Medicurio

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Fatty liver is also known as hepatic steatosis. It happens when fat builds up in the liver. Having small amounts of fat in your liver is normal, but too much can become a health problem.

Your liver is the second largest organ in your body. It helps process nutrients from food and drinks and filters harmful substances from your blood.

Too much fat in your liver can cause liver inflammation, which can damage your liver and create scarring. In severe cases, this scarring can lead to liver failure.

When fatty liver develops in someone who drinks a lot of alcohol, it’s known as alcoholic fatty liver disease (AFLD).

In someone who doesn’t drink a lot of alcohol, it’s known as non-alcoholic fatty liver disease (NAFLD). According to researchers in the World Journal of Gastroenterology, NAFLD affects up to 25 to 30 percent of people in the United States and Europe.

Fatty liver disease is becoming increasingly common in many parts of the world, affecting about 25% of people globally .

It is linked to obesity, type 2 diabetes and other disorders characterized by insulin resistance.

What’s more, if fatty liver isn’t addressed, it may progress to more serious liver disease and other health problems.

Unfortunately, it is difficult to predict whether fatty liver will progress to NASH, which greatly increases the risk of cirrhosis (severe scarring that impairs liver function) and liver cancer

NAFLD is also linked to an increased risk of other diseases, including heart disease, diabetes and kidney disease.

symptom-

There are several signs and symptoms of fatty liver, although not all of these may be present.

In fact, you may not even realize you have fatty liver.

• Fatigue and weakness
• Slight pain or fullness in the right or center abdominal area
• Elevated levels of liver enzymes, including AST and ALT
• Elevated insulin levels
• Elevated triglyceride levels

If fatty liver progresses to NASH, the following symptoms may develop:

• Loss of appetite
• Nausea and vomiting

• Moderate to severe abdominal pain
• Yellowing of eyes and skin

It’s important to see your doctor regularly for standard exams and blood tests that can diagnose fatty liver at the early, reversible stage.

In many cases, fatty liver causes no noticeable symptoms. But you may feel tired or experience discomfort or pain in the upper right side of your abdomen.

Some people with fatty liver disease develop complications, including liver scarring. Liver scarring is known as liver fibrosis. If you develop severe liver fibrosis, it’s known as cirrhosis.

Cirrhosis may cause symptoms such as:

• loss of appetite
• weight loss
• weakness
• fatigue
• nosebleeds

causes

there are many factor contribute to developing fatty liver:

• Obesity: Obesity involves low-grade inflammation that may promote liver fat storage. It’s estimated that 30–90% of obese adults have NAFLD, and it’s increasing in children due to the childhood obesity epidemic .
• Excess belly fat: Normal-weight people may develop fatty liver if they are “viscerally obese,” meaning they carry too much fat around the waist.
• Insulin resistance: Insulin resistance and high insulin levels have been shown to increase liver fat storage in people with type 2 diabetes and metabolic syndrome.
• high intake of refined carbs: Frequent intake of refined carbs promotes liver fat storage, especially when high amounts are consumed by overweight or insulin-resistant individuals.
• Sugary beverage consumption: Sugar-sweetened beverages like soda and energy drinks are high in fructose, which has been shown to drive liver fat accumulation in children and adults .
• Impaired gut health: Recent research suggests that having an imbalance in gut bacteria, problems with gut barrier function (“leaky gut”) or other gut health issues may contribute to NAFLD development.

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Less common causes include:

• pregnancy
• rapid weight loss
• some types of infections, such as hepatitis C
• side effects from some types of medications, such as methotrexate (Trexall), tamoxifen (Nolvadex), amiodorone (Pacerone), and valproic acid (Depakote)
• exposure to certain toxins

Certain genes may also raise your risk of developing fatty liver.

Diagnosing of fatty liver

To diagnose fatty liver, your doctor will take your medical history, conduct a physical exam, and order one or more tests.

Medical history

If your doctor suspects that you might have fatty liver, they will likely ask you questions about:

• your family medical history, including any history of liver disease
• your alcohol consumption and other lifestyle habits
• any medical conditions that you might have
• any medications that you might take
• recent changes in your health

If you’ve been experiencing fatigue, loss of appetite, or other unexplained symptoms, let your doctor know.

Physical exam

To check for liver inflammation, your doctor may palpate or press on your abdomen. If your liver is enlarged, they might be able to feel it.

However, it’s possible for your liver to be inflamed without being enlarged. Your doctor might not be able to tell if your liver is inflamed by touch.

Blood tests-

In many cases, fatty liver disease is diagnosed after blood tests show elevated liver enzymes. For example, your doctor may order the alanine aminotransferase test (ALT) and aspartate aminotransferase test (AST) to check your liver enzymes.

These tests might be recommended if you’ve developed signs or symptoms of liver disease, or they might be ordered as part of routine blood work.

Elevated liver enzymes are a sign of liver inflammation. Fatty liver disease is one potential cause of liver inflammation, but it’s not the only one.

If you test positive for elevated liver enzymes, your doctor will likely order additional tests to identify the cause of the inflammation.

If you test positive for elevated liver enzymes, your doctor will likely order additional tests to identify the cause of the inflammation.

Imaging studies

Your doctor may use one or more of the following imaging tests to check for excess fat or other problems with your liver:

• ultrasound exam
• CT scan
• MRI scan

They might also order a test known as vibration-controlled transient elastography (VCTE, FibroScan). This test uses low-frequency sound waves to measure liver stiffness. It can help check for scarring.

Liver biopsy

A liver biopsy is considered the best way to determine the severity of liver disease.

During a liver biopsy, a doctor will insert a needle into your liver and remove a piece of tissue for examination. They will give you a local anesthetic to lessen the pain.

This test can help determine if you have fatty liver disease, as well as liver scarring.

Treatment for fatty liver

Currently, no medications have been approved to treat fatty liver disease. More research is needed to develop and test medications to treat this condition.

In many cases, lifestyle changes can help reverse fatty liver disease. For example, your doctor might advise you to:

• limit or avoid alcohol
• take steps to lose weight
• make changes to your diet

If you’ve developed complications, your doctor might recommend additional treatments. To treat cirrhosis, for example, they might prescribe:

• lifestyle changes
• medications
• surgery

Cirrhosis can lead to liver failure. If you develop liver failure, you might need a liver transplant.

Home remedies

Lifestyle changes are the first-line treatment for fatty liver disease. Depending on your current condition and lifestyle habits, it might help to:

• lose weight
• reduce your alcohol intake
• eat a nutrient-rich diet that’s low in excess calories, saturated fat, and trans fats
• get at least 30 minutes of exercise most days of the week

According to the Mayo Clinic, some evidence suggests that vitamin E supplements might help prevent or treat liver damage caused by fatty liver disease. However, more research is needed. There are some health risks associated with consuming too much vitamin E.

Always talk to your doctor before you try a new supplement or natural remedy. Some supplements or natural remedies might put stress on your liver or interact with medications you’re taking.

What are some lifestyle changes that can help with fatty liver disease?

If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
• Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
• Get regular exercise, which can help you lose weight and reduce fat in the liver
• Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver.

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hyperthyroidism is a condition of the thyroid. The thyroid is a small, butterfly-shaped gland located at the front of your neck. It produces tetraiodothyronine (T4) and triiodothyronine (T3), which are two primary hormones that control how your cells use energy. Your thyroid gland regulates your metabolism through the release of these hormones.

Hyperthyroidism occurs when the thyroid makes too much T4, T3, or both. Diagnosis of overactive thyroid and treatment of the underlying cause can relieve symptoms and prevent complications.

causes-

A variety of conditions can cause hyperthyroidism. Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism. It causes antibodies to stimulate the thyroid to secrete too much hormone. Graves’ disease occurs more often in women than in men. It tends to run in families, which suggests a genetic link. You should tell your doctor if your relatives have had the condition.

Other causes of hyperthyroidism include:

• excess iodine, a key ingredient in T4 and T3
• thyroiditis, or inflammation of the thyroid, which causes T4 and T3 to leak out of the gland
• tumors of the ovaries or testes
• benign tumors of the thyroid or pituitary gland
• large amounts of tetraiodothyronine taken through dietary supplements or medication

symptoms-

High amounts of T4, T3, or both can cause an excessively high metabolic rate. This is called a hypermetabolic state. When in a hypermetabolic state, you may experience a rapid heart rate, elevated blood pressure, and hand tremors. You may also sweat a lot and develop a low tolerance for heat. Hyperthyroidism can cause more frequent bowel movements, weight loss, and, in women, irregular menstrual cycles.

Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided. Your eyes may also appear quite prominent, which is a sign of exophthalmos, a condition that’s related to Graves’ disease.

Other symptoms of hyperthyroidism include:

• increased appetite
• nervousness
• restlessness
• inability to concentrate
• weakness
• irregular heartbeat
• difficulty sleeping
• fine, brittle hair
• itching
• hair loss
• nausea and vomiting
• breast development in men

The following symptoms require immediate medical attention:

• dizziness
• shortness of breath
• loss of consciousness
• fast, irregular heart rate

Hyperthyroidism can also cause atrial fibrillation, a dangerous arrhythmia that can lead to strokes, as well as congestive heart failure.

How do doctors diagnose hyperthyroidism?

Your doctor will take a medical history and do a physical exam, but also will need to do some tests to confirm a diagnosis of hyperthyroidism. Many symptoms of hyperthyroidism are the same as those of other diseases, so doctors usually can’t diagnose hyperthyroidism based on symptoms alone.

Because hypothyroidism can cause fertility problems, women who have trouble getting pregnant often get tested for thyroid problems.

Your doctor may use several blood tests to confirm a diagnosis of hyperthyroidism and find its cause. Imaging tests, such as a thyroid scan, can also help diagnose and find the cause of hyperthyroidism.

Your first step in diagnosis is to get a complete medical history and physical exam. This can reveal these common signs of hyperthyroidism:

• weight loss
• rapid pulse
• elevated blood pressure
• protruding eyes
• enlarged thyroid gland

Other tests may be performed to further evaluate your diagnosis. These include:

Cholesterol test

Your doctor may need to check your cholesterol levels. Low cholesterol can be a sign of an elevated metabolic rate, in which your body is burning through cholesterol quickly.

T4, free T4, T3

These tests measure how much thyroid hormone (T4 and T3) is in your blood.

Thyroid stimulating hormone level test

Thyroid stimulating hormone (TSH) is a pituitary gland hormone that stimulates the thyroid gland to produce hormones. When thyroid hormone levels are normal or high, your TSH should be lower. An abnormally low TSH can be the first sign of hyperthyroidism.

Triglyceride test

Your triglyceride level may also be tested. Similar to low cholesterol, low triglycerides can be a sign of an elevated metabolic rate.

Thyroid scan and uptake

This allows your doctor to see if your thyroid is overactive. In particular, it can reveal whether the entire thyroid or just a single area of the gland is causing the overactivity.

Ultrasound

Ultrasounds can measure the size of the entire thyroid gland, as well as any masses within it. Doctors can also use ultrasounds to determine if a mass is solid or cystic.

CT or MRI scans

A CT or MRI can show if a pituitary tumor is present that’s causing the condition.

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What are my hyperthyroidism treatment options?

You may receive medicines, radioiodine therapy, or thyroid surgery to treat your hyperthyroidism. The aim of treatment is to bring thyroid hormone levels back to normal to prevent long-term health problems and to relieve uncomfortable symptoms. No single treatment works for everyone.

Treatment depends on the cause of your hyperthyroidism and how severe it is. When recommending a treatment, your doctor will consider your age, possible allergies to or side effects of the medicines, other conditions such as pregnancy or heart disease, and whether you have access to an experienced thyroid surgeon.

Medicines

Beta blockers. Beta blockers do not stop thyroid hormone production, but can reduce symptoms until other treatments take effect. Beta blockers act quickly to relieve many of the symptoms of hyperthyroidism, such as tremors, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers.

Antithyroid medicines. Antithyroid therapy is the simplest way to treat hyperthyroidism. Antithyroid medicines cause the thyroid to make less thyroid hormone. These medicines usually don’t provide a permanent cure. Health care providers most often use the antithyroid medicine methimazole. Health care providers more often treat pregnant women with propylthiouracil during the first 3 months of pregnancy, however, because methimazole can harm the fetus, although this happens rarely.

Once treatment with antithyroid medicine begins, your thyroid hormone levels may not move into the normal range for several weeks or months. The total average treatment time is about 1 to 2 years, but treatment can continue for many years. Antithyroid medicines are not used to treat hyperthyroidism caused by thyroiditis.

Antithyroid medicines can cause side effects in some people, including

• allergic reactions such as rashes and itching
• a decrease in the number of white blood cells in your body, which can lower resistance to infection
• liver failure, in rare cases

Call your doctor right away if you have any of the following symptoms:

• fatigue
• weakness
• dull pain in your abdomen
• loss of appetite
• skin rash or itching
• easy bruising
• yellowing of your skin or whites of your eyes, called jaundice
• constant sore throat
• fever

Doctors usually treat pregnant and breastfeeding women with antithyroid medicine, since this treatment may be safer for the baby than other treatments.

Radioiodine therapy

Radioactive iodine is a common and effective treatment for hyperthyroidism. In radioiodine therapy, you take radioactive iodine-131 by mouth as a capsule or liquid. The radioactive iodine slowly destroys the cells of the thyroid gland that produce thyroid hormone. Radioactive iodine does not affect other body tissues.

You may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range. In the meantime, treatment with beta blockers can control your symptoms.

Almost everyone who has radioactive iodine treatment later develops hypothyroidism because the thyroid hormone-producing cells have been destroyed. However, hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism. People with hypothyroidism can completely control the condition with daily thyroid hormone medicine.

Doctors don’t use radioiodine therapy in pregnant women or in women who are breastfeeding. Radioactive iodine can harm the fetus’ thyroid and can be passed from mother to child in breast milk.

Thyroid surgery

The least-used treatment for hyperthyroidism is surgery to remove part or most of the thyroid gland. Sometimes doctors use surgery to treat people with large goiters or pregnant women who cannot take antithyroid medicines.

Before surgery, your doctor may prescribe antithyroid medicines to bring your thyroid hormone levels into the normal range. This treatment prevents a condition called thyroid storm—a sudden, severe worsening of symptoms—that can occur when people with hyperthyroidism have general anesthesia.

When part of your thyroid is removed, your thyroid hormone levels may return to normal. You may still develop hypothyroidism after surgery and need to take thyroid hormone medicine. If your whole thyroid is removed, you will need to take thyroid hormone medicine for life. After surgery, your doctor will continue to check your thyroid hormone levels.

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Physical Therapy Management

Preferred Practice Patterns:

• Impaired muscle performance
• Impaired joint mobility, motor function, muscle performance, and ROM associated with connective tissue dysfunction
• Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation
• Impaired aerobic capacity/endurance associated with deconditioning 

When Is a Medical Referral Required?

• Anytime a therapist discovers unusual swelling or enlargement (with or without pain), tenderness, hoarseness, or dysphagia they should refer out.
• If your patient experiences fever, rash, arthralgia, or other side effects of antithyroid drugs, notify their physician because it may be possible to use another form of treatment.

What Should I Monitor During Treatment Session?

• Vital Signs: This is especially important if the patient is an older adult, has CAD or previous hx of heart disease, or presents with signs of dyspnea, fatigue, tachycardia, and/or arrhythmia.
• Watch for signs of hypoparathyroidism such as muscular twitching, tetany, numbness, and tingling around mouth, fingertips, or toes if patient is post thyroidectomy. Hypoparathryoidism may result 1-7 days after thyroidectomy if there are complications during the surgery resulting in unintentional removal of part of the parathyroid glands.

Safety Precautions for Therapist

• When working with patients who have been given RAI, be aware their saliva is radioactive for 24 hours following their treatment. When working with these patients it is important to take the necessary precautions if the patient is coughing or expectorating.

Hyperthyroidism and Exercise

• Some patients with Graves’ disease suffer from heat intolerance, making exercising in a hot pool a contraindication to therapy. This patient would still be able to participate in aquatic therapy in a warm pool; given the patient’s body temperature is being monitored. Typically heat intolerance is associated with thyroid storm, and will normally not occur in clients attending therapy in outpatient settings.
• Hyperthyroidism is associated with exercise intolerance and reduced exercise capacity.
• Many patients with hyperthyroidism suffer from cardiopulmonary complications often leading to atrial fibriliation, CHF, and increased risk of a MI.
• 70% of people with hyperthyroidism develop proximal muscle weakness as a result of treatment, most often affecting the pelvis and thigh muscles
• Chronic periarthritis and calcific tendinitis are also associated with hyperthyroidism. They both tend to occur in the shoulder, causing limitations in a person’s ROM, which may progress and lead to adhesive capsulitis. Therapeutic interventions using ultrasound, joint mobilizations, stretching, and strengthening may be performed once the thyroid gland is regulated. Research suggest a 6 week treatment period using pulsed US for 15 minutes at 2.5 W/cm2 at a frequency of .89 MHz is associated with short term improvement in pain levels and quality of life in adults with calcific tendonitis.
• Graves’ disease is associated with a low bone mineral density (BMD) and has also been shown to be a risk factor for hip fractures

Differential Diagnosis

• Hyperparathyroidism
• Myasthenia gravis
• Psychological disorders (anxiety, panic attacks, or mood disorders)
• Thyroid Cancer
• Atrial Fibrilation
• Congestive Heart Failure.

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The thyroid is a butterfly-shaped gland that sits low on the front of the neck. Your thyroid lies below your Adam’s apple, along the front of the windpipe. The thyroid has two side lobes, connected by a bridge (isthmus) in the middle. When the thyroid is its normal size, you can’t feel it.

Brownish-red in color, the thyroid is rich with blood vessels. Nerves important for voice quality also pass through the thyroid.

The thyroid secretes several hormones, collectively called thyroid hormones. The main hormone is thyroxine, also called T4. Thyroid hormones act throughout the body, influencing metabolism, growth and development, and body temperature. During infancy and childhood, adequate thyroid hormone is crucial for brain development.

Through the hormones it produces, the thyroid gland influences almost all of the metabolic processes in your body. Thyroid disorders can range from a small, harmless goiter (enlarged gland) that needs no treatment to life-threatening cancer. The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism.Although the effects can be unpleasant or uncomfortable, most thyroid problems can be managed well if properly diagnosed and treated.

causes-

What Causes Thyroid Problems?

All types of hyperthyroidism are due to an overproduction of thyroid hormones, but the condition can occur in several ways:

• Graves’ disease: The production of too much thyroid hormone.
• Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body’s chemical balance; some goiters may contain several of these nodules.
• Subacute thyroiditis: Inflammation of the thyroid that causes the gland to “leak” excess hormones, resulting in temporary hyperthyroidism that generally lasts a few weeks but may persist for months.
• Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.

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Hypothyroidism , by contrast, stems from an underproduction of thyroid hormones. Since your body’s energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy levels. Causes of hypothyroidism include:

• Hashimoto’s thyroiditis : In this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones.
• Removal of the thyroid gland: The thyroid may have been surgically removed or chemically destroyed.
• Exposure to excessive amounts of iodide: Cold and sinus medicines, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose you to too much iodine.You may be at greater risk for developing hypothyroidism if you have had thyroid problems in the past.
• Lithium: This drug has also been implicated as a cause of hypothyroidism.

Untreated for long periods of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone treatment.

Hypothyroidism poses a special danger to newborns and infants. A lack of thyroid hormones in the system at an early age can lead to the development of cretinism (intellectual disability) and dwarfism (stunted growth). Most infants now have their thyroid levels checked routinely soon after birth. If they are hypothyroid, treatment begins immediately. In infants, as in adults, hypothyroidism can be due to these causes:

• A pituitary disorder
• A defective thyroid
• Lack of the gland entirely

A hypothyroid infant is unusually inactive and quiet, has a poor appetite, and sleeps for excessively long periods of time.

Cancer of the thyroid gland is quite rare and occurs in about 5% of thyroid nodules. You might have one or more thyroid nodules for several years before they are determined to be cancerous. People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy for acne, tend to have a higher-than-normal risk of developing thyroid cancer.

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Poliomyelitis (polio) is a highly infectious viral disease that largely affects children under 5 years of age. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

In 1988, the World Health Assembly adopted a resolution for the worldwide eradication of polio, marking the launch of the Global Polio Eradication Initiative, spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and later joined by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.  Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then to 175reported cases in 2019. 

Of the 3 strains of wild poliovirus (type 1, type 2 and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.  Both strains have officially been certified as globally eradicated.  As at 2020, wild poliovirus type 1 affects two countries:  Pakistan and Afghanistan.

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically challenging place, and polio-free certification of the entire WHO Southeast Asia Region in March 2014.

Symptoms

Although polio can cause paralysis and death, the majority of people who are infected with the virus don’t get sick and aren’t aware they’ve been infected.

Nonparalytic polio

Some people who develop symptoms from the poliovirus contract a type of polio that doesn’t lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.

Signs and symptoms, which can last up to 10 days, include:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Back pain or stiffness
• Neck pain or stiffness
• Pain or stiffness in the arms or legs
• Muscle weakness or tenderness

Paralytic polio

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including:

• Loss of reflexes
• Severe muscle aches or weakness
• Loose and floppy limbs (flaccid paralysis)

Post-polio syndrome

Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people years after having polio. Common signs and symptoms include:

• Progressive muscle or joint weakness and pain
• Fatigue
• Muscle wasting (atrophy)
• Breathing or swallowing problems
• Sleep-related breathing disorders, such as sleep apnea
• Decreased tolerance of cold temperatures

Signs and symptoms, which can last up to 10 days, include:

• Fever
• Sore throat
• Headache
• Vomiting
• Fatigue
• Back pain or stiffness
• Neck pain or stiffness
• Pain or stiffness in the arms or legs
• Muscle weakness or tenderness

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Paralytic polio

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including:

• Loss of reflexes
• Severe muscle aches or weakness
• Loose and floppy limbs (flaccid paralysis)

Causes

Polio virus can be transmitted through direct contact with someone infected with the virus or, less commonly, through contaminated food and water. People carrying the poliovirus can spread the virus for weeks in their feces. People who have the virus but don’t have symptoms can pass the virus to others.

Risk factors

Polio mainly affects children younger than 5. However, anyone who hasn’t been vaccinated is at risk of developing the disease.

Complications

Paralytic polio can lead to temporary or permanent muscle paralysis, disability, bone deformities and death.

Prevention

The most effective way to prevent polio is vaccination.

Polio vaccine

Most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages:

• Two months
• Four months
• Between 6 and 18 months
• Between ages 4 and 6 when children are just entering school

IPV is safe for people with weakened immune systems, although it’s not certain just how protective the vaccine is in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.

Allergic reaction to the vaccine

IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it shouldn’t be given to anyone who’s reacted to these medications.

Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot. Watch for:

• Difficulty breathing
• Weakness
• Hoarseness or wheezing
• Rapid heart rate
• Hives
• Dizziness

If you or your child has an allergic reaction after any shot, get medical help immediately.

Adult vaccination

In the U.S., adults aren’t routinely vaccinated against polio because most are already immune, and the chances of contracting polio are minimal. However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should receive a single booster shot of IPV.

A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who have polio.

If you’re unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots — two doses of IPV at four- to eight-week intervals and a third dose six to 12 months after the second dose.

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Physical Therapy Management

There is no cure for PPS and to date there are no pharmaceutical treatments that have been identified at being effective in stopping or reversing the deterioration or symptoms. Emphasis is currently on managing symptoms and the role of the physiotherapist is important to help people with PPS find suitable aids and interventions to lead independent lives.

Physiotherapy is safe and effective when carefully prescribed and monitored by experienced health professionals.Cardiopulmonary endurance training is usually more effective than strengthening exercises. An intense strengthening programme using resistance or weights may be counterproductive as they can fatigue and already weaken compromised muscles. All exercise should be carefully monitored and any signs of further weakness,increased fatigue or long periods of recovery time should be an indicator to either revise the programme or stop exercise completely until recovery is evident.

Plan for Rehabilitation

Strengthening programs performed as described show a 60% increase on isokinetic strength, improved cardiorespiratory status, no decline in strength in 6-12 months, and 5% increase in isometric strength.

In one randomized controlled study, progressive resistance training program consisted of 3 sets of 8 isometric contractions, 3 times weekly for 12 weeks. Postpolio patients showed a significant improvement in their strength. The training did not adversely affect motor unit survival, and the improvement was largely attributable to an increase in voluntary motor drive.

Use of Modalities

Electrical stimulation has been used to strengthen weakened muscles or to reeducate muscles weakened through disuse, as well as to decrease pain

For myofascial pain, consider heat, electrical stimulation, trigger point injections, stretching exercises, biofeedback, muscle relaxation exercises, or static magnetic fields for trigger points. Exercise therapy and training programs in PPS patients should be carefully customized and planned by physiotherapists to avoid both overuse and disuse, and the level of physical activity should be modified to decrease pain.

Prevention

Polio survivors often ask if there is a way to prevent post-polio syndrome. Presently, no intervention has been found to stop the deterioration of surviving neurons. But physicians recommend that polio survivors get the proper amount of sleep, maintain a well-balanced diet, avoid unhealthy habits such as smoking and overeating, and follow an exercise program as discussed above. Proper lifestyle changes, the use of assistive devices, and taking certain anti-inflammatory medications may help some of the symptoms of post-polio syndrome.

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A migraine can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.A migraine is a powerful headache that often happens with nausea, vomiting, and sensitivity to light. Migraines can last from 4 hours to 3 days, and sometimes longer.

For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes.

What Can Trigger a Migraine Headache?

Some common migraine triggers include:

1. Stress. When you’re stressed, your brain releases chemicals that can cause the blood vessel changes that can lead to a migraine.
2. Foods. Some foods and drinks, such as aged cheese, alcohol, and food additives like nitrates (in pepperoni, hot dogs, lunchmeats) and monosodium glutamate (MSG) may be responsible for up to 30% of migraines.
3. Caffeine. Getting too much or withdrawing from it can cause headaches when the level in your body abruptly drops. Blood vessels seem to get used to caffeine, and when you don’t have any, you may get a headache. Caffeine itself can be a treatment for acute migraine attacks.

4.Changes in weather. Storm fronts, changes in barometric pressure, strong winds, or changes in altitude can all trigger a migraine.

5.Having your period

6.Feeling very tired

7.Skipping meals

7.Changes to your sleep

Causes

A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant.

Migraine attacks may be triggered by any of the following:

• Caffeine withdrawal
• Changes in hormone levels during a woman’s menstrual cycle or with the use of birth control pills
• Changes in sleep patterns, such as not getting enough sleep
• Drinking alcohol
• Exercise or other physical stress
• Loud noises or bright lights
• Missed meals
• Odors or perfumes
• Smoking or exposure to smoke
• Stress and anxiety

fast facts on migraines:

• Some people who experience migraines can clearly identify triggers or factors that cause the headaches, such as allergies, light, and stress.
• Some people get a warning symptom before the start of the migraine headache.
• Many people with migraine can prevent a full-blown attack by recognizing and acting upon the warning signs.
• Over-the-counter (OTC) medications can eliminate or reduce pain, and specific medications can help some people with migraine.
• People who have severe attacks can take preventive medicines.

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Symptoms

Symptoms of migraine can start a while before the headache, immediately before the headache, during the headache, and after the headache. Although not all migraines are the same, typical symptoms include:

1. moderate to severe pain, usually confined to one side of the head but capable of occurring on either side of the head
2. severe, throbbing, or pulsing pain
3. increasing pain during physical activity or when straining
4. inability to perform regular activities due to pain
5. feeling sick and physically vomiting
6. increased sensitivity to light and sound, relieved by lying quietly in a darkened room

Some people experience other symptoms such as sweating, temperature changes, stomach ache, and diarrhea.

Risk factors

Several factors make you more prone to having migraines, including:

1. Family history. If you have a family member with migraines, then you have a good chance of developing them too.
2. Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
3. Sex. Women are three times more likely to have migraines.
4. Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause.

BasicsWhat Is Migraine?Migraine StatisticsMigraine Types

• Abdominal Migraine
• Acephalgic Migraine
• Basilar-Type Migraine
• Cyclic Migraine Syndrome
• Familial Hemiplegic Migraine
• Gastric Stasis Migraine
• Hemiplegic Migraine
• Infantile Colic
• Hormonal Migraine
• Migraine Aura Without Pain
• Migraine with Aura
• Migraine with Brainstem Aura
• Migraine with Typical Aura
• Migraine Without Aura
• Ocular Migraine
• Retinal Migraine
• Seasonal Migraine
• Silent Migraine
• Sinus Migraine
• Stress Migraine
• Tension Migraine
• Vestibular Migraine

Migraine DiagnosisCauses & Triggers

• Migraine Phases
• Chronic Migraine
• Exertion Headache
• Hangover Headache
• Hypertension Headache
• Other Headache Types

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Types

Migraine is a word used to describe a wide range of related disorders. They are the most common cause of daily head pain, afflicting more than 87 percent of people who complain of daily head pain. The World Health Organization ranks migraine as the 19^th most common cause of disability worldwide.

There are several different types of migraine, which are diagnosed based on the symptoms experienced. Some are triggered by changing seasons or hormonal changes in women. Others only cause symptoms in the stomach.

In the 2018 In America survey, 4,356 respondents shared their migraine diagnosis. Chronic migraine was the most prevalent diagnosis with over 7 in 10 reporting being diagnosed with chronic migraine by a healthcare professional.

The International Headache Society has developed one of the most well-known classification systems for migraine and headache, called the International Classification of Headache Disorders (ICHD). The ICHD-III defines migraine as one of the main types of primary headaches, along with other headaches types such as tension headaches and trigeminal autonomic cephalagias.

Specific migraine types recognized by the ICHD-III include:

• Migraine without aura
• Migraine with aura
  • Migraine with typical aura
  • Migraine with brainstem aura
  • Hemiplegic migraine
  • Retinal migraine
• Chronic migraine
• Complications of migraine
  1. Status migrainosus
  2. Persistent aura without infarction
  3. Migrainosus infarction
  4. Migraine aura-triggered seizure
• Probable migraine
  • Probable migraine without aura
  • Probable migraine with aura
• Episodic syndromes that may be associated with migraine
• Although the ICHD-III does not recognize the following terms as individual migraine types, some physicians may still use them in practice:
  1. Stress Migraine
  2. Silent, or Acephalgic, Migraine
  3. Sinus Migraine
  4. Ocular Migraine
  5. Seasonal Migraine
  6. Cyclic Migraine Syndrome
  7. Gastric Stasis Migraine
  8. Tension MigraineDifferent types of migraine are diagnosed based on symptoms, therefore all people with migraine are encouraged to make note of each attack experienced. A good place to keep track of migraine and migraine symptoms is in your migraine journal. This is where you write down what you were doing before the symptoms surfaced, how long the symptoms last and how intense the symptoms were. A headache doctor or specialist will use your journal to determine what type of migraine you have, what your triggers are and how to best go treat them.
     Poll What type of migraine do you have? Migraine with aura Migraine without aura Abdominal Migraine Basilar-Type Migraine Hemiplegic Migraine Retinal migrain.

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Treatment

Migraine treatment is aimed at stopping symptoms and preventing future attacks.

Many medications have been designed to treat migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
• Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.

Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.

Medications for relief

Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:

• Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract. Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
• Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.
• Dihydroergotamines (D.H.E. 45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea. People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydrogergotamines.
• Lasmiditan (Reyvow). This new oral tablet is approved for the treatment of migraine with or without aura. In drug trials, lasmiditan significantly improved pain as well as nausea and sensitivity to light and sound. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours. Lasmiditan also shouldn’t be taken with alcohol or other drugs that depress the central nervous system.
• Ubrogepant (Ubrelvy). This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without aura in adults. It’s the first drug of this type approved for migraine treatment. In drug trials, ubrogepant was more effective than placebo in relieving pain and other migraine symptoms such as nausea and sensitivity to light and sound two hours after taking it. Common side effects include dry mouth, nausea and excessive sleepiness. Ubrogepant should not be taken with strong CYP3A4 inhibitor drugs.
• Opioid medications. People who have migraines who can’t take other migraine medications, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
• Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.

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Preventive medications

Medications can help prevent frequent migraines. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don’t respond well to treatment.

Preventive medication is aimed at reducing how often you get a migraine how severe the attacks are and how long they last. Options include:

• Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, Innopran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Tarka, Verelan) can be helpful in preventing migraines with aura.
• Antidepressants. A tricyclic antidepressant (amitriptyline) can prevent migraines. Because of the side effects of amitriptyline, such as sleepiness and weight gain, other antidepressants might be prescribed instead.
• Anti-seizure drugs. Valproate and topiramate (Topamax) might help you have less frequent migraines, but can cause side effects such as dizziness, weight changes, nausea and more.
• Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.
• Calcitonin gene-related peptide (CGRP) monoclonal antibodies. Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality) are newer drugs approved by the Food and Drug Administration to treat migraines. They’re given monthly by injection.

Lifestyle and home remedies

When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead or at the back of your neck.

Other practices that might soothe migraine with aura pain include:

• Try relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.
• Develop a sleeping and eating routine. Don’t sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day.
• Drink plenty of fluids. Staying hydrated, particularly with water, might help.
• Keep a headache diary. Continue recording in your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.
• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose aerobic activity you enjoy, such as walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.

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Alternative medicine

Nontraditional therapies might help with chronic migraine pain.

• Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points.
• Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.
• Cognitive behavioral therapy. Cognitive behavioral therapy may benefit some people with migraines. This type of psychotherapy teaches you how behaviors and thoughts affect how you perceive pain.
• Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur might prevent migraines or reduce their severity, though study results are mixed. Butterbur isn’t recommended because of safety concerns.

A high dose of riboflavin (vitamin B-2) may also prevent migraines or reduce the frequency of headaches. Coenzyme Q10 supplements might decrease the frequency of migraines, but larger studies are needed.

Due to low magnesium levels in some people with migraines, magnesium supplements have been used to treat migraines, but with mixed results.

Ask your doctor if these treatments are right for you. Don’t use feverfew, riboflavin or butterbur if you’re pregnant or without first talking with your doctor.

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Frozen shoulder is the common name for adhesive capsulitis, which is a shoulder condition that limits your range of motion. When the tissues in your shoulder joint become thicker and tighter, scar tissue develops over time. As a result, your shoulder joint doesn’t have enough space to rotate properly. Common symptoms include swelling, pain, and stiffness. You’re more likely to have the condition if you’re between the ages of 40 and 60.

Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder.

Anatomy

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint.

To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.

In frozen shoulder, the shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

The hallmark signs of this condition are severe pain and being unable to move your shoulder — either on your own or with the help of someone else. It develops in three stages:

Stage 1: Freezing

In the “freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

Stage 2: Frozen

Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.

Stage 3: Thawing

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

causes-

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes. Frozen shoulder occurs much more often in people with diabetes. The reason for this is not known. In addition, diabetic patients with frozen shoulder tend to have a greater degree of stiffness that continues for a longer time before “thawing.”

Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Symptoms

Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.

treatment-

You can leave a frozen shoulder untreated, but the pain and stiffness can remain for up to three years. A combination of the following can speed up your recovery:

1. physical therapy
2. medication
3. surgery
4. home care

Physical Therapy

Physical therapy is the most common treatment for a frozen shoulder. The goal is to stretch your shoulder joint and regain the lost motion. It can take anywhere from a few weeks to nine months to see progress. A home exercise program of gentle range of motion exercises is important. If you don’t see progress after six months of intense, daily exercises, speak to your doctor about other options.

Medications

To treat the pain and reduce your joint inflammation, your doctor may recommend an anti- inflammatory medication like aspirin, ibuprofen, or naproxen sodium. A steroid injection you’re your shoulder joint may also help.

Home Care

Placing an ice pack on your shoulder for 15 minutes at a time several times per day can help to decrease pain. If you’re working with a physical therapist, the exercises can be done at home. Your physical therapist will provide instructions on the types of exercises you must do, how often to do them, and when to push yourself harder. Most people with a frozen shoulder can improve their condition without surgery.

Surgery

If physical therapy doesn’t improve your condition, surgery is an option. From a surgical standpoint, your options are to manipulate the shoulder and put it through a full range of motion under a general anesthetic to help break up any adhesions. Another option is arthroscopic surgery. This type of surgery involves making a small cut in your shoulder and using a camera called an “arthroscope” to remove scar tissue or release it. This allows the shoulder to recover its lost motion. If your frozen shoulder is the result of an injury, surgery is usually more successful if it’s performed within a few weeks of the injury.

Surgery is usually done on an outpatient basis. Your stitches will most likely be removed after 10 days. Postoperative physical therapy is usually required as well. Many patients have their full range of motion back within three months.

Surgery carries risks, so talk with your doctor before deciding on any procedure. Some people still have pain or stiffness afterward or can’t handle the pain of physical therapy.

Prevention

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about exercises you can do to maintain the range of motion in your shoulder joint.

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Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. It affects any joint containing hyaline cartilage and the knees are the most commonly affected joints. Prevalence of OA increases with age and aging is associated with decreasing physiological functions, thus leading to major health problems. As a larger proportion of the elderly population in developed countries increasingly lives to an extreme old age, OA will be more prevalent and will be an important cause of disability in the future.

Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.

Osteoarthritis symptoms can usually be managed, although the damage to joints can’t be reversed. Staying active, maintaining a healthy weight and some treatments might slow progression of the disease and help improve pain and joint function.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

1. Pain. Affected joints might hurt during or after movement.
2. Stiffness. Joint stiffness might be most noticeable upon awakening or after being inactive.
3. Tenderness. Your joint might feel tender when you apply light pressure to or near it.
4. Loss of flexibility. You might not be able to move your joint through its full range of motion.
5. Grating sensation. You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
6. Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected joint.
7. Swelling. This might be caused by soft tissue inflammation around the joint.

Osteoarthritis commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As osteoarthritis progresses, movement patterns (such as gait), are typically affected.Osteoarthritis is the most common cause of a joint effusion of the knee.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. Osteoarthritis of the toes may be a factor causing formation of bunions,rendering them red or swollen.

causes–

Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis. Sources of this stress may include misalignments of bones caused by congenital or pathogenic causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and impairment of peripheral nerves, leading to sudden or uncoordinated movements. However exercise, including running in the absence of injury, has not been found to increase the risk of knee osteoarthritis. Nor has cracking one’s knuckles been found to play a role.

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Primary

The development of osteoarthritis is correlated with a history of previous joint injury and with obesity, especially with respect to knees. Changes in sex hormone levels may play a role in the development of osteoarthritis, as it is more prevalent among post-menopausal women than among men of the same age.Conflicting evidence exists for the differences in hip and knee osteoarthritis in African American and Caucasians.

Occupational

See also: Occupational disease and Occupational injury

Increased risk of developing knee and hip osteoarthritis was found among those who work with manual handling (e.g. lifting), have physically demanding work, walk at work, and have climbing tasks at work (e.g. climb stairs or ladders). With hip osteoarthritis in particular, increased risk of development over time was found among those who work in bent or twisted positions. For knee osteoarthritis in particular, increased risk was found among those who work in a kneeling or squatting position, experience heavy lifting in combination with a kneeling or squatting posture, and work standing up. Women and men have similar occupational risks for the development of osteoarthritis.

Secondary

Lateral

FrontalSecondary osteoarthritis of the ankle (due to an old bone fracture) in an 82-year-old woman

This type of osteoarthritis is caused by other factors but the resulting pathology is the same as for primary osteoarthritis:

1. Alkaptonuria
2. Congenital disorders of joints
3. Diabetes doubles the risk of having a joint replacement due to osteoarthritis and people with diabetes have joint replacements at a younger age than those without diabetes.
4. Ehlers-Danlos syndrome
5. Hemochromatosis and Wilson’s disease
6. Inflammatory diseases (such as Perthes’ disease), (Lyme disease), and all chronic forms of arthritis (e.g., costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
7. Injury to joints or ligaments (such as the ACL), as a result of an accident or orthopedic operations.
8. Ligamentous deterioration or instability may be a factor.
9. Marfan syndrome
10. Obesity
11. Joint infection

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Risk factors

Factors that can increase your risk of osteoarthritis include:

1. Older age. The risk of osteoarthritis increases with age.
2. Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
3. Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight adds stress to weight-bearing joints, such as your hips and knees. Also, fat tissue produces proteins that can cause harmful inflammation in and around your joints.
4. Joint injuries. Injuries, such as those that occur when playing sports or from an accident, can increase the risk of osteoarthritis. Even injuries that occurred many years ago and seemingly healed can increase your risk of osteoarthritis.
5. Repeated stress on the joint. If your job or a sport you play places repetitive stress on a joint, that joint might eventually develop osteoarthritis.
6. Genetics. Some people inherit a tendency to develop osteoarthritis.
7. Bone deformities. Some people are born with malformed joints or defective cartilage.
8. Certain metabolic diseases. These include diabetes and a condition in which your body has too much iron (hemochromatosis

treatment–physiotherapy

Physiotherapy can involve a number of different treatment and preventative approaches, depending on the specific problems you’re experiencing.

At your first appointment, you will have an assessment to help determine what help you might need.

Three of the main approaches a physiotherapist may use are:

1. education and advice
2. movement and exercise
3. manual therapy

Sometimes other techniques, such as acupuncture or ultrasound treatment, may also be tried.

Education and advice

One of the main aspects of physiotherapy involves looking at the body as a whole, rather than focusing on the individual factors of an injury.

Therefore, giving general advice about ways to improve your wellbeing – for example, by taking regular exercise and maintaining a healthy weight for your height and build – is an important part of treatment.

A physiotherapist can also give you specific advice that you can apply to everyday activities to look after yourself and reduce your risk of pain or injury.

For example, if you have back pain, you may be given advice about good posture, correct lifting or carrying techniques, and avoiding awkward twisting, over-stretching or prolonged standing.

Movement and exercise

Physiotherapists usually recommend movement and exercise to help improve your mobility and function. This may include:

• exercises designed to improve movement and strength in a specific part of the body – these usually need to be repeated regularly for a set length of time
• activities that involve moving your whole body, such as walking or swimming – these can help if you’re recovering from an operation or injury that affects your mobility
• exercises carried out in warm, shallow water (hydrotherapy or aquatic therapy) – the water can help relax and support the muscles and joints, while providing resistance to help you gradually get stronger
• advice and exercises to help you increase or maintain your physical activity – advice will be given on the importance of keeping active, and how to do this in a safe, effective way
• providing mobility aids – such as crutches or a walking stick to help you move around

Your physiotherapist may also recommend exercises that you can continue doing to help you manage pain in the long term or reduce your risk of injuring yourself again.

You can find exercise advice leaflets for some common problems, as well as exercises to prevent falls, on the Chartered Society of Physiotherapy (CSP) website.

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Manual therapy

Manual therapy is a technique where a physiotherapist uses their hands to manipulate, mobilise and massage the body tissues.

This can help:

1. relieve pain and stiffness
2. improve blood circulation
3. help fluid drain more efficiently from parts of the body 
4. improve the movement of different parts of the body 
5. promote relaxation

Manual therapy can be used to treat specific problems, such as back pain, but may also be useful for a range of conditions that don’t affect the bones, joints or muscles.

For example, massage may improve quality of life for some people with serious or long-term conditions by reducing levels of anxiety and improving sleep quality. Manual techniques are also used to help certain lung conditions.

Other techniques

Other techniques sometimes used by physiotherapists that may help to ease pain and promote healing include:

• acupuncture – where fine needles are inserted into specific points of the body, with the aim of reducing pain and promoting recovery
• transcutaneous electrical nerve stimulation (TENS) – a small, battery-operated device is used to deliver an electric current to the affected area, with the aim of relieving pain
• ultrasound – where high-frequency sound waves are used to treat deep tissue injuries by stimulating blood circulation and cell activity, with the aim of reducing pain and spasms, as well as speeding up healing

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Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.Asthma is an inflammatory disease of the airways to the lungs. It makes breathing difficult and can make some physical activities difficult or even impossible.Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.

Asthma symptoms, which include coughing, wheezing, and chest tightness, are common in an asthma attack. Sometimes asthma is called bronchial asthma or reactive airway disease. Asthma can be controlled with treatment.

Asthma symptoms

Symptoms of asthma include:

1. coughing, especially at night, when laughing, or during exercise
2. wheezing, a squealing or whistling sound made when breathing
3. tightness in the chest
4. shortness of breath
5. fatigue

Signs that your asthma is probably worsening include:

• Asthma signs and symptoms that are more frequent and bothersome
• Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
• The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

• Exercise-induced asthma, which may be worse when the air is cold and dry
• Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
• Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)

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causes

It isn’t clear why some people get asthma and others don’t, but it’s probably due to a combination of environmental and genetic (inherited) factors.

Asthma triggers

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

• Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
• Respiratory infections, such as the common cold
• Physical activity (exercise-induced asthma)
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
• Strong emotions and stress
• Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

1. Genetics. If a parent has asthma, you’re more likely to develop it.
2. History of viral infections. People with a history of viral infections during childhood are more likely to develop the condition.
3. Hygiene hypothesis. This hypothesis proposes that babies aren’t exposed to enough bacteria in their early months and years. Therefore, their immune systems don’t become strong enough to fight off asthma and other conditions.
4. Early allergen exposure. Frequent contact with possible allergens and irritants may increase your risk for developing asthma.

treatment

Treatments for asthma fall into three primary categories: breathing exercises, rescue or first aid treatments, and long-term asthma control medications.

Your doctor will determine the right treatment or combination of treatments for you based on the type of asthma you have, your age, and your triggers.

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Breathing exercises

These exercises can help you get more air into and out of your lungs. Over time, this may help increase lung capacity and cut down on severe asthma symptoms. Your doctor or an occupational therapist can help you learn these breathing exercises for asthma.

Rescue or first aid treatments

These medications should only be used in the event of an asthma attack. They provide quick relief to help you breathe again. Examples include:

• rescue inhalers and nebulizers, which are used with medicine that needs to be inhaled deep into the lungs
• bronchodilators, which work to relax the tightened muscles in your lung
• anti-inflammatories, which target inflammation in your lungs that could be preventing your breathing

If you think that someone you know is having an asthma attack, you should sit them upright and assist them in using their rescue inhaler or nebulizer. Two to six puffs of medication should help ease their symptoms.

If symptoms persist for more than 20 minutes, and a second round of medication doesn’t help, seek medical attention.

Long-term asthma control mediations

These medications should be taken daily to prevent symptoms. Some rescue treatments, such as inhalers and nebulizers, can be used daily. However, your doctor will need to adjust your dosages.

Complementary and alternative therapies should never be used during an asthma attack. If not treated properly, asthma can be life-threatening. The following remedies may help with mild asthma, but an asthma attack is a medical emergency. Follow your doctor’s instructions and make sure an inhaler is available in case you need it.

Coffee or caffeinated tea

A chemical in caffeine acts similarly to the asthma drug theophylline. It opens up airways and may ease symptoms of asthma for up to four hours.

Essential oils

Inhaling eucalyptus essential oil may ease breathing difficulties brought on by asthma. Lavender and basil essential oils also show promise. However, for some individuals, inhaling essential oils may make asthma worse. Strong smells and chemicals can trigger asthma or worsen symptoms.

Mustard oil

This fatty oil, made from pressed mustard seeds, can be massaged into the skin to help open airways. Mustard oil is different than mustard essential oil, a medicinal oil which shouldn’t be applied directly to the skin.

Bronchial asthma

Bronchial asthma is simply another name for the most common type of asthma. Symptoms include coughing, wheezing, chest tightness, and shortness of breath.

Unless a specific type of asthma is mentioned, most references made to asthma are about bronchial asthma.

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This common condition interferes with the way mucus normally drains, and makes your nose stuffy. Breathing through your nose may be difficult, and the area around your eyes might feel swollen or tender.Chronic sinusitis occurs when the spaces inside your nose and head (sinuses) are swollen and inflamed for three months or longer, despite treatment.

The sinuses are small air pockets located behind your forehead, nose, cheekbones, and in between the eyes. The sinuses produce mucus, which is a thin and flowing liquid that protects the body by trapping and moving germs away.

Sometimes, bacteria or allergens can cause too much mucus to form, which blocks the openings of your sinuses.

Excess mucus is common if you have a cold or allergies. This mucus buildup can become thick and encourage bacteria and other germs to build up in your sinus cavity, leading to a bacterial or viral infection. Most sinus infections are viral and go away in a week or two without treatment.

If your symptoms don’t improve within 1 to 2 weeks, you may have a bacterial infection.

types—

Acute sinusitis

Acute sinusitis has the shortest duration. A viral infection brought on by the common cold can cause symptoms that typically last between 1and 2 weeks. In the case of a bacterial infection, acute sinusitis may last for up to 4 weeksTrusted Source. Seasonal allergies can also cause acute sinusitis.

Subacute sinusitis

Subacute sinusitis symptoms can last for up to 3 months. This condition commonly occurs with bacterial infections or seasonal allergies.

Chronic sinusitis

Chronic sinusitis symptoms last for more than 3 months. They’re often less severe. Bacterial infection may be to blame in these cases. Additionally, chronic sinusitis commonly occurs alongside persistent allergies or structural nasal problems.

Risk Factors

Several factors can increase your risk of getting a sinus infection:

1. A previous cold
2. Seasonal allergies
3. Smoking and exposure to secondhand smoke
4. Structural problems within the sinuses (such as growths on the lining of the nose or sinuses, known as nasal polyps)
5. A weak immune system or taking drugs that weaken the immune system

Other signs and symptoms can include:

1. Ear pain
2. Aching in your upper jaw and teeth
3. Cough or throat clearing
4. Sore throat
5. Bad breath
6. Fatigue

Symptoms

Common symptoms of sinus infections include:

1. Runny nose
2. Stuffy nose
3. Facial pain or pressure
4. Headache
5. Mucus dripping down the throat (post-nasal drip)
6. Sore throat
7. Cough
8. Bad breath

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Causes

Common causes of chronic sinusitis include:

1. Nasal polyps. These tissue growths can block the nasal passages or sinuses.
2. Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages, making the symptoms of sinusitis worse.
3. Other medical conditions. The complications of conditions such as cystic fibrosis, HIV and other immune system-related diseases can lead to nasal blockage.
4. Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
5. Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.

Prevention

Take these steps to reduce your risk of getting chronic sinusitis:

1. Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
2. Manage your allergies. Work with your doctor to keep symptoms under control. Avoid exposure to things you’re allergic to whenever possible.
3. Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
4. Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.

Treatment

Your doctor will determine if you have a sinus infection by asking about symptoms and doing a physical examination.

Antibiotics are not needed for many sinus infections. Most sinus infections usually get better on their own without antibiotics. When antibiotics aren’t needed, they won’t help you, and their side effects could still cause harm. Side effects can range from minor issues, like a rash, to very serious health problems, such as antibiotic-resistant infections and C. diff infection, which causes diarrhea that can lead to severe colon damage and death.

However, in some cases, antibiotics are needed. Talk to your doctor about the best treatment for your illness.

For some sinus infections, your doctor might recommend watchful waiting or delayed antibiotic prescribing.

• Watchful waiting: Your child’s doctor may suggest watching and waiting to see if your child needs antibiotics. This gives the immune system time to fight off the infection. If your child doesn’t feel better after 2–3 days of rest, extra fluids, and pain relievers, the doctor may write a prescription for an antibiotic.
• Delayed prescribing: Your child’s doctor may give an antibiotic prescription but suggest that you wait 2–3 days to see if your child is still sick before filling it.

How to Feel Better

Below are some ways you help relive sinus pain and pressure:

• Put a warm compress over the nose and forehead to help relieve sinus pressure.
• Use a decongestant or saline nasal spray.
• Breathe in steam from a bowl of hot water or shower.

Ask your doctor or pharmacist about over-the-counter medicines that can help you feel better. Always use over-the-counter medicines as directed.

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