Jan 11, 2017

How to Spot and Prevent Deep Vein Thrombosis



When the Clot Thickens

Illustration of the veins in the lower leg and a close-up of a blood clot lodged in a vein.
Lots of things can cause pain and swelling in your leg. But if your symptoms stem from a blood clot deep in your leg, it can be dangerous. Blood clots can happen to anyone, anytime. But some people are at increased risk. Taking steps to reduce your chances of a blood clot forming in your veins can help you avoid potentially serious problems.
Blood clots can arise anywhere in your body. They develop when blood thickens and clumps together. When a clot forms in a vein deep in the body, it’s called deep vein thrombosis. Deep vein blood clots typically occur in the lower leg or thigh. 
“Deep vein thrombosis has classic symptoms—for example swelling, pain, warmth, and redness on the leg,” says Dr. Andrei Kindzelski, an NIH blood disease expert. “But about 30–40% of cases go unnoticed, since they don’t have typical symptoms.” In fact, some people don’t realize they have a deep vein clot until it causes a more serious condition. 
Deep vein clots—especially those in the thigh—can break off and travel through the bloodstream. If a clot lodges in an artery in the lungs, it can block blood flow and lead to a sometimes-deadly condition called pulmonary embolism. This disorder can damage the lungs and reduce blood oxygen levels, which can harm other organs as well. 
Some people are more at risk for deep vein thrombosis than others. “Usually people who develop deep vein thrombosis have some level of thrombophilia, which means their blood clots more rapidly or easily,” Kindzelski says. Getting a blood clot is usually the first sign of this condition because it’s hard to notice otherwise. In these cases, lifestyle can contribute to a blood clot forming—if you don’t move enough, for example. Your risk is higher if you’ve recently had surgery or broken a bone, if you’re ill and in bed for a long time, or if you’re traveling for a long time (such as during long car or airplane rides). 
Having other diseases or conditions can also raise your chances of a blood clot. These include a stroke, paralysis (an inability to move), chronic heart disease, high blood pressure, surgical procedure, or having been recently treated for cancer. Women who take hormone therapy pills or birth control pills, are pregnant, or within the first 6 weeks after giving birth are also at higher risk. So are those who smoke or who are older than 60. But deep vein thrombosis can happen at any age.
You can take simple steps to lower your chances for a blood clot. Exercise your lower leg muscles if you’re sitting for a long time while traveling. Get out of bed and move around as soon as you’re able after having surgery or being ill. The more active you are, the better your chance of avoiding a blood clot. Take any medicines your doctor prescribes to prevent clots after some types of surgery. 
A prompt diagnosis and proper treatment can help prevent the complications of blood clots. See your doctor immediately if you have any signs or symptoms of deep vein thrombosis or pulmonary embolism (see the Wise Choices box). A physical exam and other tests can help doctors determine whether you’ve got a blood clot. 
There are many ways to treat deep vein thrombosis. Therapies aim to stop the blood clot from getting bigger, prevent the clot from breaking off and moving to your lungs, or reduce your chance of having another blood clot. NIH scientists continue to research new medicines and better treatment options.
If you think you may be at risk for deep vein thrombosis, talk with your doctor.  

Post Polio Litaff, Association A.C _APPLAC Mexico

Jan 7, 2017

How the U.S. Battled Polio



| June 22, 2011

Talk to anyone old enough to remember polio epidemics in the U.S., and you will see the fear in their eyes as they talk about those terrible and unsettling times. For decades, no one knew why thousands of children would suddenly be stricken—usually in midsummer—with many dying or left permanently paralyzed.
Today, most of us in the U.S. don’t even think about polio. But if you go to villages in India’s Bihar Province or the northern states of Nigeria, or the southern part of Afghanistan, you will see that very same fear in the eyes of parents who worry that their child might be next.
I’m a dogged advocate for polio eradication and have written about it in many other articles on the Gates Notes. We are very close to ridding the world of this terrible disease once and for all. It will take focus and commitment to get it done, but I am confident we can.
That’s why I’m a fan of David Oshinsky’s insightful book, Polio: An American Story. (I’m not alone here, as it received the Pulitzer Prize for history in 2006.) It is a fascinating account of the search for a vaccine to stop the polio epidemics that swept the U.S. in the first half of the 20th century, and the remarkable efforts that led to its successful eradication from the U.S. and most other countries. Reading Oshinsky’s book a few years ago broadened my appreciation of the challenges associated with global health issues and influenced the decision that Melinda and I made to make polio eradication the top priority of the foundation, as well as my own personal priority.
Oshinsky retraces the steps of researchers trying to puzzle together how to create an effective vaccine. He’s a gifted storyteller who makes complex scientific subjects easy to understand and also captures the mood of a country terrorized by an invisible and little-understood disease. He describes in meticulous but never-boring detail the people and politics associated with one of the most important medical breakthroughs in history. 
I found it interesting that the first recorded polio epidemic in the U.S. didn’t occur until 1894, in rural Vermont. By 1908, Karl Landsteiner, a Viennese researcher who later won a Nobel Prize for his discovery of the different human blood types, isolated the poliovirus by injecting monkeys with an emulsion from the spinal cord of a boy who had just died of polio. It was one of several important breakthroughs in the early 20th century battle against killer infectious diseases, including malaria, tuberculosis, diphtheria, typhoid, and syphilis.
In 1916, a polio outbreak in New York City quickly spread to adjacent states. Despite intensive sanitation measures of the kind that had helped control other epidemic diseases such as cholera and typhoid fever, 27,000 people died that summer. In New York City, 80 percent of those who died were under five. 
I knew that Franklin Delano Roosevelt contracted polio, but did not realize until reading Oshinsky’s book how significant an influence FDR had on the search for a vaccine. He was struck in the fall of 1921 while on a family vacation in Canada. The news stunned Americans, who at the time believed the disease mainly occurred among poor children in slums. FDR was 39 and from a wealthy New York family.
For thousands of polio victims, Roosevelt symbolized that life could go on for those disabled by the disease. He helped found the National Foundation for Infantile Paralysis, now known as the March of Dimes, which provided aid to victims and funded polio research. I was impressed that even as president, FDR would often respond personally to letters sent to him by other victims. Yet, Roosevelt also went to great lengths—abetted by a cooperative press corps—to hide the fact that he needed leg braces and handrails to stand, and a wheel chair to get around. I can’t imagine an American president being able to do that today, but FDR was greatly admired at a time when the nation was dealing with a world war and the Great Depression. Somehow, he persuaded the media that obscuring the extent of his disability was necessary to reassure the public that he was healthy and capable of holding public office.
I was also fascinated by the media savvy and marketing sophistication of the March of Dimes, which used famous Hollywood actors to get out its message and was the first philanthropic organization to introduce the idea that millions of Americans—not just the wealthy—could play an important role in helping solve big social problems. In 1938, Americans mailed nearly 2.7 million dimes directly to the White House in support of that year’s March of Dimes campaign.
We sometimes take for granted the speed of scientific breakthroughs today. Yet, Oshinky’s book reminded me of the painstaking efforts scientists often must undertake. Forty years after the polio virus was discovered, scientists still didn’t know what caused it. Theories ranged from rotten fruit to houseflies to contaminated milk. They didn’t know the mechanism by which it attacked the central nervous system. They didn’t know if there was just one type of polio, or many. And they didn’t know how to grow poliovirus safely, and in large enough quantities, to produce vaccines.
Also, researchers were divided over whether a “live-virus” vaccine or a “killed-virus” vaccine would be more effective. Most virologists believed a live-virus vaccine would stimulate higher antibody levels in the blood and create a lasting immunity. Advocates of the killed-virus vaccine believed it could be just as effective, and would eliminate any risk that someone receiving an immunization could contract polio.
Jonas Salk, a young researcher at the University of Pittsburgh, was one of those who believed a killed-virus vaccine would work. It had, after all, been effective against cholera, typhoid, and diphtheria. From 1949 to 1951, Salk and his team conducted extensive testing on thousands of monkeys, using samples from human polio victims and from monkeys who had contracted the virus after being injected with the human samples. Salk’s work confirmed what had been suspected but not yet proven—all of the identified and tested strains of poliovirus fit into one of three distinct types. 
About the same time, John Enders, a researcher at Harvard, figured out how to grow poliovirus that would be safe and could be mass produced. But scientists were still stymied over how the virus was transmitted and traveled through the body. Several prominent researchers had long believed that it entered through the nose and traveled directly to the central nervous system, bypassing the bloodstream. If that was the case, a vaccine that stimulated antibodies in the bloodstream would have done no good.
Two scientists working independently, Dorothy Horstmann at Yale and David Bodian at Johns Hopkins, upended the prevailing thinking with a breakthrough discovery. Previous researchers had been unable to detect poliovirus in the blood because they were not looking for it soon enough. Horstmann and Bodian discovered that the poliovirus is in the bloodstream for only a brief period of incubation before the body’s immune system creates antibodies that destroy it. 
Salk was relentless in his pursuit of a vaccine. He began human trials against the backdrop of the worst outbreak of polio on record in the U.S.—57,000 cases in 1952. By the spring of 1954, more than 1.3 million children had taken part in the largest vaccine trial in history. It took a year for the results to be reported, and when they were, church bells tolled, factory whistles rung, and then-President Dwight Eisenhower—a war hero—broke down in tears.
Although not 100 percent effective, the Salk vaccine was considered a huge success and a great relief for an edgy nation. In 1956, the number of polio cases in the U.S. dropped by 50 percent compared to the year before, and by another 50 percent the following year. 
Meanwhile, Sabin was about to undertake the largest medical experiment in world history—a live-virus vaccine administered to 10 million children in Russia. It, too, proved a success. Considered more effective and easier to administer than the Salk vaccine, Sabin’s oral vaccine won out by 1963. 
Oshinsky’s narrative ends at about this point, but the quest to completely eradicate polio is still ongoing. In 1987, the World Health Organization launched a global initiative to eradicate polio worldwide. Since that time, about 2.5 billion children have been vaccinated, and the number of polio cases has decreased by 99 percent. Last year there were fewer than 1,500 cases in just four countries—India, Nigeria, Pakistan, and Afghanistan. 
While this is fantastic progress, the last remaining cases pose a serious danger. If not completely eliminated, polio will spread back into countries where it has previously been eradicated, killing and paralyzing perhaps hundreds of thousands of children.
The foundation is deeply involved in this final push, and I am personally committed to doing what I can to rid the world of this dreaded disease once and for all.

Post Polio Litaff, Association A.C _APPLAC Mexico

Jan 6, 2017

15 Things Your Thyroid Can Affect





Maybe you've heard people say, "I'm tired because I have a thyroid problem." Or, "I see an endocrinologist because I have thyroid issues." But how much do you really know about your thyroid? 
The thyroid is a small gland that is butterfly shaped and located at the base of the neck, just below the Adam's apple. It's part of the endocrine system, which helps coordinate many of your body's activities. The gland makes hormones that regulate your metabolism. But when it's not working right, your body can be affected in various ways.
You don't produce enough hormone.
Hypothyroidism is also known as Hashimoto's disease or Hashimoto's thyroiditis. It is most common in middle-aged women, but Hashimoto's disease can happen at any age. Here, your immune system mistakenly attacks and slowly destroys the thyroid gland and its ability to make hormones. Treatment may include taking daily medication (which you'll likely need for the rest of your life since it restores adequate hormone levels) and monitoring the dosage to ensure you're taking the right amount. Your doctor may pass on medication and take a wait-and-see-approach. 
You produce too much hormone.
Hyperthyroidism is also known as Graves' disease. This autoimmune disorder happens when the body's immune system mistakenly attacks the thyroid gland. It's hereditary and is most common in women ages 20 to 30. Some treatments include radioactive iodine therapy (taking radioiodine orally), prescription antithyroid medications (which interfere with the thyroid's use of iodine to produce hormones), beta blockers (which block the effect of hormones on the body) or surgery to remove all or part of your thyroid. 
You have a goiter.A goiter is a noncancerous enlargement of the thyroid gland. It's often caused by a lack of iodine in your diet. It's most common in parts of the world that lack iodine-rich foods and are more common in women and after age 40. Treatments depends on your symptoms, the size of the goiter and the underlying cause. Small goiters that aren't noticeable or problematic typically don't need treatment. 
You have a thyroid nodule.
Thyroid nodules are growths that form in or on the thyroid gland. They can be caused by Hashimoto's disease and iodine deficiency, though the causes aren't always known. Most are benign, but a small percentage of cases can be cancerous. They're more common in women, and your risk increases as you get older. Symptoms may resemble hyperthyroidism if you have abnormally high levels of the hormone in your bloodstream. Symptoms will be like hypothyroidism if the nodules are linked to Hashimoto's disease. Treatment depends on the type of thyroid nodule. 
Your sleep changes.
You've always been a good sleeper but suddenly can't sleep through the night? You may have an overactive thyroid, which is pumping out some hormones excessively. And that can overstimulate the central nervous system and lead to insomnia. You may also need more sleep than usual, feel tired despite a good night's sleep or have the urge to nap. That means you may have an underactive thyroid. 
Your hair is thinning.
Thinning hair, especially on the eyebrows, is a common sign of thyroid disease. An overactive or underactive thyroid affects your hair's growth cycle. Usually, most of your hair grows while some of it rests. But when your thyroid is out of order, too much hair rests at once. And that makes your hair look thinner. 
You're sweating excessively when you shouldn't be.
You're not even at the gym but you're sweating excessively. That's a common sign of a hyperactive thyroid. Since your hormone levels are higher than normal, you feel warm. 
Your skin is dry in the summer.
You may have hypothyroidism. Why? A slower metabolism can decrease sweating. And that means your skin has less moisture, making it dry. 
You suddenly feel anxious.
If you start feeling unsettled or anxious and you've never had that issue, you may have a hyperactive thyroid. Because your thyroid hormone levels are high, you feel anxious, nervous, irritable, shaky or jittery. 
You have unexplained weight gain.
When you have a lack of hormones due to an underactive thyroid, your metabolism decreases and you burn fewer calories. So, your pants may feel snug, though your exercise or eating habits have remained the same. 
You aren't gaining weight.On the flip side, you may be losing weight without changing what you eat or how you exercise. Here, you may have an increased metabolism, due to an overactive thyroid. You're hungrier and eating more, but you aren't gaining weight.
You're forgetful.
Some people say they're in a brain fog when they have an underactive thyroid. Others say they have subtle memory loss, overall mental fatigue or difficulty concentrating. That can all be blamed on an underactive thyroid.
Your bowel movements change.
You may have an underactive thyroid if you're frequently constipated. The thyroid helps regulate your digestive track. But if you don't produce enough thyroid hormones, things can get backed up. And if you have an overactive thyroid, you'll have regular bowel movements but need to go more frequently since everything is sped up.
You have too much energy.
Your body processes speed up when you have too many hormones. You may feel like you've had too much coffee or feel like you're having heart palpitations, even when you're relaxed. 
Your periods have changed.
You may not be producing enough hormones if your periods have become longer, heavier or closer together. You may be producing too many hormones if they occur further apart or have gotten lighter.
Post Polio Litaff, Association A.C _APPLAC Mexico

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