breast cancer, but death from DCIS itself is rare.

Doctors typically prescribe drugs that block estrogen for a period of five years after surgery to ward off a return of the cancer, either tamoxifen or another class of drugs known as aromatase inhibitors.

In the first large trial of its kind to compare one of these aromatase inhibitors -- anastrazole -- to tamoxifen, researchers found anastrazole was slightly better.

After 10 years, 93.5 percent of women in the anastrazole group were living breast cancer-free, compared to 89.2 percent in the tamoxifen group.

The 10-year overall survival rates were about the same in the two groups (92.5 percent for anastrazole and 92.1 percent for tamoxifen).

"The good news is tamoxifen and anastrazole are both very effective, but it seems that women have better chances of staying well with anastrazole," said lead study author Richard Margolese, a professor of surgical oncology at The Jewish General Hospital, McGill University in Montreal, Canada.

- Surgery findings -

A third study released at ASCO and published in the New England Journal of Medicine found that women who have a bit of extra tissue removed around the tumor during breast-conserving surgery, or partial mastectomy, face a reduced risk that cancer will be left behind.

The study involved 235 women with breast cancer diagnoses ranging from stage 0 to 3, some of whom were randomly assigned to have extra tissue around the tumor removed -- known as cavity shave margins (CSM) -- and some who were not.

"Despite their best efforts, surgeons could not predict where the cancer was close to the edge," said lead author Anees Chagpar, associate professor of surgery at the Yale School of Medicine.

But those who had cavity shave margins were half as likely to need surgery again, the study found.

Patients will be followed for five years to see if survival or recurrence are influenced by the procedure.

"This randomized controlled trial has the potential to have a huge impact for breast cancer patients," Chagpar said.

"No one likes going back to the operating room, especially not the patients who face the emotional burden of another surgery."

When Pain Persists After Breast Cancer Surgery

I could hear the anxiety in my sister’s voice. A week after her double mastectomy and breast reconstruction for breast cancer, she had developed a burning sensation under her right arm where her surgeon had removed several dozen lymph nodes for a postoperative biopsy. The throbbing and itching were so intense it felt “like poison ivy lit by a blowtorch.”

The physician assistant at her reconstructive surgeon’s office told her it was probably “neuropathic in origin” — probably arising from nerve damage during surgery — and that the condition, known as postmastectomy pain syndrome, or PMPS, would subside over time. And luckily for my sister, five weeks out from surgery, the pain began to wane.

But for many of the estimated 20 to 50 percent of women who develop pain after a mastectomy, it may never go away.

Photo

Credit Keith Negley

“Quite frankly, women are not always informed of the risk or the strategies that are available to reduce the risk,” said Rosemary Polomano, a professor of pain practice at the University of Pennsylvania School of Nursing. “It’s a widespread problem.”

For women already facing the physical and emotional trauma of breast cancer, chronic pain after a mastectomy can be devastating. “Pain is a psychological trigger for worry about cancer recurrence,” said Julie Silver, an associate professor at Harvard Medical School who specializes in cancer rehabilitation. “Treating PMPS really helps to relieve that anxiety.”

PMPS is generally defined as nerve-related pain that persists for at least three months after breast cancer surgery, though it can take up to six months to develop. It tends to occur in the upper chest or the underside of the arm, causing pain that women often describe as burning or shooting, and it sometimes presents, as it did in my sister, as an unbearable itch.

A number of causes have been posited for the condition, primary among them damage to the intercostobrachial nerve, which extends from the outer edge of the breast and runs along the underside of the arm.

It is not certain how many women have PMPS, but studies indicate that in addition to affecting mastectomy patients, it can also affect women who have had a lumpectomy, in which only the tumor and a small amount of surrounding tissue are removed. A study published in 2012 in the journal Breast indicated that women who had had axillary lymph node dissection — removal of some or all of the lymph nodes adjacent to the cancerous breast — were at particular risk.

Not all breast and reconstructive surgeons are aware of the extent of PMPS, which may explain why many do not mention it to their patients as a possible complication of surgery. Dr. Laura Esserman, the director of the Carol Franc Buck Breast Care Center in San Francisco, said she was shocked to learn of the prevalence of the problem when one of the speakers at a 2011 symposium she led on the management of breast cancer symptoms said that 20 to 40 percent of women complained of persistent pain after breast surgery.

“I think that patients often don’t want to complain to their surgeon,” Dr. Esserman said, “so we weren’t as aware of the problem as we should be.” She says she now always asks about postmastectomy pain as part of her postoperative patient interviews.

Many patients also remain misinformed about the potential for treatment. Dr. Michael Stubblefield, the chief of rehabilitation medicine service at Memorial Sloan-Kettering Cancer Center in New York, said he often encountered patients who had severe pain for several years after a mastectomy and were astonished to discover that it was treatable.

Doctors often use injectable steroids or anesthetics such as lidocaine and bupivacaine to mitigate the pain of PMPS, though many patients have found that the relief from these injections is short lived.

In a 2011 study, Dr. Esserman and a colleague at the University of California, San Francisco, Dr. Cathy J. Tang, combined the nerve block bupivacaine and the steroid dexamethasone, delivered at the point of maximal tenderness, to create what appears to be a more effective intervention than either one alone. The combination had been used as an analgesic — to treat pain after orthopedic surgery, for example — but Dr. Esserman said it had never been tried for PMPS.

The treatment offered many women immediate and long-lasting relief. So far, 75 percent of patients in the 2011 study have found persistent relief after one injection. About 20 percent required a second injection, and the remaining patients needed three injections. Dr. Esserman said she was not sure that the relief would prove permanent over the long run, but she was nevertheless optimistic about the treatment’s overall effectiveness.

“Even if you had to do the injection every six months,” she said, “that’s so much better than having that pain.”

An instructional video on the technique is available at the Carol Franc Buck Breast Care Center website (cancer.ucsf.edu/breastcarecenter).

That a combination of two or more classes of analgesics should be effective at treating PMPS was not a surprise to Dr. Polomano. “You derive a greater benefit by targeting several different mechanisms for pain relief,” she said.

Indeed, a growing number of surgeons and other health care professionals are using such an approach before, during and after surgery — combining, for instance a nonopioid pain reliever like acetaminophen with an opioid like morphine — in an effort to prevent the pain of PMPS from becoming chronic.

Dr. Polomano and her colleagues are working to get the word out among surgeons, anesthetists, nurses and other health care professionals “to raise awareness of the consequences of poorly controlled pain and, ultimately, to prevent it.”

Gallstones: 5 things you need to know

1. What's a gallbladder and what does it do?

Your gallbladder is tucked behind the front edge of your liver. The pear-shaped bag holds all the digestive chemicals, or bile, produced by your liver. 

"When you eat something, it squirts those chemicals out into a little tunnel that then leads into the intestinal system and helps digest your food," said Calgary Dr. Raj Bhardwaj.

2. What are gallstones?

In some people, when the bile inside the gallbladder — made up of a mix of proteins, cholesterol, calcium and other minerals — sits around for too long, it gets concentrated and clumps together, says Bhardwaj.

Dr. Raj Bhardwaj is a Calgary urgent care physician and medical contributor on CBC Radio's the Calgary Eyeopener. (@RajBhardwajMD/Twitter)

"The stones can be as small as a grain of sand or as big as a golfball."

e says gallstones can sit in the gallbladder for years, even decades, without causing any issues.

3. So, when are gallstones a problem?

When they start moving, says Bhardwaj. 

When gallstones start travelling, they can plug the tubes that connect your gallbladder to your liver and pancreas, which can cause several complications:

• Inflammation of the gallbladder.
• Jaundice.
• Inflammation of the pancreas, or pancreatitis.

While 40 per cent of pancreatitis cases are caused by gallstones, Dr. Bhardwaj says only three to seven per cent of people with gallstones will ever develop pancreatitis.

4. Symptoms

The tell-tale sign is sudden pain in either the centre or upper right portion of your abdomen, your right shoulder or between your shoulder blades.

r. Bhardwaj says it's important to remember that not all stomach pain is gallstones, and not all gallstones give pain. 

. Treatment 

• Removing your gallbladder, surgically.
• Medication to help dissolve your gallstones, but Bhardwaj says it's expensive and doesn't always work. If it does work, he says it can take a very long time — up to two years.
• Dr. Bhardwaj adds that eating fibre and maintaining a healthy weight can also help prevent gallstones, but other than surgery, there is no quick fix.

Could Heartburn Drugs Upset Your 'Good' Gut Bugs?

Study suggests class of meds upset healthy balance of bacteria in the gut

Heartburn drugs such as Prilosec and Nexium may disrupt the makeup of bacteria in the digestive system, potentially boosting the risk of infections and other problems, a small new study suggests.

The research doesn't confirm that these changes make it more likely users will become ill, and study authors aren't recommending that anyone stop taking the so-called proton pump inhibitors.

However, these antacids "should be used at the lowest dose that provides adequate relief of symptoms, and attempts to discontinue their use should be considered periodically," said study co-author Dr. John DiBaise, professor of medicine at the Mayo Clinic in Scottsdale, Ariz.

According to Harvard Medical School, billions of dollars are spent annually on antacid drugs in an attempt to combat heartburn, ulcers and gastroesophageal reflux disease, also known as GERD. Old standbys such as Maalox and Mylanta have been supplanted by more effective, more expensive drugs, including proton pump inhibitors. These include Prevacid (lansoprazole) and Protonix (pantoprazole) in addition to Prilosec (omeprazole) and Nexium (esomeprazole).

"Despite years of safe and effective use, in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use," DiBaise said.

Long-term use of proton pump inhibitors has been linked to infection with a germ called Clostridium difficile, which causes severe diarrhea, he said. Researchers have also connected the medications to vitamin deficiencies, bone fractures and pneumonia, among other conditions.

In the new study, researchers sought to understand what happens to the trillions of germs in the digestive system when people take omeprazole, the generic name for the drug best known as Prilosec.

Ten participants, aged 18 to 57, took 20 or 40 milligrams of the drug a day for 28 days. Researchers analyzed the study participants' stool samples to understand the germs in their guts.

"These microbes have evolved with us to participate in our normal development and metabolism, and perform certain functions that we would not be able to accomplish without their help," DiBaise said. Many scientists believe that people's risk of disease goes up when their normal germ makeup changes, he said.

The researchers found evidence that the medications disrupted the balance of bacteria in the digestive systems of the participants, and the changes lasted for at least a month after they discontinued the drug. It didn't seem to matter whether they took the higher or lower dose, DiBaise said.

DiBaise cautioned that the study doesn't prove that the drug causes users to become more vulnerable to C. difficile infections. However, it shows that the drug "creates a situation in the gut microbial environment that may increase an individual's susceptibility," he said.

The researchers suggest additional research is needed with a larger group of study participants.

What should users do for now? According to DiBaise, proton pump inhibitors are "the most effective medications to treat gastroesophageal reflux disease." If patients don't have the most severe symptoms, he said, other types of heartburn drugs might help. Also recommended: eating smaller portions, losing weight, not lying down for two hours after eating, and avoiding alcohol, cigarettes and "trigger" foods.

Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School, said patients shouldn't become alarmed about "the safest class of therapy I've used in the 34 years being a doctor."

The new research won't stop him from prescribing the drugs, Johnson said, adding he's "hesitant to make too much out of this." Even so, "the key message is that patients should talk to their care provider and discuss the need for these medications and justify their continued use."

The study was published Nov. 24 in the journal Microbiome.
Copyright © 2013-2015 HealthDay. All rights reserved.

Simple self-help measures ease discomfort of hemorrhoids

DEAR DOCTOR K: What can I do to ease the discomfort of hemorrhoids?

DEAR READER: Hemorrhoids are quite common, and they’re not a “serious” medical problem. But, figuratively and literally, they’re a real pain in the butt. Hemorrhoids develop when veins in the anus and rectum swell and widen. (I’ve put an illustration on my website, AskDoctorK.com.) They can be extremely painful and uncomfortable, causing bleeding and painful bowel movements. There are surgical treatments that can help when you have recurrent, painful flare-ups of hemorrhoids.

However, most of the time, simple self-help measures can ease the discomfort and allow healing. Hemorrhoids often are linked to constipation. When a person is constipated, stool piles up in the rectum and hardens. This can press on the veins that are returning blood from the rectum to the rest of the body. As a result, blood builds up in the veins, causing them to stretch. So the treatments for hemorrhoids often are treatments for constipation, as well.

I spoke to my colleague Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. She suggested some effective steps you can take to help relieve a hemorrhoid flare-up:

• STEP UP THE FIBER. Fiber draws water into stools, making them softer and easier to pass. Increasing fiber also reduces bleeding. Increase high-fiber foods (fruits, vegetables, whole grains) in your diet. Consider taking a psyllium husk fiber supplement, such as Metamucil. If psyllium causes gas or bloating, try a supplement containing wheat dextrin or methyl-cellulose. Aim to get 25 grams (women) to 38 grams (men) of fiber a day.

• TRY MINERAL OIL. Mix 1 tablespoon of mineral oil with applesauce or yogurt and eat it at breakfast or lunch. This allows the stool to slide by more easily.

• WHEN YOU HAVE TO GO, GO. Don’t delay bowel movements. Putting them off can worsen constipation, which then aggravates the hemorrhoids. Also, as you sit on the toilet, elevate your feet a bit with a step-stool. Doing so changes the position of the rectum in a way that could allow stools to pass more easily.

• SOAK IN SITZ. Sitz baths are warm, shallow baths done in a basin that fits under the toilet seat. Take sitz baths three or four times a day, for 15-20 minutes each. The water will keep the area clean, and the warmth will reduce inflammation and discomfort. Dry the rectal area thoroughly after each bath.

• SOOTHE YOURSELF. Apply a cold compress or icepack to the anal area. Or try a cool cotton pad soaked in witch hazel. Many over-the-counter hemorrhoid products, like the iconic brand Preparation H soothing cream, are available.

You can also ask your doctor about prescription preparations, which contain stronger anti-inflammatory drugs and numbing medications. If, despite all of these measures, your hemorrhoids start to bleed, continue to bleed or hurt more, or begin to interfere with bowel movements, talk to your doctor. He or she can tell you about procedures to remove or reduce hemorrhoids.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115

Can hemorrhoids be treated without surgery?

A very common question that I am asked is whether everyone with hemorrhoids needs surgery. And the truth of the matter is that only a minority of patients need surgery for hemorrhoids. Many times, I am actually able to treat hemorrhoids more effectively in the office than in the operating room. So, who can be treated in the office and who needs surgery for hemorrhoids?

First, we should talk about the difference between external and internal hemorrhoids. I’ve talked about this difference in another post as well. External hemorrhoids have pain nerves and can’t be treated with hemorrhoid banding. Imagine if you put a rubber band on your finger – it would hurt; that’s why you can’t rubber band external hemorrhoids. But, internal hemorrhoids don’t have pain nerves. They have nerves known as autonomic nerves, which supply sensations similar to the intestinal tract (that’s why we can have cramps due to gas). Because internal hemorrhoids don’t have pain nerves, they can be treated with procedures in the office.

There’s a grading scale for hemorrhoids. It’s useful to understand this so we can talk about different types of hemorrhoids:

* First Degree – Bleed only, but do not prolapse

* Second Degree – Bleed, prolapse, but spontaneously reduce

* Third Degree – Bleed, prolapse, and require manual reduction

* Fourth Degree – Bleed, prolapse, and are irreducible

Most colon and rectal surgeons believe that the most effective office-based procedure to treat internal hemorrhoids is rubber band ligation. This is typically done for grades one, two, and three internal hemorrhoids. We use a small scope called an anoscope to view the hemorrhoid. A special device called (you guessed it) a bander is used to place a rubber band on the hemorrhoid. That sticks the hemorrhoid down to the wall. For patients who have prolapse of hemorrhoids (the hemorrhoid comes out when they move their bowels), the prolapse is stopped with the banding. The band will then fall off, along with the hemorrhoid, in about 10-14 days. Hemorrhoid banding is a very effective treatment for bleeding caused by hemorrhoids and prolapse.

Typically, hemorrhoids of grades 1-3 can be effectively treated in the office with hemorrhoid banding. Banding for grade 3 hemorrhoids is less successful than for grade 1 hemorrhoids, but it still is effective. And, let’s face it, not many people are excited about hemorrhoid surgery. So, it’s often worthwhile to try. I’m fairly effective in keeping patients with grades 1-3 hemorrhoids out of the operating room.

Grade 4 hemorrhoids are treated less often with rubber band ligation. But, I often see patients who have both external hemorrhoids and grade 3 internal hemorrhoids at the same time. So, the internal hemorrhoids can be treated with banding and the external hemorrhoids often don’t cause any problems afterward.

However, one thing that should be pointed out is about grade 1 hemorrhoids. Just because there is rectal bleeding doesn’t mean that it is caused by hemorrhoids. I’m not trying to scare anyone, but one of the more common scenarios is a patient with rectal cancer who thinks that bleeding that has been occurring is due to hemorrhoids. This can be differentiated by a colonoscopy.

As you can see, there are a lot of subtleties in hemorrhoids. This is one of the more common things that I treat as a colon and rectal surgeon.

Remember, and if you’ve read my other posts you’ll already know this, make sure and get your daily fiber! That is the main over-the-counter treatment that is effective for hemorrhoids. Many of the over-the-counter creams just aren’t effective.

- See more at: https://thecolorectalcenter.com/anorectal-conditions/can-hemorrhoids-be-treated-without-surgery/#sthash.56ZXDnQJ.dpuf

Defining Heart Disease

People often equate heart disease with heart attacks, but they’re not one and the same. While heart attacks occur because of heart disease, heart disease is a broad term for many conditions that can raise your risk of stroke or heart failure.

UR Medicine preventive cardiologist Dr. John Bisognano explains five common forms of heart disease and offers tips for managing or preventing them.

1. Coronary artery disease

Coronary artery disease (CAD) occurs when plaque (cholesterol and fat deposits) builds up in the arteries that supply oxygen-rich blood to the heart. The plaque causes arteries to narrow, slowing or preventing the flow of blood. When our hearts don’t get enough blood, the resulting pain is called angina. If the artery is completely blocked, it can cause a heart attack.

Many times people learn they have this condition after they’ve experienced a heart attack. Doctors assess your risk of CAD by checking cholesterol, blood pressure and blood glucose levels and reviewing your family’s history of heart disease. If you’re at risk, your physician will likely prescribe inexpensive medications to lower your blood pressure, cholesterol and glucose levels, and closely monitor your condition. Tests to check for CAD include electrocardiogram (EKG), exercise stress test, chest x-ray, angiogram and cardiac catheterization.

2. Hypertension

Hypertension, or high blood pressure, is a silent disease. One in five Americans have it and don’t know it. That’s why doctors make a habit of using the arm cuff to check our patients’ levels as often as we can, looking closely at both the top and bottom numbers. This is important because when the force of blood pressing against the walls of your arteries is elevated, it raises the heart’s workload and can cause serious damage to the arteries as well as the heart.

The first number of a blood pressure reading is the systolic pressure, when the heart is squeezing. The second is the diastolic blood pressure, when the heart is relaxed between beats and when the elastic recoil of the arteries continues to push blood forward. Both numbers are important.

A reading below 120/80 is normal. If your top number is between 120 and 139, or your bottom number is 80 to 89, you are on the way to having hypertension. That means you probably need to make some lifestyle changes to prevent or at least delay becoming hypertensive and needing medications to get the numbers down. If your top number is 140 or above and your bottom number is 90 or above, you have hypertension.

The higher the number, the greater your health risks. Your doctor will likely recommend a combination of lifestyle changes and medication to lower your blood pressure and reduce your risk of heart disease, kidney disease or stroke. For some people over 60 without diabetes of kidney disease, a blood pressure over 150/90 triggers the need for treatment with medications.

3. High cholesterol

High cholesterol is linked to increased risk of heart disease, stroke and peripheral vascular disease. Our bodies need some cholesterol, but not too much, which can lead to plaque build-up in arteries and reduce blood flow to the heart. There are different types of cholesterol. Doctors check cholesterol levels (through a blood test) to determine the level of “bad” cholesterol, or LDL, and triglycerides, which your body stores in fat cells. On the other hand, you want to raise your “good” (HDL) cholesterol. It helps get rid of the bad kinds. Many people try to lower their cholesterol by eating a healthy diet, which is important for our overall health, but a big factor in the cause of high cholesterol is in our genes.

4. Heart attacks

Heart attacks happen when blood flow stops to a portion of the heart. Sometimes it’s caused by a clogged artery (coronary artery disease) or a blood clot that abruptly forms in the artery, eliminating blood flow. Symptoms of a heart attack are most commonly excruciating chest pain or pressure that sometimes radiates down the left arm or the neck, shortness of breath, dizziness and nausea.

5. Cardiomyopathy

Cardiomyopathy is a weakness or stiffness or the heart muscle. This is concerning because it means the heart muscle doesn’t contract and relax normally and that means blood can’t move through the heart efficiently.  It can be caused by coronary artery disease, occur as a result of a heart attack, or may result from years of high blood pressure.

A Beginner’s Guide On Cures For Hemorrhoids

If you were to consult a medical website, you will see that there are various ailments that can be experienced by people today. One of the more serious and uncomfortable ailments is that of hemorrhoids. The causes of hemorrhoids are vast and the treatments can be lengthy with high risks of side effects.

This article will provide information on permanent cures for hemorrhoids working in a short period of time. Furthermore, the cures listed below do not include pharmaceuticals, do not include any surgeries, and do not cause severe side effects.

If you would like to discover more about natural hemorrhoid treatments I would suggest you read this article http://wheretobuyvenapro.net/venapro-reviews/ for all the details you need about a popular and effective option.

The Cause Of Hemorrhoids

The most common cause of hemorrhoids is the inflammation of different body tissues in the anal canal. This swelling is typically caused by an increased internal pressure occurring in the rectal or pelvic area.

If you begin feeling these symptoms, it is highly recommended that you contact a doctor as hemorrhoids can be dangerous if left untreated for long periods of time.

The Diagnosis Of Hemorrhoids

Many individuals find the bowel movement excruciating and the squeezing motion of the movement will be painful and produce blood. A symptom of internal hemorrhoids is the presence of blood and mucus on a stool.

This can be found by checking your stools or finding blood on tissue paper. The blood is often a sign of internal pressure and can be a sign of hemorrhoids.

However, blood dripping from the anus can also be a sign of cancer and intestinal infections. It is essential you consult a medical doctor if this symptom is present.

To obtain a diagnosis of hemorrhoids, the medical professional will need to perform a very simple and non-invasive physical examination. This is done to confirm the presence of potential hemorrhoids in the anal canal.

The examination can be completed quickly and a diagnosis is generally obtained soon after this.

An external hemorrhoid is often simpler to diagnose as one will not need an invasive examination into the anal canal. External hemorrhoids develop outside the rectum and are clearly visible; however, this does not make external hemorrhoids any less dangerous than internal ones.

An external hemorrhoid may form outside the rectum, but it will also develop a blood clot inside the anal canal. This clot may disappear when the tissues are inflamed and may contract during bowel movements.

Another test that may be conducted is a colonoscopy or sigmoidoscopy. These tests will investigate the different colonic regions and determine the exact area of bleeding.

This is generally done if the physical examination did not present with definite diagnostic results. Contrary to popular belief, the colonoscopy or sigmoidoscopy are not signs of severe damage, but merely a further investigation into the cause of bleeding.

The Treatment Of Hemorrhoids

As with the examination for hemorrhoids, the treatments are relatively simple. In many cases, the medical professional will request that you perform a developed routine at home to alleviate any symptoms of the hemorrhoids (i.e. the pain when having bowel movements).

A doctor may also provide oral medication as treatment; as well as a topical solution to ease the pain when having bowel movements. In many cases, hemorrhoids can cause itching which can be addressed through anti-itch prescriptions.

What Does the Thyroid Do?

The thyroid regulates the metabolism through the body’s endocrine system. Cells throughout the body depend on the thyroid gland to break down nutrients in food for conversion to energy. Your metabolism determines the way your body utilizes energy.

If you feel sluggish or hyperactive, it could result from the way the thyroid manages your metabolism. Disorders of the thyroid occur when hormones aren’t released properly by the gland.

The thyroid gland receives messages from the brain to produce hormones when necessary. The hypothalamus in the brain releases stimulating hormones to alert the pituitary gland, located near the hypothalamus, to release more thyroid- stimulating hormones.

The thyroid, located at the front portion of the neck, then produces its hormones by extracting iodine from blood. The thyroid gland is shaped like a butterfly and sits below the larynx or Adam’s apple. The gland has two lobes that are attached by a bridge-like tissue known as the isthmus.

Among the jobs of the thyroid is to regulate metabolism, heartbeat, and body temperature by releasing its hormones. The thyroid also plays a role in voice quality.

A thyroid can become overactive or underactive, which can cause a variety of disorders. Thyroid problems can be caused by genetics, stress, toxins, nutritional deficiencies, or pregnancy.

Hyperthyroidism results from excessive hormone release. It can cause a chemical imbalance in the body. The condition may last for a few weeks or longer and can usually be treated. In rare cases, it be the result of malfunctions of the pituitary gland or cancerous growths in the thyroid.

Hypothyroidism stems from a lack of thyroid hormone production. It can be dangerous for newborns and infants because the hormones are necessary for proper mental and physical development. In extreme cases, the disorder can cause mental retardation or stunted growth.
Infants usually have their thyroid checked for defects soon after birth. Treatment begins immediately when problems are discovered. Symptoms of hypothyroidism for adults include poor appetite and the frequent need to sleep. People who have had thyroid problems in the past are vulnerable to hypothyroidism. It can also result from excessive exposure to iodide in certain medicines or dyes given during X-rays.

Do you have an overactive thyroid?

Millions of people have an overactive thyroid gland. Many don’t know it. This condition, known as hyperthyroidism, occurs more often in women than in men. Since the thyroid gland controls the body’s metabolism, an overactive thyroid puts the body into overdrive.

The symptoms of an overactive thyroid can be subtle and suggest any number of other health problems, ranging from a bowel problem to heart disease or a mental health issue. Some of the signs and symptoms of an overactive thyroid include:

• Heat intolerance. A sped-up metabolism leads to an increase in body temperature.

• Exhaustion. A body perpetually in overdrive tires out more quickly.

• Emotional changes. Fatigue coupled with an overstimulated central nervous system can lead to a variety of emotional changes. Anxiety intermixed with depression, as well insomnia or irritability, are not uncommon.

• Perspiration and thirst. As your body temperature rises, your sweat glands tend to overwork, and you feel the need to continually replenish fluids.

• Constant hunger. As your body uses up energy, it tends to cry out for more. Some people have an insatiable appetite.

• Unexplained weight loss. Even though you may eat constantly, you could lose weight, usually between 5 and 10 pounds—even more in extreme cases.

• Racing heart. You may notice your heart racing out of the blue. This can occur when you are exerting yourself or when you are relaxing. You may find your pulse is much faster than normal.

• Enlarged thyroid gland. Sometimes, but not always, the thyroid gland becomes enlarged and may protrude from the neck to form a goiter. If the goiter is large enough, it may feel lumpy.

• Hand tremors. Overstimulated nerves can make your hands shake. The shaking may be subtle, or it could be to the point where you can’t steadily carry a drink without spilling it.

• Diarrhea. An overactive thyroid causes the digestive system to speed up, and this leads to frequent, loose bowel movements.

• Eye problems. In some people with an overactive thyroid gland, eye problems can occur and be quite severe. The most common eye symptom is a retraction of the eyelids that makes the eyes appear to bulge or stare dramatically. Your eyes may also be puffy and watery, and you may experience double vision.

• Hives. You might notice an itchy rash, which can be relieved with antihistamines.

• Menstrual changes and infertility. Women may notice lighter or missed periods, and may have trouble becoming pregnant.

If you notice these symptoms, call your doctor and ask about having your thyroid tested. Left untreated, an overactive thyroid can cause other health problems, such as an increased risk for osteoporosis and potential heart trouble.

To gain a greater understanding of hyperthyroidism and hypothyroidism, as well as how your thyroid works, buy Thyroid Disease, a Special Health Report from Harvard Medical School.

Early Summer is the Perfect Time to Decrease Hernia Risk by Adopting an Exercise Regimen, Notes Dr. Shirin Towfigh

In light of recent patient questions about the best ways to reduce their risk of a hernia, Dr. Towfigh reminds patients that exercise can help reduce hernia risks in a variety of ways.

Los Angles, CA (PRWEB) June 26, 2015

As one of the Western United States’ leading experts on abdominal wall hernias, Dr. Shirin Towfigh of the Beverly Hills Hernia Center regularly fields questions from patients and colleagues about the best ways to prevent, diagnose, and treat hernias. Recently, says Dr. Towfigh, the attention of many patients has been turned to the area of hernia prevention and what each individual can do to decrease their personal risk factors for hernias. Dr. Towfigh explains that this is the perfect time of year to address that question, as exercise is often the best answer to the question of hernia prevention. “While year-long exercise is the best defense against a hernia, June weather offers an extra incentive to anyone who has yet to adopt a routine.” According to Dr. Towfigh, there are two main ways that exercise can reduce a patient’s risk of developing a hernia:

• It Can Strengthen Abdominal Muscles – A hernia occurs when internal organs protrude through a weakness in the abdominal wall. Dr. Towfigh notes that a weakness can be more easily exploited and stretched when the muscles are weak. By adopting an exercise regimen that works to strengthen the abdominal muscles, prospective patients can help stop naturally occurring holes from turning into hernias.
• It Can Aid in Weight Loss – Dr. Towfigh notes that being overweight and risk of a hernia are very closely correlated. This makes sense, as excess fat can cause increased internal abdominal pressure, which can press upon and stretch the abdominal wall, resulting in a hernia. Yet, it should be noted that extremely rapid weight loss can increase the risk of a hernia, so adopting a steady, consistent exercise and diet regimen is best.

While exercise is perhaps the best, most proven way that patients can reduce the risk of developing harmful hernia symptoms, Dr. Towfigh notes that there are a variety of other behavioral modifications that current or prospective hernia patients may consider, especially when a surgery has already been scheduled. Dr. Towfigh states that, while it is understandable that many patients may need to remain on blood thinners or aspirin for other medical conditions, these can increase the risk of bleeding after hernia repair. Also, smokers should note that, because nicotine can worsen blood flow, it is recommended that patients stop smoking prior to surgery in order to aid in the healing process.

If patients want to learn more about the various risk factors for preventing hernias or surgical complications after a hernia repair, they can call Beverly Hills Hernia Center at 310-358-5020 or visit them online at http://www.beverlyhillsherniacenter.com today.

For the original version on PRWeb visit: http://www.prweb.com/releases/HerniaCenter/PreventativeCare/prweb12793894.htm

How To Know If You Have A Hernia

A hernia is simply a hole in a muscle that causes a range of symptoms.

“The abdominal cavity is essentially a basket of muscle holding your organs within it.  A weakness in the basket will often lead to a hole, which is by definition a hernia,” according to Michael R. Castellano, MD, FACS, director of the Hernia Center at Staten Island University Hospital. As the hole becomes larger or when internal organs, usually the intestines, begin to push through it, discomfort may turn to pain.

“The most common symptoms of a hernia are discomfort and swelling, but there are others,” says Dr. Castellano. An intermittent twinge, a dull ache or severe pain or burning may occur.   Swelling may be mild asymmetry or swelling to a large firm lump.  Prompt medical evaluation should be sought if severe acute pain becomes associated with a firm lump.

Symptoms of an incarcerated hernia tend to be more severe. Incarceration occurs when intestine or intra-abdominal fat become stuck within the hernia in the abdominal wall leading to bloating, nausea, vomiting and severe pain, and even emergency situations.

Diagnosing a hernia

Most hernias can be diagnosed by physical examination from a qualified health care provider.  Symptoms suggestive of a hernia, without obvious physical evidence of one, warrant an evaluation by a surgeon with expertise in this area.  On occasion, a sonogram, CT scan or MRI may be necessary.

Treating a hernia

If a hernia is small and not causing any symptoms, watchful waiting may be acceptable.  However, if a hernia protrudes or if any symptoms are present, then it should be repaired.

Today, most hernia repairs are done in about thirty minutes as an outpatient procedure.  Then can be done without general anesthesia, utilizing local anesthesia with IV sedation instead.  This is safer, more comfortable and less stressful for most patients.

Dr. Castellano offers advice to protect ourselves against developing a hernia.

Avoid lifting heavy objects, but when lifting is necessary, breathe through a lift and bend from the knees, not the waist.  Moving furniture, carrying suitcases, shoveling snow and weight lifting at the gym are common activities resulting in hernias.

Maintain a healthy weight, by adopting a healthy lifestyle.  Eat less and move more.

A healthy diet devoid of processed food and full of fiber will usually eliminate constipation, which is a common cause of hernia formation, especially in older people. Stop smoking.  This dangerous habit often leads to a chronic cough, which can result in a hernia.

6 Steps to Heal Your Thyroid

As I explained in last week's blog, the thyroid system plays a critical role in your metabolism. Along with insulin and cortisol, your thyroid hormone is one of the big three hormones that control your metabolism and weight.

The key is the right testing to confirm that a sluggish thyroid is contributing to a stalled metabolism and other problems.  Once you know this for sure there are many ways to help correct thyroid problems.

There are so many reasons for low thyroid function, yet I see many patients whose doctors have ignored this problem. One young female patient had more than 30 percent body fat and was unable to change her body no matter how hard she worked. She ate perfectly, exercised with a trainer every day, yet her body wouldn't budge. She also had a slightly depressed mood and other vague symptoms.

I treated her with a low dose of a natural thyroid replacement.

What happened?

Well, she lost 20 pounds and improved her body composition and mood. And all of her other symptoms went away.

How did I know she and other patients had low thyroid function? I ask about symptoms, perform a physical exam, and consider potential causes of thyroid problems. Then I do the right tests.

Most doctors just check something called thyroid-stimulating hormone (TSH), which doesn't give a full picture of the thyroid. In fact, even the interpretation of this test is incorrect most of the time.

The newer guidelines of the American College of Endocrinology consider anybody with a TSH level over 3.0 as hypothyroid. (1) Most doctors think that only anything over 5 or 10 is worth treating. Unfortunately, this leaves millions suffering unnecessarily.

Besides TSH, Functional Medicine practitioners perform other essential tests including free T3, free T4, and thyroid antibodies. We also look for associated problems such as gluten intolerance, food allergies, and heavy metals, as well as deficiencies of vitamin D, selenium, vitamin A, zinc, and omega-3 fats.

Last week I provided some strategies to address underlying causes of hypothyroidism. Here, I want to dive a little deeper to address some strategies to heal your thyroid.

Correcting these problems requires an integrative approach. It involves more than simply taking a thyroid pill. As you'll see, it involves nutritional support, exercise, stress reduction, supplements, reducing inflammation, and sometimes eliminating certain foods and detoxification from heavy metals (such as mercury and lead) and petrochemical toxins (such as pesticides and PCBs).

To integrate all of these elements and create a successful set of techniques to cope with your thyroid problems, I recommend these six strategies.

Strategy 1: Eliminate the causes of thyroid problems.

Carefully consider things that may interfere with your thyroid function and eliminate them. As you will see, there are a good many things that can impede optimal thyroid function.

Diet is a good place to begin. Certain foods have developed a reputation for playing a role in thyroid dysfunction, but this reputation isn't necessarily connected to the latest scientific evidence.

For instance, soy foods and the broccoli family (broccoli, cabbage, kale, Brussels sprouts, and collard greens) have all been linked to thyroid dysfunction, but they also have many other health benefits. Research on these foods to date has been less than conclusive. In one study, rats fed high concentrations of soy had problems with their thyroid. The take-home message: If you are a rat, stay away from tofu. Human studies have shown no significant effect when soy is consumed in normal quantities. (2)

On the other hand, there are food groups where substantive evidence supports a link to an autoimmune disease of the thyroid that slows down your metabolism.

Gluten is one of them. (3) If you think you are having a thyroid problem, you need to do a blood test to identify any hidden reaction to gluten found in wheat, barley, rye, oats, kamut, and spelt. Gluten sensitivity or allergy can cause many different types of symptoms, from migraines to fatigue to weight gain.

Besides doing the blood test, you can simply eliminate gluten from your diet for three weeks. If your symptoms go away, you have a clue that your system might not like this food. If you want to take this self-test a step further, reintroduce gluten into your diet and see if your symptoms recur. If they do, that is another major clue.

There are other food allergies besides gluten that can stall thyroid function. You might want to work with a medical practitioner to pinpoint and eliminate these food allergies. A good place to begin is my book The Blood Sugar Solution 10-Day Detox Diet.

Besides certain foods and food allergies, toxins can slow down your thyroid. Testing yourself for mercury and getting it out of your system and your environment becomes crucial. (4) You also want to avoid fluoride, which has been linked to thyroid problems, (5) and chlorinated water.

Checking for pesticides is more difficult, but supporting your body's detoxification system by eating organic foods, filtering your water, and eating detoxifying foods can be very helpful to heal your thyroid.

Stress also affects your thyroid function negatively. Military cadets in training who were subjected to intense stress had higher levels of cortisol, higher inflammation levels, reduced testosterone, higher TSH, and very low T3. Treating the thyroid without dealing with chronic stress can precipitate more problems.

A common form of chronic stress -- adrenal gland exhaustion or burnout -- particularly becomes dangerous for hypothyroidism. Adrenal gland exhaustion occurs when your adrenal glands are unable to keep up with the physiological needs created by stress.

To remedy this chronic stress, incorporate what I call active relaxation. You might also consider my UltraCalm CD to melt away stress and anxiety.

Strategy 2: Regular Exercise and Saunas

Exercise stimulates thyroid gland secretion and increases tissue sensitivity to thyroid hormones throughout the body. Ideally, you will want to sweat, and the exercise should be vigorous. Regardless of your current fitness level, you will find a helpful, easy-to-implement workout plan here.

Besides being an excellent way to relax your muscles and your mind, saunas or steam baths are a good way to flush your system of pesticides that could be contributing to your thyroid problem.

Saunas are an important aid to weight loss and thyroid repair because as you lose weight, fat tissue releases stored toxins such as PCBs and pesticides (organochlorines). (6) These toxins lower your T3 levels, consequently slowing your resting metabolic rate and inhibiting your fat-burning ability. (7)

Detoxifying becomes an important part of improving your thyroid function. If you don't detoxify, your ability to lose weight decreases as you lose weight because of the released toxins' detrimental impact on thyroid function.

Strategy 3: Eat Foods That Provide Nutritional Support for Your Thyroid, and Avoid Those That Don't

Every step on your road to healing and weight loss depends on proper nutrition and using food to communicate the right information to your genes. (8) Treating your thyroid is no exception.

Choose foods that offer nutritional support for your thyroid.  The production of thyroid hormones requires iodine and omega-3 fatty acids; converting the inactive T4 to the active T3 requires selenium; and both the binding of T3 to the receptor on the nucleus and switching it on require vitamins A and D, as well as zinc. You will find these nutrients in a whole-food, clean, organic diet. To get therapeutic levels of these nutrients, please use the supplement protocol in strategy 4.

Thyroid-boosting foods include seaweed and sea vegetables, which contain iodine. Fish (especially sardines and salmon) contains iodine, omega-3 fats, and vitamin D. Dandelion, mustard, and other dark leafy greens contain vitamin A. Smelt, herring, scallops, and Brazil nuts contain selenium.

You want to avoid foods that can interfere with thyroid function. These include the aforementioned gluten. Also, choose clean sources of soy protein in moderation and avoid processed soy products.

Strategy 4: Use Supplements That Support Your Thyroid

Key nutrients for healthy thyroid function are included in my basic supplement recommendations, including a multivitamin and mineral supplement that contains selenium, iodine, zinc, vitamins A and D, and omega-3 fats (fish oil). You will find all these nutrients at my store, as well as a thyroid support kit.

One warning is that if your adrenal glands are burned out from long-term stress, treating the thyroid without supporting the adrenal glands through relaxation and adaptogenic herbs (such as ginseng, rhodiola, or Siberian ginseng) can actually make you feel worse.

I also recommend working with an experienced practitioner who can address individual nutrient needs for your thyroid and, if necessary, also your adrenal glands.

Strategy 5: Have Your Thyroid Tested

There is no one perfect way, no one symptom nor test result, that will properly diagnose low thyroid function or hypothyroidism. The key is to look at the whole picture -- your symptoms and your blood tests -- and then decide.

Doctors typically diagnose thyroid problems by testing your TSH levels and sometimes your free T4 level. But some doctors and clinicians have brought the "normal" levels of those tests into question.

The diagnosis of "subclinical" hypothyroidism that I discussed last week depends on having a TSH level higher than 5 m IU/ml and lower than 10 m IU/ml. As I mentioned above, new guidelines suggest anything over 3 is abnormal. While an improvement, practitioners following these guidelines may still miss many people who have normal test results and a malfunctioning thyroid system.

To get a complete picture, I recommend looking at a wider range of functions:

• Thyroid-stimulating hormone (TSH), the ideal range is between 1 and 2 m IU/ ml.
• Free T4 and free T3 (the inactive and the active hormone).
• Thyroid antibodies (TPO), looking for an autoimmune reaction that commonly goes undiagnosed if the other tests are normal, as doctors don't routinely check this.
• Thyroid-releasing hormone (TRH) stimulation test.
• A 24-hour urine test for free T3, which can be helpful in hard-to-diagnose cases.

A physician experienced in ordering these tests and interpreting the results can provide a more comprehensive picture of how your thyroid is functioning.

If you think you have an undiagnosed thyroid problem, insist that your doctor perform these tests or find a doctor who will. They are essential to fill in the pieces of the puzzle standard tests don't provide.

Strategy 6: Choose the Right Thyroid Hormone Replacement

Ultimately, to properly balance a thyroid that is severely out of balance, you will need to go on some type of thyroid hormone replacement therapy.

Altering your diet and your lifestyle will certainly help tremendously, but if your thyroid isn't functioning properly, you may need to take some additional thyroid hormones to supplement its output. Knowing what's available and what to ask about can empower you to make better decisions about your health.

When I went to medical school and did my residency, I learned about only one treatment for low thyroid function: a synthetic form of T4 that wasn't FDA-approved until recently.

Why do doctors prescribe it? Because that is all they learn to prescribe. But that doesn't make it the best treatment for everyone. Some people benefit from Synthroid, but in some cases the symptoms don't seem to go away using only T4, even if their tests return to normal. So what is the right treatment?

The answer is, it depends.

Part of the beauty (and the headache) of Functional Medicine is that no one treatment works for everyone. A combination of experience, testing, and trial and error becomes necessary to get any treatment just right.

At the same time, I've discovered the majority of my patients benefit from a combination hormone treatment including both T4 and T3. Synthroid is just T4, the inactive hormone. Most doctors assume that the body will convert it to T3 and all will be well.

Unfortunately, pesticides, stress, mercury, infections, allergies, and selenium deficiencies can block that process. Since 100 percent of us have pesticides stored in our bodies, we will all likely have some problem with Synthroid.

The most common treatment I use is Armour thyroid, (9) a prescription drug made from desiccated (dried) porcine thyroid. It contains the full spectrum of thyroid hormones, including T4, T3, and T2 (10). That last one -- T2 -- is a little-known product of thyroid metabolism that actually may be very important. The right dose ranges from 15 to 180 milligrams, depending on the person.

Many doctors still hold the outdated belief that the preparation is unstable and the dosage difficult to monitor. That was true with the old preparation of Armour, not the new one. (See www.armourthyroid.com for more information.)

Sometimes the only way to find out if you have a thyroid problem is a short trial of something like Armour thyroid for three months. If you feel better, your symptoms disappear, and you lose weight, it's the right choice. Once started, you needn't take it for life.

Sometimes, once all the factors that disturbed your thyroid function have been corrected, you may be able to reduce or discontinue the dose. As with any treatment, always work with a physician experienced in using medications to treat your thyroid.

Careful monitoring is essential. Taking too much thyroid hormone or taking it if you don't need it can lead to undesirable side effects, including anxiety, insomnia, palpitations, and, over the long term, bone loss.

Conclusion 

Over my several decades working as a Functional Medicine doctor, I can assure you that even in the toughest cases, you can heal your thyroid. With some patients, I can do this through the dietary, nutrient, and lifestyle factors I've discussed here. For others, that healing requires trial and error using several medications and working closely with a physician.

The bottom line is that you should never lose hope. Taking a proactive approach and working with a trained practitioner can correct many thyroid issues.

If you've ever had a sluggish thyroid or other thyroid issues, I encourage you to join our upcoming 10-Day Detox Diet Challenge which will have a bonus segment on Thyroid.  Receive a free Ebook, an additional 30 minute live call with a nutritionist, extra coaching support, and my 7-step plan for reversing Hypothyroidism.  Click here to register by June 18.

Wishing you health and happiness,
Mark Hyman, MD.

Mark Hyman, M.D. believes that we all deserve a life of vitality -- and that we have the potential to create it for ourselves. That's why he is dedicated to tackling the root causes of chronic disease by harnessing the power of Functional Medicine to transform healthcare. He is a practicing family physician, a nine-time #1 New York Times bestselling author, and an internationally recognized leader, speaker, educator, and advocate in his field. He is the Director of the Cleveland Clinic Center for Functional Medicine. He is also the founder and medical director of The UltraWellness Center, chairman of the board of the Institute for Functional Medicine, a medical editor of The Huffington Post, and has been a regular medical contributor on many television shows including CBS This Morning, the Today Show, CNN, The View, the Katie Couric show and The Dr. Oz Show.

References 

(1) Cooper DS. Subclinical Hypothyroidism. NEJM. 2001 Jul 26;345: 260- 265.

(2) Persky VW, Turyk ME, Wang L, Freels S, Chatterton R Jr, Barnes S, Erdman J Jr, Sepkovic DW, Bradlow HL, Potter S. Effect of soy protein on endogenous hormones in postmenopausal women. Am J Clin Nutr. 2002 Jan; 75( 1): 145- 153. Erratum in: Am J Clin Nutr. 2002 Sep; 76( 3): 695

(3) Toscano V, Conti FG, Anastasi E, Mariani P, Tiberti C, Poggi M, Montuori M, Monti S, Laureti S, Cipolletta E, Gemme G, Caiola S, Di Mario U, Bonamico M. Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients. Am J Gastroenterol. 2000 Jul; 95( 7): 1742-1748.

(4) Ellingsen DG, Efskind J. Effects of low mercury vapour exposure on the thyroid function in chloralkali workers. J Appl Toxicol. 2000 Nov- Dec; 20( 6): 483- 489.

(5) Galletti PM, Joyet G. Effect of fluorine on thyroidal iodine metabolism in hyperthyroidism. J Clin Endocrinol Metab. 1958 Oct; 18( 10): 1102- 1110.

(6) WJ, Pan Y; Johnson AR, et al. Reduction of chemical sensitivity by means of heat depuration, physical therapy and nutritional supplementation in a controlled environment. J Nutr Env Med. 1996;6: 141- 148.

(7) Pelletier C, Imbeault P, Tremblay A. Energy balance and pollution by organochlorines and polychlorinated biphenyls. Obes Rev. 2003 Feb; 4( 1): 17- 24. Review.

(8) Bland J. Nutritional Endocrinology, Normalizing Hypothalamus-Pituitary-Thyroid Axis Function, 2002 Seminar Series Syllabus.

(9) Gaby AR. Sub-laboratory hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004 Jun; 9( 2): 157- 179.

(10) Goglia F. Biological effects of 3,5-diiodothyronine (T( 2)). Biochemistry (Moscow). 2005 Feb; 70( 2): 164- 172.

What Causes Thyroid Disease?

Why did I get thyroid disease?

This is a question anyone with a new diagnosis of thyroid disease will naturally ask. I hear it several times each week in my practice. I think it is important to understand for several reasons.

One is just intellectual curiosity. When things go wrong, we want to know why in order to have some sense of understanding and control. Without it, we are left unsure of what else might go wrong unexpectedly.

Another is prevention. If this happened to you, what can you learn that might help prevent your loved ones from experiencing it?

One of the most useful reasons for understanding why you have thyroid disease is this: By knowing how it happened, the steps that will help you feel better become more apparent.

Thyroid disease is primarily an immune disease. In this post, I'll explain why your immune system attacks your thyroid. In the next, I'll explain the most common ways this plays out, namely Hashimoto's thyroiditis and Graves' disease.

To understand how your thyroid can go wrong, let me first explain a few key concepts related to it, your immunity and your genes.

Nutrients
Your thyroid needs iodine in order to function. At first glance, that does not seem too unusual. Many parts of your body need nutrients to work right. In some ways, however, this relationship is different. As best we can tell, your thyroid is the only part of your body that needs iodine. This is unusual. Every other nutrient we know of is used for many body processes with a large variety of reactions.

Another unusual thing about iodine and your thyroid is that it needs a pump. All of the other nutrients our body uses are found in adequate amounts in our bloodstream (assuming we are not deficient). Your bloodstream cannot carry enough iodine for a thyroid, so your thyroid has a pump that pulls iodine inside of it at concentrations up to 100 times what is found in the blood. This pump can be part of the problem, leading to thyroid disease because it can pull toxins inside your thyroid, along with the iodine. Ironically, the best-documented toxins to trigger thyroid disease not only include iodine itself, but also perchlorate, lead, mercury and over 200 other environmental chemicals. [1]

Immunity
The other player involved in this response is your immune system. Overall, your immune system acts like a home security guard. Its job is to keep dangerous bacteria, viruses and fungi from getting inside your body and hurting you. Imagine a home security guard attacking your mail carrier. When the guard attacks something from outside of you that is not dangerous, we call this an allergy. Imagine the security guard attacking your pet by mistake. Your pet is harmless, and it's supposed to be inside your home. When your immune system attacks something that is supposed to be inside of you, we call this an autoimmune reaction. In most cases, you are better off when your immune system attacks something unnecessary rather than when it ignores something dangerous. Allergies may be a nuisance, but they are better than letting bacteria create septic shock. If your home security guard was overworked and had a high stress load, he may be more apt to attack the wrong things. It is also true that your immune system is more likely to make mistakes when it has more stress, like ongoing infections, allergies or problems in the intestinal tract.

Other Hormones
Your thyroid gland is an interconnected part of your endocrine system. Each gland in the system has a distinct rule, yet they also interact with one another. The glands that have the most ties with your thyroid include the ovaries and the adrenals. This is one of the reasons women get more thyroid disease than men. When the adrenal glands change their output of stress hormones, this can both stress the immune system and make your cells not absorb thyroid hormones properly. The ovaries produce estrogen, which causes your liver to make proteins that weaken the thyroid hormones. Because of this, anytime there is a big change in the ovaries, it can cause the thyroid strain. These times include pregnancy, perimenopause, and menopause.

Genes
The last part of this equation is your genetic makeup. The data is very strong that disease runs in families. This happens because toxins are part of the chain of events that trigger thyroid disease, and there are genes that determine how effectively you can detoxify your body. We are all exposed to countless chemicals each day. Some have estimated there are over 3 million new chemicals in our environment since the 1900s [2]. You can think of your genetic ability to detoxify as how stain-resistant a fabric is. With some fabrics, you can spill pasta sauce or berries and know they will rinse right off. With others, it will be stained forever by the same foods. Even though we are all exposed to toxins, some of us are apt to have more of those toxins stay inside of us than others.

Now that you understand the players, here's how it all can produce the perfect storm that leads to thyroid disease:

Step one: You have some degree of genetic susceptibility to thyroid disease. Choose your parents wisely.

Step two: Your body is exposed to chemicals that can be concentrated within your thyroid. These build up inside the thyroid and create chronic inflammation.

Step three: Fluctuations in hormones from your ovaries or adrenals may cause strain on your thyroid.

Step four: Some stressor to your immune system, like an infection, an airborne allergy or a food reaction, causes it to become too aggressive.

Step five: Your immune system now starts to attack your thyroid.

Understanding these steps is helpful to reduce your risk of thyroid disease. For those who have thyroid disease, understanding these steps should help you understand the steps that should be taken to regain your health.

In the next edition to this article, I will discuss the most common effects this attack against your thyroid can have and what practical steps you can do to improve your health.

References:

[1] Gedalia I, Brand N: The relationship of fluoride and iodine in drinking water in the occurrence of goiter. Arch Int Pharmacodyn Ther 142:312, 1998

Gupta P, Kar A: Role of ascorbic acid in cadmium-induced thyroid dysfunction and lipid peroxidation. J Appl Toxicol 18:317-20,1998.

[2] http://www.worldwatch.org/system/files/EP132C.pdf

Do You Know the Signs of Thyroid Disease?

Ten percent of women and three percent of men will experience thyroid disease, which can affect every organ in the body.

Angela Dispenzieri was blessed with great health her whole life, until about five years ago when she started feeling anxious and overheated.

“I started noticing I had a fast heart rate, and feeling sweaty, dizzy,” she says. The problem was centered in a small butterfly-shaped gland in her throat — the thyroid.

“Thyroid hormone is important in the metabolism of basically every cell, every tissue, every organ in the body,” says Dispenzieri’s doctor, John Morris III, MD, an endocrinologist at the Mayo Clinic.

If the thyroid is not producing enough hormone — a condition called hypothyroidism — metabolism slows. You may feel weak, sluggish, and cold. You may gain weight without overeating. This condition is especially serious in children because the thyroid is essential to growth and brain development.

If the thyroid is producing too much hormone — called hyperthyroidism — the symptoms are the opposite. You may feel nervous and hot, and you may lose weight while eating normally.

“It affects the heart and the nervous system,” says Dr. Morris. “It increases the metabolism so that patients need to eat more and more in order just to maintain their weight.”

Morris determined Dispenzieri’s hyperthyroidism was caused by an autoimmune condition called Graves’ disease. In Graves’ disease, the body’s immune system attacks the thyroid gland causing it to become overactive.

RELATED: Are You at Risk for Thyroid Disease?

In her case, the best solution was to shut down her overactive thyroid gland. That was done by giving her a radioactive iodine solution to drink. The thyroid absorbs iodine, so the radioactive material accumulated there and destroyed the gland.

Without a working thyroid gland, Dispenzieri must take a synthetic form of thyroid hormone every day as a pill. The drug she takes, levothyroxine, is the most commonly prescribed medication in the United States.

Dispenzieri is a medical doctor and a cancer researcher at Mayo Clinic, so she appreciates the work that went into developing the artificial hormone that now keeps her and millions of others alive.

Thyroid hormone was first purified by a researcher at the same hospital where Dispenzieri does her research — the Mayo Clinic. On Christmas Eve 1914, a young chemist named Edward Kendall became the first to successfully crystallize thyroid hormone in the laboratory.

“Discovery in medicine was amazing then,” Dispenzieri says. “It’s amazing now.”

If you suspect you have a hernia, docs warn not to wait before having it checked out

Rajon Jernigan's pain was getting more predictable. Whenever he used his abdominal muscles in any task, he felt extreme tightness and squeezing in his abdomen.

"We put in a hardwood floor at our house and, being bent over and pulling and

pushing, I could really feel it," said the 36-year-old East Pennsboro Township man.

He was feeling an umbilical hernia that he had been watching for about five years, waiting to have surgery when necessary.

"I was keeping a good eye on it, but you never know. I decided it was time. The recovery time would have been longer had I waited," said Jernigan, who had hernia surgery in January.

The danger in waiting too long, he knew, was the possibility of a strangulated hernia, where the blood flow to the surrounding tissue would be cut off and emergency surgery would be needed.

About 5 million Americans every year are affected by hernias

About 5 million Americans every year are affected by hernias, which go by many different names depending on where they are located. Initial symptoms are pain and often a bulge that can be felt. Hernias frequently show up in the groin, the navel or at a previous surgical site.

Hernias occur when a force too strong for the body's tissue to withstand ends up causing part of an internal organ or tissue to bulge through the weakened area, said Dr. Joseph Esposito, general surgeon with PinnacleHealth Surgical Associates.

"This results in a hole in, usually, the abdominal wall, but it can happen anywhere, even through the diaphragm, which is called a hiatal hernia," Esposito said.

Bulge a common symptom

The most common kind is an inguinal hernia, which is mostly found in men. It typically appears in the groin area above the inguinal ligament and causes the omentum (the fatty apron surrounding the abdominal organs) or intestines to protrude through the abdominal wall, said Dr. Paul Kunkel, surgeon with Holy Spirit General Surgery, a Geisinger Affiliate

Dr. Paul Kunkel, surgeon with Holy Spirit General Surgery says there's not much that can be done to avoid a hernia. When lifting something heavy, he advises lifting from the butt and using your whole body for better leverage, bending at the knees.Provided photo 

A femoral hernia, which is more common in women, is a bulging located near the groin and thigh that occurs when a small part of intestine pushes through the wall of the femoral canal, which is located below the inguinal ligament.

"They can be more dangerous because there is a higher likelihood of the tissue being trapped and people develop a bowel obstruction. The bowel can die and that portion must be removed," Esposito said.

Umbilical hernias are most common in babies and usually close on their own. However, adults can get them as well and sometimes, as in Jernigan's case, surgery is needed to repair them.

In a ventral hernia, the intestine pushes through the abdominal wall, often at the site of a previous abdominal surgery, Kunkel said. This type of hernia is most common in overweight people who are inactive after abdominal surgery and in smokers.

"Obesity puts more pressure on your abdominal wall and it's harder to heal after surgery," Kunkel said. "Also, smoking decreases oxygen levels so the tissues don't heal as well."

A hiatal hernia is different from the other types in that it involves the stomach, which can bulge up through the diaphragm into the chest. Many people have small hiatal hernias and never know it, however, heartburn can be one cue that a hiatal hernia is brewing.

"If you have a lot of heartburn or difficulty swallowing, you should get it checked," Esposito said. "You can also have pressure in the chest, which a lot of people confuse with a heart attack."

 If a hiatal hernia is large, surgery may be needed to pull the stomach back into place and make the opening of the diaphragm smaller.

While Jernigan was having his umbilical hernia repaired, he decided to have a repair made to a second hernia he had known about since childhood. When he was 9, Jernigan had surgery for an epigastic hernia located in the middle of his abdomen between the breastbone and the belly button. Recently, he had begun to feel a bulge in his abdominal wall that suggested repair was needed again.

"I didn't have pain, but if I got too dehydrated, I began feel discomfort," he said. "I knew that once you have this type of hernia, you are at risk for having it again." 

Complications can arise 

While watchful waiting is fine for some hernias that don't cause pain, there are complications that can arise. If the tissue or intestine gets stuck and cannot be pushed back, an incarcerated hernia can occur. If the intestine becomes incarcerated, it can twist and obstruct the bowel. An incarcerated hernia becomes strangulated if it loses blood supply, which is a definite surgical emergency, Kunkel said.

Hernias are generally fixed in one of two ways, either open surgery or laparoscopically. Robotic surgery is sometimes an option as well.

"With the patient completely asleep or just sedated, we make a small incision in the groin and dissect down to the defect and patch it with a polypropylene mesh and sew the patient back up," Kunkel said. "With laparscopic repair, the patient has general anesthesia and we patch the defect from the inside through three tiny incisions. This method is less painful and speeds the healing process by two to three weeks."

Robotic surgery is also an option for some hernia repairs. It offers a three-dimensional camera that helps the surgeon see better, but it may not always be the most cost-effective surgery, Esposito said.

Jernigan had robotic surgery and said he would recommend it. He has memories of a months-long, painful recovery from his first hernia surgery as a child.

"Dr. Esposito wondered if I was interested in robotic. He promised me the recovery time was significantly less and he was right. I was back to work in two weeks," said Jernigan, who works in law enforcement. "I still have two months of lifting restrictions - nothing more than 20 pounds - but just the fact that I'm mobile and can function normally without any discomfort is great."

Prevention not easy 

There isn't much that can be done to prevent hernias.

"Use good judgment. Don't overdo things. Don't smoke," Kunkel said. "Don't lift massive amounts unless you have to and when lifting, lift from the butt and use your whole body for better leverage, bending at the knees."

If a bulge is noticed, don't wait more than a day or so to have it checked, Kunkel said.

"The more you ignore it, the worse the problem can become,'' Esposito said. "The larger a hernia becomes, the greater the likelihood of complications." 

Embarrassing diseases are a real pain in the...

There are the diseases you don't want to get because they'll kill you. Then there are the diseases you don't want to get because you are too embarrassed to discuss them out loud, even with your doctor.

Hemorrhoids often fall into the latter category.

By age 30, more than half the population has one or more hemorrhoids symptoms. It's one of the most common ailments, and yet talking about the extreme pain, bleeding, and itching in your anal or rectal area is another story. Heck, even typing that sentence made me blush.

Studies show only a third of patients with symptomatic hemorrhoids actually seek medical help. Most would rather suffer in silence.

In fact, Google stats show a disproportionate number of you type the word "hemorrhoid" into that search box, and come to CNN looking for help.

As a member of the medical team, let me personally thank you for trusting CNN to give you accurate medical information. We are a great first step. But sometimes you really should talk to a doctor, even if it's hard to choke out words for problems like "hemorrhoids," "herpes," "toenail fungus" or anything else "down there," as one patient called their pelvic region.

"It is so important for you to be able to talk to your doctor, because your health is at stake," said Carrie Bernat. Bernat works at the University of Michigan Medical School training medical students to offer better patient-centered care. Your relationship with your doctor "needs to be based on trust and respect, otherwise information will be missed on either side and it will have a negative impact."

In other words, a failure to communicate with your doctor can hurt your health.

Thankfully, hemorrhoids are not all that dangerous. The veins near your anus or rectum have gotten swollen. There are topical creams you can buy at the drugstore to treat them. You can make dietary changes like adding more fiber and drinking more water to reduce your chances of having them. You could even try something called a sitz bath to make them feel better.

But sometimes hemorrhoids are beyond the help of home remedies. They can become so painful you need surgery. Hemorrhoids can come back even after you treat the symptoms and stay a real pain in the -- well you know. A doctor can help.

It's also good to talk to a doctor for peace of mind. What if it's not really hemorrhoids? What if it's something else?

"Letting go of the idea that something is embarrassing is important, because the physicians are trained to handle all these things in a confidential way," Bernat said. "I know that's easier said than done, but they can't take care of you if they don't know what is going on."

We've got the medical studies to prove it.

For instance, one study found that poor communication between a doctor and a patient when it came to a less embarrassing disease, asthma, may be one of the reasons minorities have less effective treatment outcomes.

"Good communication is essential to help me find the sweet spot as far as treatment," said Dr. Greg Diette who was a co-author on the study and works at Johns Hopkins.

Diette tries to work around a patient's reticence. He starts each appointment with open-ended questions.

He's mindful not to interrupt. He builds rapport. "Then when there are things I need to know, only then do I ask specifics," he said. And he's always sure to ask a final question.

"At the end, I always ask 'Is there anything so far that we have not talked about?' and that's often when I get the great questions," Diette said.

Some doctors call these the "hand-on-the-door questions."

He says some doctors also try to work around this discomfort by having you fill out a survey before you go in to see them. The thinking is that you will feel more comfortable filling that out, rather than talking about a problem. Then it will be the doctor prompting you with questions.

If you get a sense that your doctor is in a hurry, don't let that get to you, even if that may be easier said than done. A 2012 study found that patients didn't want to ask too many questions because they worried they would be perceived as "difficult," particularly when they sensed the doctor had a time constraint.

"Asking questions, discussing preferences or disagreeing with a recommendation are communication skills used in everyday life," the study said. But "for many patients these may be novel in the context of a medical consultation."

So be sure to be an empowered patient and take your time and advocate for yourself when you go in to get things checked out. Doctors are used to talking about all sorts of medical issues, even if you are not.

Write down what you want to say ahead of time or put together a checklist so you can be sure to cover all your questions. Be honest on those surveys you get before you go into the office. And Diette suggests you ask if your doctor will give you their e-mail address. Sometimes he thinks it's easier for some of his patients to put things in writing, rather than say them out loud.

If all that doesn't work and you still don't feel comfortable communicating with your doctor, Bernat has a simple suggestion: Find one you can talk to.

It's that important.

"People don't want to offend or hurt anyone's feelings, but medicine is a customer-based process," she said. "Find someone you are comfortable with. It's essential so that getting information out of you is not a tug of war."

How does the thyroid manage your metabolism? - Emma Bryce

Nestled in the tissues of your neck is a small, unassuming organ that wields enormous power over your body: the thyroid. Emma Bryce explains how the thyroid, like the operations manager in a company, is tasked with making sure that all the cells in your body are working properly.

Lesson by Emma Bryce, animation by Tremendousness.