Eczema, clinically known as Dermatitis, is a chronic skin condition, which causes the skin to become inflamed, dry, red and itchy. Eczema is derived from the Greek word “ekzein”, which means “to boil out” and is an apt description of what this condition does.

Eczema affects approximately 11% of children and an estimated three percent of the adults that visit a dermatologist. Eczema is not contagious or life threatening, but can cause severe discomfort if serious cases are not treated.  There are various forms of Eczema, ranging in severity and a variety of symptoms, as well as treatment options.

Symptoms of Eczema

Symptoms of Eczema can range from mild to very serious. Also, some individuals will have seasonal flare-ups, while others may suffer year around. Mild symptoms can usually be managed with creams and include:

• Dry skin
• Redness
• Itchiness
• Scaly skin

More serious symptoms of Eczema may include:

• Severe itching, especially at night
• Bleeding skin that cracks when scratched
• Skin that crust over and forms painful scabs
• Inflamed areas that leak clear fluid, which is called “weeping”

Types of Eczema

Atopic Eczema is commonly used to describe eczema in general, but the prefix “atopy” actually means eczema that is inherited. Many cases are classified as inherited, because the overwhelming majority (80%) of cases are diagnosed by the age of five. Although not known for sure, this leads clinicians to believe that inherited traits coupled with environmental triggers initiate the eczema flare-ups. Immune system abnormalities have also been indicated. Individuals who have Atopic Eczema are more likely to develop Hay Fever or Asthma during their lifetime as well.

Contact Dermatitis, often known as Allergic Eczema, is an irritation that occurs when a person comes into contact with a specific item or allergen. This can be something that briefly comes into contact with the skin, such as an article of clothing or something with longer lasting contact, such as jewelry. Some common triggers for Contact Dermatitis are:

• Clothing made of harsh fibers
• Clothing detergent
• Costume jewelry
• Latex gloves
• Certain foods
• Perfume that contains artificial scents
• Lotions and creams that contain synthetic coloring agents and other ingredients
• Shampoo and body wash that contain harsh cleansers, such as Sulphates
• Work environments containing synthetic or hazardous materials.

Usually, the symptoms of Contact Dermatitis will abate once the offending allergen is located and removed from your environment. A common way to search for the trigger is by using the elimination method. Remove one thing at a time from your environment and evaluate whether the symptoms improve at all. You may try washing all clothes in a detergent for sensitive skin, eliminate harsh cleansers or remove items one by one from your diet. Once the trigger is identified, keeping it at bay will usually resolve the problem.

Discoid Eczema is also known as Nummular Dermatitis or Discoid Dermatitis and consists of round or coin shaped patches of Eczema and usually occur on the lower legs, but can be found elsewhere. The patches can be less than a half inch in diameter or much larger. Discoid Eczema is similar in appearance to wing worm, and often a culture will be examined for a positive identification. Discoid Lupus is not though to be brought about by an allergic reaction like Contact Eczema, but can result from injury to the skin.

Discoid Eczema presents in two forms- wet and dry. In wet Discoid Eczema, the skin is usually bumpy, cracked and may be oozing. The dry form will be more flat, itchy and flaky. Sanitation is key, as it is common for Discoid Eczema lesions to become infected with bacteria and even the flesh eating Staphylococcus virus.

Discoid Lupus can be treated a number of ways. First and foremost, take care to avid any activity that can further damage the skin. For example, use gloves or breathable long sleeved shirts to protect skin from the environment. Secondly, depending on the severity, topical and oral medication may be prescribed.

If the outbreak is mild to moderate, an oral antihistamine may suffice to calm itching, while balms and lotions can be used to moisturize and protect the skin. Glycerin and Lanoline based moisturizers are best for this. For more severe, crusted and weeping cases, oral antibiotics will be prescribed to control infection, along with topical steroid creams to reduce the inflammation and severity of the rash. An oral antihistamine will likely be prescribed as well to control itching. This course of treatment will likely take a few weeks to show effectiveness and it is possible for there to be hyper pigmentation or scarring, especially in darker complexioned individuals.

Seborrhoeic Eczema can affect both adults and children and is usually confined to the scalp and face, but often extends to the neck, armpits, under the breast and the genital area. Some cases may show irritation on the torso, as well as behind the knees.

Often beginning as heavy dandruff, Seborrhoec Eczema progresses to skin that is reddish and inflamed, with thick, crusty white scales that often flake off. The affected areas can have a slick, crusty and greasy appearance. On the face, it is common to find patches in and behind the ears, in the eyebrows and alongside the nose.

In children, patches are often found in the diaper area, scalp and in the creases and folds of skin behind the legs and arms. Research has shown that individuals with Seborrheoic Eczema show an elevated level of yeast on the skin, which breeds in the affected areas. There is no conclusive study, but an overgrowth of Candida in the body may cause the external symptoms of Seborrhoeic Excema.

Traditional medical theory is that this type of Eczema is reoccurring over a person’s life time, if the initial onset is during the adult years. Typical treatments include topical or oral steroids and a moisturizer for extremely dry patches. For children, usually an antifungal or steroid cream is recommended in severe cases. However, young children will usually grow out of the condition.

Gravitational Eczema is also known as Stasis Eczema or Varicose Eczema. This form of eczema is distinct in that it is usually concentrated on the lower legs and occurs in older individuals, those that are overweight and people who have suffered from blood clots in the legs.

Gravitational Eczema is the result of intense, prolonged pressure on the veins, which often occurs in cases of poor circulation, where instead of blood flowing back up towards the heart, it pools in the lower legs and puts a strain on the blood vessels there. Over time, these vessels leak or burst, allowing fluid to pool under the skin. This can cause visible brown and red patches under the skin and eventually the thinning and breakage of the skin barrier. When this happens, the area becomes a weeping ulcer, which may crust over at times and leak at others.

Gravitational Eczema is usually treated with compression stockings, if detected early. These special stockings help to push fluid up the leg back towards the heart and avoid pooling on the legs and damage to the veins there. It helps to place clean cloths or bandages inside of the stockings to help ease friction and provide a buffer to catch any leaking fluid.  Topical steroids will be prescribed for serious cases. Antibiotics may be prescribed if the area becomes infected.

Baby Eczema

Eczema in babies and small children can often be more troublesome than in adults. As children, especially babies have extremely sensitive skin and cannot express themselves, it is often trial and error to identify what may be causing the problem. Below are common reasons for eczema in young children:

• The mother’s hormones still in the baby’s system from the birth
• Harsh soap and lotion
• Itchy clothing fibers
• A particular baby formula
• Medication or spicy food transferred via breast milk
• Living with a smoker
• Pet fur
• Irritating bedding
• Some baby jewelry

With children, especially a newborn, it is important to make sure that everything that touches their skin is as non-irritating as possible. If your baby is experiencing Eczema, examine their environment for possible irritants.

Cradle Cap is also a very common form of Seborrhoeic Eczema that occurs in newborns. Cradle cap may appear immediately after birth, or after a few months. A common issue, this form of Eczema can be treated by rubbing natural oil on the baby’s scalp and lightly brushing away flakes. Also, be careful to use a mild baby shampoo, so as not to further irritate the scalp. Cradle cap usually resolves on its own with proper maintenance.

Causes of Eczema

There is no documented cause of Eczema in traditional Western medical journals.  However, researchers believe that a combination of heredity, allergies and environmental factors play a role. Most of the information available in traditional medical literature focuses on relieving the symptoms of Eczema. However, both traditional and alternative medicines identify similar genetic commonalities, triggers and aggravators of Eczema, discussed below. These include allergies, stress, food sensitivities, environmental factors,  or immune system irregularities, as discussed below.

Diet plays an important role in overall health and the avoidance, and treatment of chronic diseases. A health practitioner will examine the diet as an initial source of inflammation. Many individuals have discovered that they have food intolerances that cause allergic reactions in the form of Eczema. Common culprits are:

• Dairy
• Gluten
• Sugar
• Nuts
• Fish
• Spicy food
• Processed meat
• Soy products
• Artificial colors and preservatives

Often a range of allergy testing or employing the elimination diet can pinpoint a food intolerance that may be causing Eczema flare ups. Eczema causing food allergies are more prevalent in young children, with the average age being between two and four years old. Avoiding those foods should reduce the immune response that triggers Eczema.

Environmental Allergens are also common instigators of Eczema. If you have tried testing for food allergies to no avail, it may be beneficial to have your home or office evaluated for mold, asbestos or mites. These environmental allergens can also trigger severe immune responses, resulting in the manifestation of Eczema. Using an indoor air filter and replacing infested home materials, removing pet fur and dander and regularly cleaning carpets may reduce symptoms.

Stress is a powerful agent in the body and can cause a number of symptoms, one of which is Eczema. Traditional medicine has identified stress as an aggravator for eczema, if not an originating cause. However, Alternative medicine fully acknowledges the mind/body connection and the ability for thoughts and emotions to impact physical health. Prolonged, chronic stress can stimulate an ongoing stream of stress hormones, wear out the endocrine system and can compromise immune function. This can present in a number of ways, one of which is Eczema.

If stress is a likely factor, it is beneficial to have a thorough workup of the endocrine system and check all hormones levels. Often, rebalancing these systems will provide tremendous relief. In addition, lifestyle changes can also help to reduce the severity of Eczema, as well as prevent future occurrences. Finding ways to better manage stress is vital to continued overall health.

Personal Care Items that are used by millions everyday can cause allergic reactions and prompt Contact Dermatitis. Many people are unaware of this, as there is no government body that oversees the testing and regulation of personal care products, allowing producers can use whatever ingredients they like. The vast majority of products used to shave, moisturize, and scent contain synthetic chemical ingredients. The average person soaks up an estimated 126 ingredients from 10 personal care products a day. As many of these ingredients are not natural, they are not easily assimilated into the body and blood stream. The body sees them for what they are: foreign substances that not only provide no nourishment, but in many cases actually cause harm.

Ways to Avoid Harmful Personal Care Products

• Buy organic or natural personal care items. However, beware of products that tout the natural label, but are just a synthetic cocktail, with perhaps one or two natural ingredients.
• Avoid ingredients with strong preservatives, such as Parabens.
• Stop using shampoo and body wash that contain Sulphates, which are harsh industrial strength cleansers that can dry and irritate the skin.
• Check the toxicity level of specific personal care items using the Environmental Working Group’s “Skin Deep” Database:  http://www.ewg.org/skindeep/
• Make your own skin care products using ingredients such as pure shea butter, aloe vera, glycerin and natural oils.
• Study the skin nourishing properties of many fruits and other foods. Milk and honey baths, avocado facials and oatmeal scrubs, to name a few. 
  

Diagnosing Eczema 

Eczema is largely diagnosed based on a visual examination. The physician will examine all inflamed areas and question the patient about the duration and severity of the problem. In some cases, a small skin biopsy may be taken to rule out other illnesses. Some physicians may also request an allergy panel to assess if there are any foods or environmental allergies that could be prompting the Eczema.

Common Eczema Treatments

Eczema treatment is usually divided into three categories: Moisturizers, Topical Medicinal Creams and Oral Medications. Below is an explanation for each category, along with common items and brands.

Moisturizers are a common first line of defense in Eczema. The goal is to re-hydrate the skin, minimize flaking and avoid skin breakage. The most effective moisturizers will have a high natural oil content and be devoid of dye and fragrance. Common Eczema moisturizers are:

• Cetaphil lotion or Eucerin Crème
• Pure Shea Butter
• Almond oil, Castor oil, Tea Tree oil
• Glycerin based moisturizers
• Lanoline
• Pure Emu oil

Medicinal creams are prescribed for harder to manage Eczema. Topical corticosteroids creams, in particular, are strong medications that work to suppress the inflammatory nature of Eczema, allowing the skin to heal. Caution must be used, however, because corticosteroids can have side affects, especially with prolonged use.

Oral Medications are of a few varieties. For mild to moderate eczema, oral antihistamine medication may be prescribed, such as Benadryl. This type of medicine reduces the itch associated with Eczema and also has the additional benefit of sedation, which makes it easier to sleep without scratching. Also, in instances that patches of Eczema have become infected, oral antibiotics will be prescribed to fight the infection.

Alternative Health Treatments for Eczema

Probiotics may be prescribed by a holistic health practitioner to treat Eczema, especially if the patient presents symptoms of leaky gut syndrome as well.  Probiotics are the good bacteria found in the gut that helps to maintain a healthy ecosystem in the body. However, because of diet, lifestyle and other factors, the bad bacteria can proliferate at a high rate and overwhelm the system. This can cause small holes in the intestines and colon which allows food particles to escape and enter the bloodstream, causing an allergic reaction. Taking probiotics helps to rebalance and repair the gut and reduce the inflammatory allergic response that may be causing eczema.

Probiotics are safe for children and adults, with a study conducted by The Journal of Clinical & Experimental Allergy showed a remarkable decrease in Atopic Eczema symptoms in infants that were fed Probiotic supplemented formula, over the group that received regular formula. The probotic group showed reduced inflammation markers and visible signs of Eczema.

Traditional Chinese Medicine and Acupuncture are another alternative modality for treating Eczema. Chinese medicine dictates that manifestations such as Eczema are allergic reactions from an imbalance in one or more of the body’s organs or systems. This imbalance inhibits the flow of life force energy and causes systemic upset. Chinese medicine attributes allergic symptoms to an excess of damp and heat in some of the major organs. In the case of Eczema, the lungs, spleen, and kidneys are indicated.

It is believed that a number of factors cause the imbalance in these organs, one of which is the consumption of phlegm stimulating dairy. As the digestive systems of babies and children are extremely delicate, it is recommended that they consume rice or almond milk, and possibly goat’s milk (the most easily digestible), or soy milk in moderation. It is also recommended to greatly reduce sweet and greasy food, as they contribute to the moist/phlegm problem, and to dilute even fresh fruit juice.

Another possible reason for the Eczema breakouts in Chinese Medicine is the introduction of heat bearing toxins that are introduced with immunizations in children and the flu shot in adults. These toxins overwhelm the body and produce an allergic reaction. Detoxifying the body by means of regulating the diet, consuming special herbal blends and receiving acupuncture treatments has shown improvements in as little as a few weeks to three months.

Herbalists use the many healing elements of nature to calm the inflamed itchy rash that is eczema. Some effective herbal and floral remedies include using Licorice gel or Chamomile cream to sooth dry irritated skin and promote healing. Also, Calendula and Echinacea creams reduce help to reverse immune response and calm inflammation. Chicken weed reduces itching and irritation and gently cleanses the skin or toxins and burdock tea may be taken internally for the same result. Herbalist also will recommend that individuals with Eczema cleanse the colon, a major toxin storehouse and complete an herbal kidney flush.

References

The Mayo Clinic. Contact Dermatitis: http://www.mayoclinic.com/health/contact-dermatitis/DS00985
Australian Society of Clinical Immunology and Allergy: Eczema http://www.allergy.org.au/content/view/173/1/
The Environmental Working Group. Skin Deep: http://www.ewg.org/skindeep/faq/
National Eczema Society. Seborrhoeic eczema in Adults: http://www.eczema.org/seborrhoeic.html
Kids Health. Eczema:  http://kidshealth.org/parent/infections/skin/eczema_atopic_dermatitis.html#
NHS. Treating Atopic Eczema: http://www.nhs.uk/Conditions/Eczema-%28atopic%29/Pages/Treatment.aspx
New Zealand Dermatological. Discoid Eczema:  http://dermnetnz.org/dermatitis/nummular-dermatitis.html
Journal of Clinical & Experimental Allergy: Vol.30, Issue 11. Pages 1605-1610. Nov. 2000. Found online at:

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2222.2000.00943.x/full

Acupuncture Today. Treating Childhood Eczema With Acupuncture and Chinese Herbs: http://acupuncturetoday.com/mpacms/at/article.php?id=30039

Lupus affects a reported 1.5 million individuals in the United States and 5 million across the globe. However, Lupus is known as the “copycat illness”, because its symptoms are similar to those of other diseases. As such, many people with Lupus may be misdiagnosed or take longer to receive a diagnosis, if at all. As a result, it is believed that the number of Lupus cases is vastly underreported.

Lupus is a unique illness in that it consists of reoccurring cycles of flares and remission. When the immune system is overactive and causes damage to the body, this is called a “Lupus flare”. This period of disease activity lasts for just a few days at a time in some patients, while others experience flares for weeks or months at a time. The disease activity then abates for a period of time. Careful monitoring and medical intervention can minimize the severity of Lupus flares and allow the patent to better cope when they occur.

Lupus is classified as a “chronic illness”, which means that the symptoms last for more than six weeks and often for the person’s lifetime. However, with early detection and treatment, it is possible to minimize symptoms, or even eliminate them altogether.

Common Lupus Misconceptions

Lupus has recently received more national exposure, however, there are still many people who are unfamiliar with the illness. Because of this, many misconceptions abound, such as:

• Although it does involve the immune system, Lupus is not akin to HIV, the virus that causes AIDS. The difference between the two is that in AIDS, the immune system is hypoactive, meaning it is not able to effectively fight at all. In the case of Lupus, the immune system is overactive to the point of damaging many areas of the body at once.

• Lupus is not contagious and certainly not transmitted sexually or through the exchange of blood or other bodily fluids. You cannot get Lupus by being around someone who has it or by using their personal belongings.

• Lupus is not related to cancer and affects the bodily in a different way. Mutated cancer cells grow in a particular part of the body and potentially overtake that organ. Left unchecked, cancer can spread to other areas as well. With Lupus, the damage is caused by the attacking antibodies of the overactive immune system.

Lupus does not only affect African American women. Although more prevalent in this group, women from all races have been diagnosed with Lupus. Also, although less frequently, men and children are diagnosed as well.

Risk Factors

Lupus is seen predominantly in women, with greater than 90% of diagnosed cases being female. Also, Lupus is more prevalent in ethnic communities, with women of color being three times as likely to develop Lupus as other women. This group includes African Americans, Latinos, Hispanics, Asians and Pacific Islanders.

Also, Lupus is a disease that primarily affects women of childbearing age, from15-44, with 15% of cases presenting symptoms before the age of 18. There has been a genetic correlation indicated, as 13% of individuals with Lupus have a relative with the disease. Children of parents with Lupus are at minimal risk of developing the illness later in life, noted at 5%.

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Lupus Symptoms

The symptoms of Lupus are caused by antibodies attacking various organs and systems in the body. Antibodies are produced by the immune system as a means or fighting disease. However, in the case of Lupus, the body misinterprets what is actually harmful and sends antibodies to attack healthy tissue and organs. This attack causes inflammation in the affected area, which results in the following common symptoms:

• A reddish or purple butterfly shaped rash across the nose and cheeks, known as the molar rash. This is present in approximately 65 percent of Lupus diagnosis.
• Fingers and toes that change color and become swollen and painful, a sign of possible Reynaud’s Syndrome.
• Swollen joints or tissue
• Sudden or severe hair loss
• Sores in the mouth or nose that last more than a few days
• Low red blood cell count
• Sensitivity to sunlight
• Chest pain or trouble breathing
• Anemia
• Tingling, headaches or seizures
• Chronic fatigue, even after a full nights rest

For many, the first symptoms are constant fatigue, joint pains and the most recognizable, the molar rash. Often individuals will experience the frustration of not feeling well, but not being able to pinpoint exactly why. In other cases, a person may be misdiagnosed because of the similarity of the symptoms of Lupus to other illnesses. A number of factors will be examined, in addition to blood work to make a definitive diagnosis.

Types of Lupus

Lupus is a complex illness that manifests in different ways. Because Lupus can affect any area of the body, two people may present entirely different symptoms. The physician will take into account the overall landscape of the patient’s health and individual symptoms when trying to ascertain which form of Lupus the patient may have. Lupus cases are classified as follows:

Systemic Lupus Erythematosus

Also known as SLE, Systemic Lupus is by far the most prevalent form. With this type of Lupus, any and all of the body’s organs and systems can be affected. When the immune system becomes overactive, it may impact one area more than others, or severely attack many areas at once.

Patients with systemic Lupus will experience many of the symptoms listed above and often simultaneously. It is imperative that patients with SLE monitor their condition and report any new developments to their physician in order to control potential long term damage.

Cutaneous Lupus Erythematosus

Cutaneous Lupus refers to inflammation of the skin, which is made up of three layers. Approximately five percent of patients with Cutaneous Lupus Erythematosus go on to develop Systemic Lupus. Cutaneous Lupus presents in the following ways:

• The most prevalent form of skin Lupus is Discoid Lupus. The name is derived from the fact that the lesions that present resemble small disks. The lesions are often red and scaly. Discoid Lupus can be localized, meaning it is limited to the face, neck, ears and scalp. It can also be general, with lesions appearing on the back, torso, arms and other areas of the body. Childhood Discoid Lupus manifests in children, but is more prominent in boys. A greater percentage of boys that have Discoid Lupus develop Systemic Lupus later in life.
• The Butterfly or Molar Rash is another form of Cutaneous Lupus. Also called the mask of the wolf, for its shape. This rash is usually red, raised and inflamed. The rash is spread across the nose and both cheeks and may itch, but usually does not. The skin in the affected area can become dry and may peel. The area is also usually sensitive to light and touch.
• Subacute Cutaneous Lupus Erythematosus is a subset and is characterized by red and scaly rashes in the cleavage area and the forearms, areas which are typically exposed to the sun.

Drug-induced Lupus Erythematosus

The onset of Lupus can also be triggered by a reaction to ongoing use of certain medications. Medical drugs are chemical compounds and at times are difficult to metabolize. In fact, a study identified that many cases of drug induced Lupus correlated with a reduction in the critical enzyme N-acetyltransferase. These individuals are unable to properly metabolize certain drugs and as a result there is more of the drug residue in their body. Over time, this builds up and causes an immune system reaction.

There are thirty known drugs that can induce Lupus. However, most instances are induced by three drugs, which are:

1. Hydralazine is a pharmacutical drug used to treat hypertension. However research has shown that ongoing use can trigger Lupus symptoms. In a study reported in the British Journal of Medicine, 10.4% of patients developed drug induced Lupus after receiving 200mg of hydralazine a day over a three year period. In participants who received a lower dose of 100mg a day over three years, the Lupus rate was 5.4%.
2. Procainamide is an anti-arrhythmic drug, which helps to regulate irregular heart patterns. However, it has been positively linked to the onset of Lupus syndrome. The drug prompts the development of anticardiolipin antibodies, as well as anti-DNA and Anti-histone antibodies. Procainamide is administered orally or through intravenous infusion and in addition to Lupus syndrome, can cause fever, rashes, blood clots and muscle pain. Patients who are weaned off of the medication often experience a reduction in their Lupus symptoms.
3. Isoniazid is a drug which is used to treat tuberculosis and has been linked to drug induced Lupus. Common side affects of prolonged Isoniazid use mimic many lupus symptoms, such as fatigue, rashes, joint and muscle pain, as well as many more. Recommended treatment is to discontinue use of Isoniazid and introduce a course of prednisone to counteract the autoimmune response. Results have shown gradual reduction of Lupus symptoms with this course of treatment.

Neonatal Lupus

In rare instances, a mother with Lupus may develop antibodies which affect her unborn child. A baby normally begins receiving antibodies from the mother at 12 weeks gestation. Passing these antibodies to the fetus helps to protect it against illness. However, in the case of Lupus, the mother also makes antibodies against her own healthy tissue, which can be passed to the fetus as well.

The most common manifestations of Neonatal Lupus are skin rashes, congenital heart block, low red blood cell levels and issues with the liver. Women with Lupus will be tested for auto-antibodies by their high risk prenatal provider. If there is evidence of antibodies, the mother is closely monitored during the pregnancy to detect any issues with the baby’s heart, including receiving regular fetal echocardiograms.

If an issue is discovered with the baby’s heart, in some cases, it may be advantageous to treat the mother with steroids in hopes of reducing the severity of the heart block. The prognosis for survival is good, however children with a complete heart block will need to use a pacemaker to regulate their heart rhythm. While it is possible for a child with a congenital heart block to live a long life, some statistics do show that approximately 19% of cases result in miscarriage or stillbirth.

Childhood Lupus

Twenty percent of diagnosed cases of Lupus are in children, with the majority presenting in girls over the age of ten. While it is possible to show signs of Lupus before ten, it is rare that symptoms develop before the age of five. However, as in adults, Lupus can be damaging to internal organs and systems if left untreated.

If a child is complaining of joint pain, constant aches or develops a prolonged skin rash, it is important to follow up with the pediatrician. They can determine whether the symptoms necessitate involving a specialist to fully evaluate the child’s condition.

If a child does test positive for lupus, it is critical to work closely with health care providers to monitor the progression of the disease and adhere to medical recommendations regarding medication and other therapies. Treatment is typically the same as in adults – NSAIDs,  Corticosteroids, or other immunosuppressive drugs.

As a child is still developing, it is important to pay close attention to the affect of specific symptoms and medications to their health and mental state. Side affects of medication can include weight gain, abnormal hair growth, acne, issues with bone density and a higher risk of cancer. In addition to a rheumatologist, the child or family may also need to seek the aid of a psychologist to help them deal with the strain of the disease.

Causes of Lupus

Officially, there is no known medical cause of Lupus. Medical researchers have studied the inflammatory nature of Lupus, but have not been able to isolate a specific cause of the disease. However, many naturopathic doctors and holistic healers have identified common reasons why individuals are beset with Lupus. The most common are:

Stress

Many individuals experience their first lupus flare after a bout of extreme stress. It could be stress from a divorce, career, or relationships. The body is designed to deal with stress effectively and produces hormones to aid in this. However, prolonged or extreme stress will produce a never ending stream of cortisol and adrenalin and can be very harmful long term.

Alternative health practitioners understand that the mind and body are intrinsically connected and point to chronic stress as a major component of developing Lupus. It is proven that stress creates physical symptoms, many of which can morph into full blown Lupus. The excessive stress hormones, as well as mental toxicity that develops poisons the body, causing the immune system to malfunction, inflammation to occur and the development of Lupus symptoms.

Toxin overload

We currently live in a toxic environment. Chemicals and pollution are widespread and absorbed by the body on a daily basis. This can be through the use of chemical skin care products, polluted water, radiation, harsh cleaning products, and many more. The body is equipped to process and expel the toxins we absorb, however not on the massive scale our current intake requires.

As a modern, industrial society, the payoff for progress is often chemical or toxin exposure. Often, the organs of elimination, such as the lymphatic system, liver and kidneys become overtaxed when trying to flush toxins from the body. As it is not able to process them all, excess toxins are often dumped back into the blood stream or attach themselves to organs and tissue. Over time, this prompts an immune system response that is often exaggerated and causes the chronic inflammation know as Lupus.

Diet

Diet is often a major component in Lupus. The current nature of commercial food makes it less than optimal for long term health. The infusion of chemical dye, flavoring agents and preservatives is an unhealthy practice, which can harm the body over the long term.

Additionally, pesticides and insecticides are used to grow food before it even reaches the processing stage. These chemicals alter the nature of the food and produce fruits and vegetable that contain varying amounts of dangerous chemicals.  Ongoing consumption of chemically grown and preserved foods can lead to chemical toxin overload and inflammation.

Excessive consumption of processed white sugar and flour can also contribute to Lupus. These items are simple carbohydrates which the body is unable to use or store in an effective, healthy manner. The nutritional value is very low and in the case of flour, may actually cause an allergic reaction in the body. May individuals with Lupus have also identified that they are gluten intolerant and have benefited from removing wheat from their diet.

Hormonal Imbalances

The body is a complex mix of hormones, which form a balanced cocktail. However, if the mix is altered, there may be serous health consequences. An overproduction or insufficiency of a specific hormone can alter the way the body process food, deals with stress, processes information and a host of other functions. Balanced hormones are critical to overall mental and physical health and hormonal imbalances have been indicated in a number of illnesses, including Lupus.

Diagnosing Lupus

Lupus is not the easiest disease to diagnose, due to its copycat nature. The symptoms that many patients experience can be commonly found in other chronic and episodic illnesses. Also, many patients experience a general feeling of being unwell, but may be unable to accurately pinpoint their symptoms. In order to receive an accurate diagnosis, the patient and physician each must play an important role.

The Patient’s Role

To be your best advocate, it is important to tune into your body and evaluate what you are feeling. Is it shortness of breath, a skin rash, or possibly joint pain? It is important not to dismiss feeling and symptoms, as they may help your doctor in diagnosing your condition.

One of the most effective means of aiding your doctor in ascribing a diagnosis is to write down a thorough list of your symptoms. When doing so, include the frequency/duration of each symptom, as well as the severity. Also, be descriptive. If you experience pain in your joints, write down in which joints and whether it is just in the mornings, or ongoing. Even after being diagnosed, taking your list to your doctor at each appointment helps him to track your symptoms, and evaluate the effectiveness of the prescribed treatment plan.

The Physician’s Role

If you explain your symptoms to your primary care physician, he will likely refer you to a specialist, such as a rheumatologist or internist. They are specifically trained to evaluate and treat illnesses such as Lupus. Initially, the doctor will perform an examination and may feel parts of your body to sense inflammation, such as the face, hands, ankles and knees. Inflammation in these areas may be indicative of Lupus.

The doctor will also listen to your lungs with a stethoscope to gauge any breathing issues and also listen to your heart to rule out swelling of the out layer around the heart, which causes a discernable rubbing sound. The doctor may also test your vision, reflex response and other indicators of central nervous system involvement.

Additionally, the doctor will ask you a series of questions regarding your symptoms. There are an established set of 11 specific symptoms that doctors look for in people with Lupus. If you answer yes to four out of the eleven symptoms below, it is possible that you have Lupus.

1. Molar or butterfly rash across the cheek
2. Disk shaped lesions
3. Sensitivity to sunlight
4. Ulcers in the nose or mouth
5. Arthritis
6. Inflammation of membranes in the lungs, the heart, or the abdomen
7. Evidence of kidney disease
8. Neurological involvement
9. Low red and white blood cells and a low platelet count
10. Immunologic abnormalities
11. Positive antinuclear antibody (ANA) test

Testing for Lupus

In addition to the criteria above, which includes the ANA test, additional testing may be ordered to provide certainty regarding the diagnosis. The most common tests that are ordered to screen for Lupus are:

Testing for Antibodies

Antibodies are proteins which are made by the body in response to colds, viruses and other infections. They seek out the invaders and destroy them. Antibodies are a critical part of the immune system, however in Lupus patients they work somewhat differently. In a person with Lupus, the body creates what is called “auto-antibodies”, which is an antibody produced to attack healthy tissue or organs. There are various tests to detect antibodies, including the following:

Antinuclear Antibodies (ANA Test) – The nucleus of a cell is the area which acts as a command center. The ANA attaches itself to the cell’s nucleus and causes damage to the cell from the inside. In severe cases, it can destroy the cell.

A positive ANA result is founded in 97% of patients with Lupus. However, it is important to note that the ANA antibody can also be an indicator of another illness.

Phospholipid Antibodies (ApLs)- These antibodies attack the bodies blood vessels and arteries, causing problems with blood flow and clotting. The blood vessels become narrower and can prompt a stroke, miscarriage, heart attack or blood clots in the legs, arms or lungs. Pregnant women with lupus should be screened for Phospholipid Antibodies early in their pregnancy.

Double-Stranded DNA antibodies (DsDNA)- this antibody attacks the actual DNA strand, which is the genetic map of the cell and the body overall. Not all Lupus patients test positive for DNA antibodies, but they are found in approximately 50%.

Ro/SS-A and La/SS-B Antibodies – Both of these are antibodies produced to fight proteins in the cells nucleus. They are linked to Sjögren’s syndrome, which occurs in some patients with Lupus.

Ro/SS-A antibodies are linked to Cutaneous Lupus, which is a photosensitive inflammation of the skin.

RNP antibodies (Ribonucleoproteins)- these antibodies attack proteins that are responsible for maintaining the cell’s chemical reactions and overall health. RNP antibodies may be present in numerous autoimmune illnesses.

Other Tests to Identify Inflammation

C-reactive protein (CRP) – This protein is produced by the liver. Patients with high CRP levels may be experiencing inflammation of the liver, which can be an indication of Lupus activity.

Erythrocyte sedimentation rate (Sed Rate)- The sedimentation rate is a test that gauges the level of inflammation in the body. With a high level of inflammation, the blood cells tend to clump together and move at a different rate of speed than normal blood cells.

Biopsies- A biopsy can be done to extract a sample of tissue and analyze it for signs if cellular damage. The skin and kidneys are common biopsy areas.

Complete Blood Count (CBC)- A CBC is a test that analyzes various components of the blood cells, including white blood cell, platelet and serum levels.

Urine Tests – When seeking to diagnose Lupus, urine tests are often performed to look for Proteinuria, which is protein being spilled into the urine stream. Also, the urine is examined to see if the kidneys are properly filtering waste. The presence of cellular waste in the urine can indicate kidney inflammation, which can be serious if not treated.

Lupus Complications

Systemic Lupus can affect any organ or system in the body. Prolonged inflammation of organ tissues or blood vessels can cause serious damage if left unchecked, some of it irreversible. Below are the most common systems affected by Lupus.

• Kidney involvement is one of the most common risks associated with SLE. The kidneys become inflamed under the attack of immune system antibodies. Prolonged inflammation can inhibit the kidney’s ability to filter waste from the blood. This is labeled as Lupus Nephritis and may eventually require dialysis. In severe cases, a kidney transplant may be required.
• Pulmonarycomplications are also common in systematic Lupus, but are of varying types. Chronic inflammation can cause problems with the sack surrounding the lungs (Pleuritis), Inflammation of the entire lung (Pneumonitis), the lining of the lungs, and blood clots in the lungs (Pulmonary Emboli).In the case of lung involvement, the physician will order chest x-rays or a CT-scan to assess the amount of inflammation and possible damage. Additionally, test such as a pulmonary function test will be conducted to assess the lung capacity of the patient. It is not uncommon for a Lupus patient to have reduced lung capacity relative to a healthy person.Anti-inflammatory drugs or corticosteroids are used to treat most lung problems, but in the case of infection or excess fluid in the lungs, drainage or antibiotics may become necessary.

• The MusculoskeletalSystem describes the network of bones, joints and muscles in the body. With lupus, any of these areas may be attacked by antibodies to varying degrees. 90% of Lupus patients complain of joint or muscle pain over the course of their illness and for approximately 50%, chronic joint pain is the first clue that something may be seriously amiss.Arthritisthat is usually associated with Lupus may be less severe and potentially deforming than rheumatoid Arthritis, but it can be very debilitating nonetheless. Lupus arthritis occurs when the joints and tendons become chronically inflamed, causing warmth, tenderness, stiffness and pain. Treatment for joint pain is usually comprised of non steroidal anti-inflammatory drugs (SNAIDs), low dose steroids or anti-malarial drugs, such as Plaquenil.Lupus sufferers are also at risk for Osteoporosis, a disorder which affects bone density. Certain medications prescribed for Lupus can weaken bones and reduce the body’s ability to rebuild them. Also, nutritional deficiencies in Calcium and Vitamin D can contribute to Osteoporosis. Smoking, hormonal fluctuations and being of Asian or Caucasian heritage also increase your risks of developing this disease.Musclepain due to inflammation is common in Lupus and especially more noticeable during a Lupus flare. Approximately 50% of patients complain of muscle tenderness or pain. This condition is often treated with anti-inflammatory drugs and possibly muscle relaxers to provide temporary relief.

  Muscle pain and weakness can also unfortunately be induced by some of the drugs used to treat Lupus, such as Plaquenil and prednisone. Discontinuing the medication and undergoing a period of physical therapy can help to restore muscle strength and function.

• Heart complications from Lupus include inflammation of all areas of the heart, including the lining (Pericarditis), blood vessels (Coronary vasculitis) and heart tissue (Myocarditis). Pericarditis is the most common heart complication for Lupus patients and its symptoms include chest pain that changes with movement, improving when you lean forward and intermittent shortness of breath. Heart problems are most commonly diagnosed through a combination of blood test and chest x-rays or electrocardiograms. Common treatment consists of anti-inflammatory drugs or corticosteroids.

• Blood Disorders can be present in those with Lupus. These include:

•  Anemia which is often characterized as a low red blood cell count, but more specifically speaks to a reduction in Hemoglobin, which is the protein inside blood cells that transport oxygen to various parts of the body. Anemia can cause chronic fatigue. Anemia can be prompted by some drugs used to treat Lupus, a lack of iron, or malfunctioning kidneys. If anemia is confirmed, the patient may be prescribed iron supplements, their Lupus medication may be adjusted, or they may be prescribed medication to stimulate an increased production of red blood cells.
• Thromobocytopenia is the term for a low blood platelet count. Blood platelets are housed in the bone marrow, but can be attacked by antibodies developed by a Lupus patient. As a result, the patient is more susceptible to nosebleeds, bruises and easy bleeding through the skin. Treatment for severe cases may include intravenous administration of gamma globulin or a spleenectomy. In most cases, the patent’s medication must be reevaluated to ensure it does not further stimulate bleeding.
• Leukopenia is the reduction of white blood cells and can lead to infection if not treated. This condition is often prompted by immunosuppressive drugs prescribed for Lupus. If a patient experiences Leukopenia, the doctor will likely temporarily reduce the medication dosage to allow the white blood cell count to be replenished.
• Thrombosisoccurs when the body’s normal clotting mechanism goes into overdrive, causing blood to thicken when there is no sign of an injury. These clots can potentially travel to the lungs, heart or brain and cause major blockages and ruptures of the blood vessels.Thrombosis is especially worrisome for pregnant Lupus patients, as the clots can travel to the placenta and disrupt blood flow to the fetus, resulting in low birth weight, abnormalities or even preterm death. This is often the result of antiphospholipid antibodies in the mother and it is critical for pregnant Lupus patients to be tested for this antibody. Thrombosis is usually treated with blood thinners, such as the prescription drug Warfarin, but it is not safe to use in pregnancy. Pregnant women will likely be prescribed heparin instead.

• Neurological InvolvementAs with any other body system, the Nervous System is also susceptible to damage from the chronic inflammatory characteristic of Lupus. The nervous system is comprised of three distinct parts and while symptoms may vary depending on location, treatment is usually comprised of anti-inflammatory drugs, steroid treatment or anti-malarial drugs. Neurological symptoms of Lupus can often occur, and then disappear. However, if the same area sustains too many inflammatory bouts, permanent damage is possible. It is promising to note that with early detection and treatment, long term complications can be avoided.

• The Central Nervous System (CNS)is the most well known of the three and is comprised of the brain and spinal chord. The symptoms of this form of neurological Lupus include headaches, seizures, depression, stroke, vision problems, confusion and difficulty concentrating.One of the more serious forms of CNS Lupus is CNS Vasulitis, which is severe inflammation of the brain’s blood vessels. Left unchecked, this can be potentially deadly. Patients who present with CNS Vasculitis are immediately admitted into the hospital and placed on corticosteroid therapy to reduce the inflammation and swelling.It is important some to note that some of the symptoms mentioned above (with the exception of CNS Vasculitis), can be produced as side affects of medication routinely prescribed to treat Lupus. Before a definitive diagnosis can be made, medicinal complications should be ruled out.

• The Peripheral Nervous System (PNS) controls sensation and movement of the body. With Lupus, these nerves may become inflamed or compressed by the inflamed tissue that surrounds them. This results in sensations such as facial pain, vision problems, drooping eyelids and ringing of the ears.

• The Autonomic Nervous(ANS) System is the part that regulates many of the body functions that we take for granted, including breathing, sensations of hot and cold, the body’s elimination functions, the release of certain hormones and muscle reaction and movement.The affects of Lupus on the ANS is that is sends confusing hyperactive messages to the body, prompting reactions such as diarrhea, vomiting, tingling and mental confusion. Symptoms usually subside with treatment by means of standard Lupus medication.

Treatment Options for Lupus

There are four main classes of drugs used to treat Lupus, with a fifth that has been introduced to treat the skin manifestations of the disease. They are:

NSAIDS- Non Steroidal Anti-inflammatory Drugs are used to treat mild cases of Lupus. They help to reduce and control inflammation and include brand names such as Motrin and Aleve.

Corticosteroids- are a powerful class of drugs, which work to reduce inflammation and to suppress an overactive immune system. Oral corticosteroids, which is the form most prescribed for Lupus have the most side affects. They include glaucoma, weight gain, elevated blood pressure, cataracts, reduced bone density, and the slower healing of wounds.

Anti-malarial Drugs- it has been found that one of the benefits of drugs that treat malaria is that it can help control the inflammation caused by a Lupus flare. The most commonly prescribed anti-malarial is Plaquenil.

Chemotherapy- is used in severe cases to combat a severely overacting and damaging autoimmune response. However, similar to cancer patients, chemotherapy can cause a number of side affects in Lupus patients, such as hair loss, nausea, skin problems and exhaustion.

Alternative & Holistic Remedies for Lupus

Detox Cleansing

In Alternative Medicine, illness is classified as the representation of an imbalance in the body, mind or spirit. In the case of Lupus, the body has become extremely toxic, to the point where the immune system sees it as an enemy to be attacked. Toxicity can be of the following types:

Diet- With the current Standard American Diet (SAD), people consume extremely large quantities of antibiotic injected meat, sugar and other simple carbohydrates, unhealthy fats and a myriad of artificial sweeteners, preservatives and coloring agents.

Over the years, this type of diet wears on the digestive system and the body as a whole. Everything that humans consume becomes building blocks for cells, tissue, blood and organs. If the food that is being consumed is more man made and chemically laden than natural and wholesome, it will affect the body over time. The nourishment that the cells receive is compromised, thus resulting in the formation of tissue that is compromised. When this gets to epidemic proportions in the body, the immune system will attack what it sees as compromised tissue. This brings about the inflammatory response in Lupus.

Environmental Toxins/Medication- In an industrial, high tech society, we inhale and come into contact with multiple toxins everyday. From toxins in the air to your favorite perfume, these chemicals are taken into your body and can have an adverse affect.

Additionally, most over the counter and prescription medications contain a number of synthesized chemicals. In addition to all of the side affects listed in small print, prolonged use over time can literally poison the body. By continuously infusing the body with chemical cocktails, it becomes like a cloudy fish tank. The body instigates an autoimmune response in a desperate effort to clean house.

Chronic Stress- In our hyper connected society, many people are unknowingly suffering from chronic stress. It may be from a high pressure job, a rigorous academic load, or obligation to family or the community. The tendency to overbook and overload ourselves leads the body to continuously remain in stress mode, with its fight or flight sense activated. This pumps a continuous stream of stress hormones into the blood stream, such as Cortisol and Adrenalin. These hormones are extremely useful when dealing with danger or temporary stress. However, is they are used continuously, they can poison the body.

How to Detox the Body

There are many ways to go about removing accumulated toxins from your system and replacing them with much needed nutrients. Amongst the most popular and effective are:

Juicing/Green Smoothies are often used as a detox mechanism. By combining the juice of pure and organic fruit and vegetables you give the body a liquid infusion of nutrients. Also, because you are not consuming solid foods for the most part, the body is able to save energy normally used for digestion and more easily assimilate nutrients through the colon walls and eliminate stale waste.

Depending on the individual, a juice/smoothie cleanse can last from 3 to 21 days. Some will incorporate a small amount of raw nutritious foods, such as salads along with the liquid juices, while others will stick to fluids such as vegetable broth. It is important for first time cleansers to do so under the guidance of a cleanse master and to understand that it may take multiple cleanses to fully rid their body of toxins and restore optimal health.

Story of Using Green Smoothies to Cure Lupus:

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Colon Cleansing and Colonic Irrigation are two very effective methods for removing impacted fecal matter that may have been stored for years and is now poisoning your body. With herbal colon cleansing, the individual usually takes some form of fiber supplement, usually mixed with juice or water in the morning. The fiber expands in the colon and works to gather old waste and push it through the intestines. Later that night, you may be directed to drink an herbal tea which usually contains Senna leaf, which has a laxative affect. This works to push out the consumed fiber and the waste it has gathered. Individuals will usually experience a strong urge to eliminate during the night or first thing in the morning.

Colonic Irrigation, or Colonic Hydrotherapy, as it is often called is the practice of allowing water to flow into the body through the anus and provide a deep cleansing to the intestinal tract. The amount of water can range from a few liters in an enema bag, or a few gallons using a professional hydrotherapy kit. The water gently, yet forcefully enters the colon, and when it drains out, brings waste with it. If the hydrotherapy session is being performed by a professional, often there will be a drainage system that immediately removes the waste. For optimal cleansing, it is recommended to schedule 3-6 hydrotherapy sessions, as each one will be able to reach further and pull out waste lodged deeper in the intestinal tract.

Colon cleansing aids your health due to the fact that the nutrients from food are released into the blood stream and cells through the walls of the intestines. However, if you consume a large amount of chemically laden food, the body instinctively tries to protect itself. Instead of releasing the toxins into the blood stream, it cocoons them in what is known as mucoid plaque- a jelly like substance, which can harden over time. This sticks to the walls of the intestines and over time festers, poisoning the colon and gut. Also, if this continues over a period of years, eventually some of the toxins begin to leak into the blood stream, where they are consumed by cells and can eventually compromise them, prompting an autoimmune response. Cleansing the intestine and colon regularly provides many benefits to Lupus patients, as well as the general public.

Other Holistic Lupus Remedies

While cleansing is the best way to minimize or eliminate Lupus symptoms, there are also other things that can be done to aid in providing relief.

Yoga is a beneficial exercise, especially for those that suffer from joint pain. Learning to breathe correctly, gently stretch and flex joints can provide much desired increase in flexibility and pain relief. There are specific yoga routines that can help reduce back pain, tension in the legs and arms and provide an overall relaxing experience.

Flaxseeds and Fish Oils both provide Omega fatty acids which help to reduce inflammation, lubricate joints and regulate the digestive tract. Flaxseeds can be added to salads and yoghurt, or the oil can be taken by the spoonful as a supplement.

Reducing Meat, Dairy and Sugar from your diet has also been shown to benefit lupus patients. The reason for this is that these items are relatively harder on the digestive system than other foods and they also have an acidic affect on the body, which throws off the bodies PH balance. In the case of sugar, it also causes problems with the pancreas and is stored as fat in the body. Many natural practitioners classify white sugar as a dietary poison which in its highly refined state, compromises the body’s ability to function correctly. Most meat on the other hand contains the antibiotics and growth hormones routinely given to factory farmed animals. When eaten, these chemicals transfer to your body and are integrated by your cells.

Reduce Stress and Establish a Support Network

One of the leading triggers of a Lupus flare is stress. A major component in reducing Lupus flares is to eliminate stress as much as possible from your life. While some amount of stress is normal, many individuals operate within an unhealthy zone. To reduce the impact stress has on your health, this may mean changing jobs, pulling back from community involvement, or learning how to say “no”. Often women diagnosed with Lupus are typical Type A personalities and are used to being in the lead. Once diagnosed with Lupus, however, it is important to your health to take a step back.

Also, Lupus has the ability to reduce the mobility of the individual and limit the tasks they are comfortably able to do on their own, especially during a flare. For these reasons, it is critical to have a good support network. Allowing others to help run errands, mind children, or just provide emotional support goes a long way in providing comfort in an illness that is often misunderstood and isolating. Because many of the symptoms of Lupus go undetected by the eye, it is important to establish boundaries for yourself and let others know when you are unwell.

Although Lupus is a chronic illness, there is hope for greatly improving your quality of life or even eliminating the disease altogether through integrative diet and lifestyle changes.

References:

Lupus Foundation of America: http://www.lupus.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Neonatal Lupus:   http://www.neonatallupus.com/neonatal-lupus.html
The British Medical Journal. The lupus syndrome induced by hydralazine: a common complication with low dose treatment: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1442447/
British Journal of Rheumatology. Systemic Sclerosis Complicated by Procainamide Induced Lupus and Antiphospholipid Syndrome: http://rheumatology.oxfordjournals.org/content/37/11/1236.full.pdf
Annals of Rheumatic Disease. Systemic Lupus Erythematosus Induced by Isoniazid http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004845/
Drugs.com. Isoniazid Side Affects: http://www.drugs.com/sfx/isoniazid-side-effects.html
Lupus Foundation of Colorodo. Questions and Answers: http://www.lupuscolorado.org/q&a.htm#children
Lupus.org. Childhood Lupus: http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutindividualized03.aspx?articleid=315&zoneid=87

The body responds to anemia and low oxygen delivery with neuronal nitric oxide synthase (nNOS), an enzyme which helps the body adapt and use oxygen more efficiently. Long-term however, anemia can cause damage, especially neurocognitively. There are two major types of anemia, ACD and IDA. The rare anemia disorders can be very complicated and require a hematologist’s expert opinion to diagnose.

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Types of Anemia

Anemia of Chronic Disease (ACD)

An underlying disorder or condition causes immune system activation and anemia. Inflammation mediates and decreases red blood cell count (RBC) production, and sometimes, existing RBCs may have a shortened life span. The term ACD is common but sometimes misleading, as the generic term is sometimes applied to anemic syndromes caused by drugs given for a condition. The usual definition encompasses:

• after major trauma and surgery
• acute and chronic infections
• autoimmune disorders
• other severe illnesses

New research suggests that anemia is an adaptive physiologic response to disease and patients may fare better if the anemia is NOT aggressively treated. Some scientists now believe that anemia treatment to raise hemoglobin levels may lead to earlier death and that physicians should do a better job in finding the exact cause of the anemia.

Iron-Deficient Anemia (IDA)

Diagnosis of IDA prompts an investigation into the cause. Iron deficiency results from excessive iron requirements (ex. athletes and pregnant women), inadequate iron intake (ex. low economic status), or increased iron loss (ex. menstruating women). Lack of iron in the body causes shortness of breath (dyspnea), pale skin color (pallor), fatigue, and appetite for non-food items. A clinical examination and a history interview attempts to find the underlying cause. About 25 percent of the population, mostly women and children, have iron deficiency without rising to the level of diagnosed IDA. Official classification of IDA includes low serum iron and other biomarkers including:

• Microcytic – abnormally small red blood cells.
• Hypochromic – decrease in the concentration of corpuscular hemoglobin.
• Low reticulocyte count – the body’s production of immature red blood cells.
• Increased total iron-binding capacity (TIBC) – transferrin’s ability to transport iron.
• Less than 16% transferrin saturation – the ratio of serum iron and total iron-binding capacity, multiplied by 100.
• Low serum ferritin – ferritin stores iron, and releases it in a controlled manner.

Sickle Cell Anemia– a hereditary disease which causes blood cells to form a crescent or sickle shape. These fragile cells cannot deliver enough oxygen to the tissues and often get stuck in the blood flow. This is a very severe and painful disease, often requiring hospitalization. Patients experience agonizing pain in the skeleton, chest, and/or abdomen. Patients may also have a high temperature, infection, pneumonia-like symptoms and heart problems. Sickle cell is handed down from parents to children. If one parent has the sickle cell gene, the child will be a carrier. If both parents have the sickle cell gene, the child will have sickle cell disease. Currently, scientists believe that the gene mutated many years ago in order to mount a defense against Malaria.

Aplastic Anemia – the bone marrow does not produce enough platelets, red blood cells and white blood cells. Often, no cause is identified, or the cause is an attack on the bone marrow by the white blood cells. In other cases, drugs or toxins can reduce the bone marrow’s ability to produce sufficient new cells.

Sideroplastic Anemia – may be a hereditary disease which is characterized by inefficient hemoglobin biosynthesis in the bone marrow. The hemoglobin fails to incorporate iron, or fails to sense iron and oxygen, resulting in deficits of normal levels of iron in cellular compartments.

Toxins or Mineral deficiencies – anemia symptoms can occur due to a copper deficiency, and lead or aluminum intoxication due to exposure to lead paint and other hazards. Some cases may be hereditary.

Iron Refractory Anemia – the gene TMPRSS6 is mutated and causes inhibition of iron absorption and iron release mechanisms.

Fanconi Anemia – a defect in the genes causes deficits in oxygen delivery, fighting infection and forming blood clots. The DNA is unable to repair itself because the FANCA protein cannot reach the cell nucleus. Patients often develop cancer and die by the age of thirty.

Congenital Dyserythropoietic Anemia – ineffective erythropoiesis (low concentration of hemoglobin and reduced amounts of reticulocytes) caused by a mutation in the SEC23B gene. Researchers believe that the mutation began around the time of the Roman empire in Italy.

Autoimmune Hemolytic Anemia – may begin very quickly and be very serious as the immune system attacks itself. Half of all cases have an unknown cause and the other half are caused by medications or another disease.

Diamond-Blackfan Anemia – mutations in the RPS19 gene are thought to cause some cases. Patients often have deformities and heart defects and are diagnosed within two years of birth. Patients live an average of 40 years.

Postpartum Anemia – about half of all women, as high as 80% of women in some countries, develop anemia after giving birth to a child. Women who were anemic before giving birth and women who suffer extreme blood loss during birth have the highest risk. Postpartum anemia is a major health problem for new mothers and may be partially responsible for postpartum depression and emotional instability.

Epidemiology

Chronic Anemia

The true number of chronic anemia cases may not be known, as many conditions and diseases cause immune system activation. About eighty percent of people who require hospitalization for serious conditions will develop anemia. Many chronic renal failure patients and rheumatoid arthritis patients have chronic anemia. About 10 percent of older people, who often have more diseases and poor diet, have chronic anemia.

Iron-Deficient Anemia

Iron deficiency anemia incidence varies greatly by country. Developed countries may have between 3 to 8 percent incidence in the population. Developing countries with lower economic status and nutritional deficiencies, may have as high as 80 percent incidence in the population. However, these rates are declining as governments are moving to fortify food products with iron. Blood loss is the most common precipitating event but other causes of IDA include:

• Inadequate diet
• Impaired absorption
• Heavy menstruation
• Athletic pursuits
• Blood donation
• Pregnancy
• Gastric surgery
• Celiac disease
• Gastrointestinal disorder
• Hiatal hernia
• Hemorrhoids
• H. pylori infection
• Unknown causes

Anemia Complications

Chronic Anemia results in serious complications including:

• Cardiac failure
• Angina
• Hypertension
• Acute renal failure
• Lung injury
• Tumor and Cancer
• Gastric Bypass Surgery
• Respiratory Disease
• Stroke
• Death

Iron-Deficient Anemia in pregnant women and children impairs the developing child and cannot always be repaired. Even mild anemia can have long-lasting effects on the brain and the body. Other complications for people of all ages, races and gender of include:

• Performance – athletes with iron deficiencies do not perform as well.
• Growth delays in infants and children.
• Developmental delay
• Cognitive impairment
• Mood disorders
• Learning problems and attention deficits
• Preterm births
• Heart failure

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Anemia Symptoms

Symptoms of mild, moderate or severe anemia of any cause:

• Pallor – looking pale or yellow color or looking different than normal.

• Fatigue – tiring easily or a rapid loss of energy.
• Weakness – not having enough energy or strength.
• Decreased exercise tolerance – feeling short of breath when attempting to exercise.
• Feeling dizzy or lightheaded.
• Passing out or fainting.
• Irregular heart beating.
• Having symptoms of an underlying disorder like fever, weight loss, night sweats, stiff joints, rash or hives.

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Anemia Diagnosis

Risk Factors

Chronic Anemia

• Being an intensive care patient in the hospital.
• Having an autoimmune disorder like rheumatoid arthritis and inflammatory bowel disease.
• Having cancer, a malignancy, or tumor.
• Having an infection.
• Having a major trauma or accident.
• Having surgery.
• Having a chronic disease.

Iron-Deficient Anemia

• Having a low socioeconomic status and nutritional deficits.
• Being a black women – white women have a 7 percent chance of anemia whereas black women have a 25 percent chance.
• Being pregnant – iron is lost each day with a net loss over nine months of about 680 mg of elemental iron.
• Giving birth.
• Eating a vegan diet – vegans and vegetarians have a 40 percent chance of being anemic.
• Having heavy periods – menorrhagia, fibroids and other bleeding disorders negatively affect iron status.
• Being on hemodialysis – iron deficiency occurs due to blood loss and poor iron absorption.
• Having celiac disease – half of all celiac disease patients have or will develop anemia.
• Having gastric surgery.
• Using NSAIDs – non-steroidal inflammatory drugs like ibuprofen, aspirin, and naproxen can cause ulcers and bleeding.
• Being obese.
• Having a Helicobacter Pylori infection.
• Having hookworm – some countries frequently see hookworm cases which cause anemia.
• Being an athlete.

Diagnostic Factors

Chronic Anemia

To diagnose chronic anemia, a physical examination is conducted, a medical history is taken and risk factors are assessed. Symptoms of an underlying disorder are usually found with an absence of bleeding and the extent of anemia is mild to moderate. Testing may become complex with further testing to ensure diagnostic certainty and rule out other causes. Hematology experts are commonly consulted in diagnosing chronic anemia.

Lab studies include a full blood count including hemoglobin, serum ferritin, and serum soluble transferrin receptor, FBC, peripheral blood smear, reticulocyte count, serum iron, TIBC, transferrin saturation, CRP, ESR, creatinine, LDH, and liver function.

Lab studies commonly indicate:

• normochromic or microcytic hypochromic anemia
• low absolute reticulocyte count
• low serum iron
• low TIBC
• low percent transferrin saturation
• elevated ferritin

Physical findings include:

• Symptoms of fatigue, weakness, shortness of breath, pallor, changes in activity levels or exercise tolerance.
• Symptoms of infection or autoimmune disorder like a stiff neck, joint pain, abdominal or bone pain, rash or hives, and breathing problems.
• Paleness in the eye bed (conjunctival pallor) the palms, palmar creases and nail beds.

Factors not found or likely due to another cause:

• Bleeding – if bleeding is present, a different protocol is initiated. Serum iron, TIBC, iron saturation, and ferritin tests rule out iron deficiency anemia.
• High alcohol intake – alcohol consumption is associated with folate or B12 deficiency.
• Exposure to chemicals, toxins or radiation. Specific and direct questioning about radiation, and chemical exposure is necessary.
• Drug or medication use known to cause anemia.
• Poor nutritional history.

Other Diagnostic Tests

• Bone marrow examination for evaluation of iron stores and bone marrow disorders.
• Renal insufficiency
• Thyroid disease
• Liver disease
• Serum B12 and folate tests for ruling out deficiency.

Iron-Deficient Anemia

Diagnosing iron deficient anemia involves a physical examination, a medical history, risk factor assessment and blood tests. Symptoms specific to iron deficiency are commonly found and a systematic search for bleeding is conducted. Symptoms specifically indicating iron deficiency include fatigue and pallor, but also include:

• Pica – a key factor and a craving for non-food items like ice, dirt or paint. About half of iron deficient patients have these abnormal cravings. Cravings are cured with iron replacement.
• Nail changes – about 30 percent have thinning nails, however some other conditions can cause this symptom.
• Hair loss – common symptom.
• Dysphagia – about 10 percent of patients have trouble swallowing.
• Muscular performance deficits – the time that exercise or maximum workload is tolerated decreases. Performance event times are decreased in comparison to normal subjects or previous performance. Performance is restored with iron replacement.
• Mouth and tongue – a burning tongue, bigger or smaller bumps on the tongue, or sores on the mouth commonly occur and are corrected with iron replacement.
• Gastric – gastritis and reduced acid secretion in the stomach.
• Restless legs syndrome – a key factor and common symptom of IDA.
• Lower GI tract irritability, rectal lesions, tumor or hemoroids.
• Growth impairment – infants, children and adolescents may not grow normally.
• Cognitive and behavioral impairment – attention deficits, memory, learning and negative behavioral conditions may sometimes occur.
• Heart failure – severe anemia can cause heart problems which often reverse with iron replacement.

Laboratory Testing

Initial laboratory testing includes:

• Full Blood Count (FBC) (including haemoglobin and haematocrit, platelet count, MCV, MCH, MCHC, red cell distribution width) and peripheral smear.
• Reticulocyte count.
• Iron profile.

Laboratory Blood Results for Iron Deficiency Anemia:

• Serum iron – low
• Total iron-binding capacity (TIBC) – increased
• Transferrin saturation – less than 16%
• Serum ferritin – low and less than 12 nanogram/mL.

Other Diagnostic Tests to determine bleeding:

• Bone marrow biopsy – most accurate test but often not necessary, as it is used mostly for patients who have an unclear blood studies.
• Urine testing – test for blood loss from the renal tract.
• Upper or lower endoscopy – for upper or lower GI symptoms like nausea, burping, constipation or change in bowel habits.
• Rectal exam – insufficiencies or malignancies found in about 1% of patients.
• Celiac disease tests
• Vaginal exam

Anemia Classification and Causes

Normal ranges vary slightly for men and women, and according to age and race. Classification is based on the number of oxygen transporting proteins in the blood:

• Life-threatening anemia: less than 6.5 g/dL
• Severe anemia: less than 8 g/dL
• Mild/moderate anemia: less than 8-11.0 g/dL
• Men older than age 15 years: less than 13 g/dL
• Women older than age 15 years: less than 12 g/dL
• Pregnant women: less than 11 g/dL
• Children 6 months to 5 years: 11 g/dL
• Children 5-11 years: 11.5 g/dL
• Children 12-13 years: 12 g/dL

Causes Found in Chronic Anemia

• cellulitis
• chronic kidney disease
• chronic pulmonary disease
• congestive heart failure
• dermatomyositis
• diabetes mellitus
• endocarditis
• fungal infections
• giant cell arteritis
• hepatitis
• HIV
• infection
• inflammatory bowel disease
• lymphoma
• malignancy
• multiple myeloma
• osteomyelitis
• pneumonia
• polymyalgia rheumatica
• pyelonephritis
• renal cell carcinoma
• rheumatoid arthritis
• scleroderma
• SLE
• soft tissue infections
• thrombosis
• trauma
• tuberculosis

Causes Found in Iron-Deficient Anemia

Iron deficiency and iron deficient anemia has four causes:

• Iron intake deficits because of inadequate diet.
• Impaired absorption of iron.
• Iron loss including bleeding, menstruation, blood donation, self-induced bleeding, dialusis and runner’s anemia
• Iron requirements increase due to athletic pursuits, pregnancy, or lactation.

Anemia Treatment

Chronic Anemia

Treatment for Anemia of Chronic Disease (ACD) seeks to improve or cure the underlying disorder or disease. Anemia levels usually correspond to the level or activity of the disease and treating the disease often cures the anemic condition. Treatment of the anemia is sometimes warranted and appropriate. Patients with a disease that cannot be treated and accompanied by non-severe anemia, often do not require aggressive treatment of anemia. Examples of these situations include excision of tumors, remission of malignancies, and recovery after infections. Monitoring and observation of the anemia is practiced in these cases.

Anemia is now understood to be an adaptive physiological condition whereby the body mounts a defense to disease by altering or blocking iron status. Iron circulation decreases in order to stop growth rate of infections, tumors or malignancies. Treatment of the anemia increases iron circulation and decreases the survival rate of the patient. These types of treatment decisions are often left with specialists. Treatment of the disease condition and anemia also depends on availability of treatment, insurance status and other economic factors.

Individual treatment plans will vary. The established protocol for chronic anemia patients does follow an established pattern however:

1/ Treatment of the underlying disease.
2/ Follow with observation of the patient, disease and blood levels.
3/ If the disease does not respond to treatment and/or the anemia continues and poses a risk like pulmonary disease or heart failure, secondary or adjunct treatment like RBC transfusion is initiated. Red blood cell transfusions raise anemia levels to normal. Some people may not be candidates for transfusions because transfusions may pose a risk or are not available. Some people have rare blood types or may have conscientious objections to transfusions. Risks possible with transfusions:

• acute hemolysis with shock
• allo-immunization
• delayed hemolytic transfusion reaction
• iron overload
• lung injury
• volume overload
• infectious disease transmission

4/ Erythropoiesis-stimulating agents (ESAs) – if transfusions are necessary long-term, ESAs are used alternatively to avoid transfusions. However, iron deficiency must be ruled out first. ESAs stimulate RBC production and are manufactured using recombinant DNA. Risks of ESA treatment are mild but include respiratory or cardiovascular events, tumor growth, and if hemoglobin levels are raised too high (>12 g/dL), the risk of early death increases. Hemoglobin levels are checked monthly, stabilized and treatment is discontinued if necessary, or if no improvement is seen after eight to twelve weeks.

ESAs can be a first option in some conditions:

• chronic kidney disease has a nearly 100 percent response rate.
• Non-myeloid malignancy with chemotherapy treatment.
• HIV treatment with zidovudine.
• Multiple myeloma has an 80% response rate.

ESAs

Epoetin alfa : 40,000 to 60,000 units subcutaneously once weekly.

Darbepoetin alfa : 200 to 300 micrograms subcutaneously once every 2 weeks.

5/ Supplemental Iron

Elemental iron supplementation may be needed during ESA therapy to increase iron saturation and hemoglobin and achieve an optimal response. Heart failure patients in particular, benefit from iron therapy. Intravenous iron is preferred over oral iron because optimizing ESA is contingent on raising transferring saturation to between 30 to 40 percent. Iron is not given to patients with infection, as iron may promote microorganism growth.

Iron Interventions

• Sodium ferric gluconate – doses of 62.5 mg intravenously once weekly or once every two weeks. This formula is preferred over iron dextran for less risky negative reactions.
• Iron dextran -dose depends on patient’s blood values and weight but doses are commonly 50 mg intravenously once weekly or 50 mg intravenously once every 2 weeks. A test dose is mandatory as a small number of patients have an anaphylactic reaction. Low molecular -weight iron dextran is preferred over high-molecular weight dextran.
• Sodium ferric gluconate complex : 62.5 mg intravenously once every 2 weeks
• Iron sucrose – doses of 50 mg intravenously once weekly or once every two weeks.

6/ Monitoring – seeks to control blood levels. Scrutiny depends on the nature of the underlying disease and treatment of choice.

Iron-Deficient Anemia

Treatment of iron-deficient anemia entails oral iron supplements. Iron is ingested for 3 to 6 months after retesting shows normal iron levels in the blood. Iron is better absorbed with vitamin C and meat. Calcium, fiber, tea, coffee and wine inhibit the absorption of oral iron. Some patients find iron is better tolerated in the intestinal system by taking a lower doses or taking liquid iron.

1/ Oral iron salts commonly used include

• ferrous sulphate : 2-3 mg/kg/day total divided in doses.
• ferrous gluconate : 2-3 mg/kg/day total divided in doses.
• ferrous fumarate : 2-3 mg/kg/day total divided in doses.

2/ Ascorbic acid – Vitamin C is recommended if iron absorption is poor. The dose is 500 mg orally two to three times daily.

3/ Intravenous (Parenteral) Iron – Some patients do not tolerate oral iron and have high volume iron losses and iron must be replaced intravenously.

• Iron dextran – a test dose must be given as some patients experience anaphylactic reactions, an extreme shock to the body. The dose depends on the patient’s blood profile and body weight.
• Ferric gluconate – has a less extreme reaction incidence. The dose is commonly 125 mg intravenously once weekly for 8 weeks.
• Iron sucrose – has similar adverse consequences as iron dextran. The dose is commonly 200 mg/dose five (5) times within a 14-day period.
• Ferumoxytol – used with iron deficiency and kidney disease. The dose is 510 mg intravenously as a single dose given an hour after dialysis.
• Ferric carboxymaltose : the dose depends on patient’s blood profile and body weight.

4/ Treatment failure with oral iron, vitamin C and intravenous iron needs further investigation into causes of bleeding.
5/ Red Cell Transfusion – transfusion is based on a clinical need and co-existing disease factors. Receiving transfusions does not eliminate the need for other iron supplements as transfusion does not raise iron levels significantly. Evidence is emerging that transfusions may be overused. Older, stored blood may have more negative consequences. However, transfusions are commonly used for patients who have chest pain or lightheadedness. Transfusions can improve symptoms and activity tolerance.
6/ Patients who do not respond to treatment and have debilitating symptoms are placed on bed rest.
7/ Monitoring – seeks to control blood levels and depends on the cause of the anemia and treatment of choice. Retesting occurs after 3 to 6 months and yearly afterwards.

Interfering Drugs and Supplements

Some medications and supplements interfere with iron absorption:

• calcium
• cholestyramine
• colestipol
• H2-receptor antagonists
• magnesium
• manganese
• neomycin
• quinolone antibiotics
• tetracyclines
• zinc

Anemia Prognosis

When the underlying cause of anemia is found and responsive to treatment, anemic conditions improve or resolve. If the anemia does not resolve following successful treatment of a condition, an investigation is necessary to find the second cause of anemia. If blood testing finds restored hemoglobin, an additional six months is needed to restore iron levels. In addition, if anemia is due to nutritional deficits, stopping iron supplements may cause anemia to return.

Anemia Prevention

Iron supplementation – for high risk people including those infants with low socio-economic status, low birth weight babies, pregnant women, those in developing countries, pre-term babies, black, Alaskan and Native American people. Children in high malaria countries are not recommended for iron supplementation. The World Health Organization recommends that all women of childbearing age, even adolescents, if living in a country with a high incidence of anemia, take supplements.

Dietary Intervention

Iron fortified foods are highly preferred and many governments seek to improve their food sources, especially iron fortified milk. Other fortified food includes orange juice and yogurt. Essential fatty acids, iron, zinc, copper, iodine, selenium, vitamins A, D, E, C, B1, B2, B6, and B12, folic acid, niacin and pantothenic acid have all been added to food. Another type of anemia, Vitamin deficiency anemia or megaloblastic anemia is caused by a lack of folic acid and vitamin B12 in the body. Rare cases of anemia have been cured with combinations of iron, certain vital amino acids, and proteins mixed into food. Two strategies for fortification of food:

• Enhance the food sources that are preferred and eaten in quantities. For instance, some countries eat large quantities of wheat, so governments find that enhancing wheat is simple, nutritionally effective, and cost effective.
• Enhance condiments that are preferred and commonly consumed. For instance, fish sauce, curry powder, salt, and sugar have been effectively fortified.

Iron absorption is dependent on the bioavailability of the iron and the other food items eaten at the same time.

• Increases absorption – vitamin C and red meat.
• Decreases absorption – polyphenols in some vegetables, tannins in tea and wine, phytates in bran, and calcium in dairy products.

Vitamin B12 and folic acid supplements are proven useful. Blackstrap molasses is a good source of iron, B vitamins, and minerals. Some herbal supplements are considered to promote health, but generally, a well- balanced diet is enough to prevent iron deficient anemia.

Other Interventions

Breastfeeding – is highly encouraged for the first six months of a baby’s life. After that, supplemental foods, especially iron rich foods, can be added but breast feeding should continue until the child is 2 years old. In addition, health advocates recommend that women wait at least 2 years before having another child. Breastfeeding and pregnancy is a negative condition affecting the mother’s health, the baby’s health and the gestating infant’s health.

Preventing Teen Pregnancy – may reduce anemia incidence because pregancy combined with adolescence, places a high demand for iron on both the mother and the child. The mother loses iron during birth and in the postpartum period, which also impacts the child who needs the iron from the mother’s breast milk. The combination of demands of adolescence, pregnancy, birth, postpartum and breastfeeding is particularly troubling to health advocates.

Emerging Possibilities

New Drugs

Anemia which occurs due to chemotherapy, trauma, sepsis, malaria, kidney dialysis sometimes do not respond to treatment but may respond to a new class of drugs. Scientists added a corticosteroid and a prolyl hydroxylase inhibitors (PHI) to burst forming unit-erythroids (BFU-Es) which made 300 times more red blood cells. They hope to use these drugs to treat chronic anemia, rare anemia and even hope to use them to reduce steroid use for other conditions.

Another alternative is administration of a drug with the protein Gas6. This protein has been shown to increase sensitivity to recombinant erythropoietin and increase cell signalling. These studies were conducted on mice, however researchers hope to duplicate their studies in humans. In mice, recombinant erythropoietin with the protein Gas6, or with protein Gas6 alone, was successful in treating chronic and acute anemia. The Gas6 protein worked to increase red blood cells to normal levels.

Goat Milk

Milk from goats has been found to have similar nutritional profiles as does human milk. Goat milk improves iron status because it aids iron absorption, regenerates hemoglobin, and minimizes the negative effect of calcium on iron absorption. Goat milk has more medium-chain fatty acids that provide good energy and low body fat storage.

Goat milk also provokes less allergic reactions because it contains less casein alpha 1 than cow’s milk. In addition, goat milk has more oligosaccharides that act as prebiotics and promote a good intestinal environment. Researchers consider it an excellent functional food rich in calcium, phosphorous, zinc and selenium. Some countries are using this new information and providing infant formulas made from goat milk.

Mathematical Model

Researchers at  Massachusetts General Hospital (MGH) and Harvard University have developed a mathematical model which can predict who is likely to develop anemia before the anemia occurs. They compressed clinical data into a small program to compare against the general population. The mathematical model simulates young and mature red cells, and how they develop over time. By comparing healthy cell development to common anemia types, they were able to predict  the development of iron-deficiency anemia. This model can be very important in finding causes of anemia like colon cancer in the critical window when treatment is effective.

Diagnostic Tests

• Urinary Hepcidin – this test can differentiate between iron deficiency anemia and anemia of chronic disease and is being evaluated by researchers.
• Hypochromic erythrocytes – percentages can be calculated manually, in hematology analyzers and is useful in identifying iron deficiency anemia
• Reticulocyte hemoglobin – red cell infants or baby hemoglobin cells decrease within the first few days of IDA. This test is highly sensitive but not widely available yet.
• Erythrocyte Protoporphyrin – immediately precedes hemoglobin and increases when iron in insufficient to form hemoglobin.
• Zinc protoporphyrin – elevated levels are found in iron deficiency anemia and chronic anemia. The test has medium sensitivity and medium to high specificity.
• Soluble transferrin receptor – can be used to differentiate between normal levels of iron and iron deficiency.

Related conditions

• Acute pyelonephritis
• Behcet’s syndrome
• Cellulitis
• Chronic renal failure
• Community-acquired pneumonia
• Crohn’s disease
• Giant cell arteritis
• Hepatitis A
• Hepatitis B
• Hepatitis C
• HIV infection
• Hodgkin’s lymphoma
• Hospital-acquired pneumonia
• Idiopathic inflammatory myopathies
• Infective endocarditis
• Multiple myeloma
• Non-Hodgkin’s lymphoma
• Osteomyelitis
• Polyarteritis nodosa
• Polymyalgia rheumatica
• Pulmonary tuberculosis
• Renal cell carcinoma
• Rheumatoid arthritis
• Sarcoidosis
• Systemic lupus erythematosus
• Systemic sclerosis (scleroderma)
• Systemic vasculitis
• Ulcerative colitis
• Urinary tract infections in men
• Urinary tract infections in women
• Wegener’s granulomatosis

References

http://www.ncbi.nlm.nih.gov/pubmed/21934611

http://www.stmichaelshospital.com/media/detail.php?source=media_releases/2011/20111003b_mr

http://www.physorg.com/news189363375.html

http://www.ncbi.nlm.nih.gov/pubmed/19786206

http://esciencenews.com/articles/2011/03/02/new.advances.genetic.studies.fanconi.anemia.patients

http://www.eurekalert.org/pub_releases/2011-10/i-id-stm100711.php

http://www.ncbi.nlm.nih.gov/pubmed/21710167

http://www.newswise.com/

http://www.eurekalert.org/pub_releases/2011-03/w-pws033111.php

http://www.sciencedaily.com/releases/2010/04/100419102423.htm

http://www.ncbi.nlm.nih.gov/pubmed/21974839

http://www.urmc.rochester.edu/news/story/index.cfm?id=3150

http://www.sciencedaily.com/releases/2011/03/110325024934.htm

http://www.ncbi.nlm.nih.gov/pubmed/21979835

http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/1-57881-020-5/en/

http://www.sciencedaily.com/releases/2011/10/111012124202.htm

http://www.ncbi.nlm.nih.gov/pubmed/21929634

http://www.physorg.com/news/2010-11-mathematical-life-red-blood-cells.html

http://www.foodproductdesign.com/news/2011/05/study-goat-milk-is-a-functional-food.aspx

http://www.wi.mit.edu/news/archives/2010/hl_1222.html

Causes and Prevention of Rotavirus Diarrhea

Occurring during the months of winter and spring in the United States Rotavirus is highly contagious.  Children who attend daycare or are hospitalized are at particular high risk of contracting it, but everyone is at risk.  This virus is easy spread by the hand to mouth method.   This virus can lay dormant in an infected person for several days and during this time it remains just as infectious as when there are active symptoms. The virus can be spread by anything touched by an infected person including toys, food, furnishings, doorknobs, the hand of a person who touched one of these items that was contaminated already and even through droplets that landed on a surface from a cough or sneeze.

• Frequently washing your hands and teaching your children good hand washing is a good way to help lessen the chances that your child will contract Rotavirus infection.
• Disinfect toys, especially if your child has siblings or playmates
• Use disinfectant wipes on doorknobs, telephones, stair rails, light switches, water faucet handles, toilet handles and seats, counters and furnishings in your home, especially during the spring and winter months
• Babies under the age of 32 weeks can receive an immunization for Rotavirus

Treatment of Rotavirus Diarrhea

No specific treatment is known for Rotavirus.  Since it is a virus, antibiotics do not treat the infection.  The virus will normally resolve itself within 3 to 8 days. Measures to treat the symptoms of the virus are mainly focused on preventing dehydration related to the rotavirus diarrhea.

Keep your child as comfortable as possible, offer as much oral fluids as they will accept, you may want to use fluids that contain electrolytes such as Pedialyte to help replace lost minerals and fluids. If severe diarrhea is present your child may require intravenous fluids to prevent or reverse dehydration.

Rotavirus Diarrhea can lead to Dehydration

Rotavirus diarrhea is caused by Rotavirus which is extremely contagious.  This factor of the virus can be very dangerous in that it can lead to dehydration.  Infants and small children will dehydrate faster than adults and therefore should be observed closely for symptoms of dehydration such as a dry mouth, crying without tears, a decrease in urination or no urination.  They may develop an elevated temperature and become lethargic, non responsive or just overly sleepy.  If your child is experiencing diarrhea and these symptoms are noticed you need to seek emergency care immediately.

Causes of Edema in the Lower Extremities

There are multiple causes of edema.  Identifying the cause is an important aspect of not only treatment but of prevention and getting early treatment for medical conditions which may be the cause of this symptom.

Edema in the lower extremities is common in many people who are on their feet a lot such as nurses, cashiers, hair dressers and others. This occurs when the veins in the lower extremities are not able to keep up with the demands of returning blood to the heart.  The arteries are pumping blood faster to the lower extremities than the veins can return it.  This can be caused by restrictive clothing, weak leg muscles, varicose veins, or diseased vessels in the lower legs.  If your job requires a lot of standing or walking, tries to plan frequent rest periods and elevate your legs while resting.  It is optimal that your legs are higher than your heart, but this may not be possible in the work environment.

Edema in the lower extremities can be the result of a blood clot or a tumor which obstructs the flow of blood through the vessel.  These can threaten your limbs and should be reported to your physician.  Some leg edema can be related to other conditions such as heart disease or congestive heart failure, liver or kidney disease. Any edema lasting more than a few days should be reported to your physician.

Symptoms of Edema in the Lower Extremities

You may notice your shoes are tighter on your feet, or that your ankles or calves are a little larger than normal.  You can press your finger tips into the tissue and remove them and it leaves an indentation, this is known as pitting edema.  Edema is identified by swelling in various areas of the body; sometimes removing the cause can alleviate the symptoms.

Treatment of Edema in the Lower Extremities

Treating edema means identifying the cause.  Once the cause is identified treatment can begin and be effective.  Treatment can be as simple as resting and elevating extremities or as complicated as removal or a clot.  Depending on if the edema is the result of another illness or condition you may require treatment for that condition to be able to relieve the symptom of edema.  It is very important that any edema lasting more than a day or two and not relieved with rest and elevation be evaluated by a doctor to help determine possible underlying causes.

Causes of Measles

Measles are very contagious.  The virus lives in the mucous contained in the throat or nose of the infected person.  An infected person is contagious from 4 days prior to showing symptoms until 4 days after they resolve.  If they sneeze or cough causing infected droplets to land on surfaces such as furniture, telephones or touch door knobs after they have particles on their hands the disease can be contracted if you also touch these surfaces and then touch your mouth or eyes for several hours.  Good hand washing and covering your mouth and nose when you cough or sneeze is essential.

Symptoms of Measles

The symptoms of measles will usually appear about 10 to 12 days after you have been exposed.

The symptoms of measles include:

• Fever
• Runny nose
• Dry cough
• Conjunctivitis, red and inflamed eyes
• Light sensitivity
• Skin rash that resembles large, flat blotches.  They often seem to flow into each other
• Koplik’s spots which appear as tiny white spots with bluish-white tinged centers inside the mouth on the cheek lining.

Treatment for Measles

If measles are already established there is not a treatment to cure them, they will run the course and care is taken to treat symptoms and prevent spreading the disease.

There are some treatments to protect those at high risk who may have been exposed to measles before they are established.

• Immune serum globulin can be given to women who are pregnant, people with weak immune systems and infants who have been exposed to the virus.  This is an injection of antibodies which can help defend against the infection developing or make the symptoms less severe if given within 6 days after being exposed.
• Post exposure vaccination is available within the first 72 hours of exposure for people who have not been immunized, this includes infants.  The post exposure vaccine is to provide protection against developing the infection and if it does still develop it can help make the symptoms less severe and shorten the duration.

If the infection is established treatment is in management of the symptoms.  Analgesics may be given for fevers and discomfort.  Some cases of measles will result in complications such as ear infections or pneumonia and if these develop they will be treated with antibiotics.  To prevent the spread of the virus due to it being highly contagious there is usually some type of isolation for the infected person.  Keeping them in one area of the home, assigning one bathroom for their use only can help prevent other household members from contracting measles.  Your physician should be able to tell you the measures you should take.

What is Sleep Bruxism?

Sleep Bruxism is a condition in which you may clench, grind or gnash your teeth while you sleep.  This condition can also occur unconsciously during the day, when you are not asleep, known as simply Bruxism.  It can be caused by a variety of reasons including both physical and psychological.  Some of the suspected causes include stress, suppressed frustration or anger, misalignment of the upper and lower teeth, it can be in response to ear pain or complications of other disease processes such as Parkinson’s or Huntington’s Disease.  Uncommonly, it is a side effect of some psychiatric medications.

Signs and Symptoms of Sleep Bruxism

Many people who have Sleep Bruxism may not even be aware of the disorder.  It is important to be aware of the signs and symptoms which can include:

• Chewed tissue inside your cheek or indentions on your tongue
• Frequent Headaches or Jaw Pain
• Grinding or clenching of the teeth, your sleep partner may be able to hear this, the sound can be loud enough to awaken them from sleep
• Damaged teeth – teeth may be chipped, fractured, worn down or flattened
• Tooth sensitivity
• Pain or tightness in your jaw muscles
• Chronic facial pain
• Earaches

Treatments for Sleep Bruxism

Sleep Bruxism may be mild and sometimes does not require any treatment. Some cases may be more frequent and severe leading to disorders of the jaw, damage to the teeth, headaches and other potential harmful conditions. Usually children who experience sleep Bruxism will outgrow it and most cases in adulthood can be managed by managing the cause and are usually not severe enough to require treatment.

If treatment is necessary it can include use of a dental splint or a mouth guard at night, these can be custom fit for your mouth by your dentist.  Correction of misaligned teeth or jaw can help if this was the cause.  If you have damaged your teeth you may require dental intervention to repair the damage and prevent further complications.

Sleep Bruxism caused by stress may be managed with stress management strategies such as relaxation, meditation, exercise or professional counseling.

Possible Causes of Pulmonary Arterial Hypertension

Due to the low incidence of its occurrence it has made it even more difficult to determine its cause.  Animal models are generally studied to help determine causes of disease, but with PAH an acceptable animal model has not been available to study.  There are theories as to the cause and it has been shown that people with certain conditions or exposure to some substances have a higher tendency for development of the condition.

Researchers believe that persons who have blood vessels that are particularly sensitive to certain external or internal factors which cause constriction of the vessels have an increased tendency for PAH.  People with Raynaud’s disease, a condition in which the toes and fingers of the individual turn blue when they are exposed to cold because of the extreme sensitivity of the blood vessels seem more likely to develop PAH than those without the condition.

The diet drug Fen-Phen has shown to have a significant association with the development of PAH.  Scientific studies have shown that the effect of the medication and development of the disease may not be apparent for several years after stopping the medication.

Other factors thought to influence the development of pulmonary arterial hypertension include the use of cocaine, pregnancy and HIV.  These factors can trigger constriction of the pulmonary artery which can result in PAH.  There has been some indications that the condition is inherited or that if you have a family history of PAH you may be at an increased risk for its development.  These causes are theories and observations, the exact cause or causes of PAH continue to be unknown.

Symptoms and Diagnosis of Pulmonary Arterial Hypertension

Symptoms of PAH are generally related to breathing. They may happen suddenly or slow progress over time.

• Progressive shortness of breath, this is especially noticeable with activity
• Breathing rapidly and hard, hyperventilation
• Fatigue
• Fainting
• Increased and progressive weakness of the muscles
• Dizziness or lightheadedness
• Cough up blood
• Cyanosis, this may begin gradually but progresses.

Diagnosis of PAH is not an easy task.  It is rare that it is noticed on routine medical examinations because the symptoms can be easily attributed to other conditions of the heart and lungs.  To make a diagnosis involves ruling out all other reasons for the symptoms.  The diagnosis can only be confirmed when other reasons for the high blood pressure in the lungs arteries such as blood clots in the lungs, chronic obstructive pulmonary disease, heart disease and other possible causes have been tested and eliminated as the source.

A physical examination by the physician may reveal a distention of the veins in the neck, water retention and swelling of the hands and feet or legs and an enlargement of the liver.  These findings are due to the difficulty of the right ventricle of the heart has trying to pump blood into the lungs blood vessels.

Other tests for the diagnosis and to determine the progress of the disease include:

• Electrocardiogram – This should show an enlargement of the right side of the heart.
• Chest X-Ray – This will also show enlargement of the heart and is a good way to monitor the condition as it progresses.
• Echocardiogram – This is an ultrasound of the heart.  This can measure the size of the heart and is also a good way to follow the diseases progression.  Sometimes the echocardiogram can estimate the pressure of the right ventricle of the heart and of the pulmonary arteries.
• Cardiac catheterization – This is an invasive procedure, but it is the best way to diagnose PAH.  With this procedure the physician is able to measure the pressures on the right ventricle and calculate the resistance of the lungs arteries.

Treatments for Pulmonary Arterial Hypertension

There are only two different options for treating pulmonary arterial hypertension.  These two options are medications and a lung transplant.

Multiple medications are used in the treatment of PAH.

• Prostacyclin analogues – medications which enable the blood vessels in the lungs to expand allowing the blood to move through them without as much resistance.
• Endothelin receptor antagonists – medications to help reverse the effects of a substance in the blood known as endothelin. Endothelin causes the blood vessels to constrict.
• Anticoagulants – medications used to prevent blood clotting.
• High dose calcium channel blockers – medication which promotes vasodilation by helping the muscles in the blood vessels to relax.
• Diuretics – medications which help to remove excess fluids from the body.  Excess fluid may accumulate due to the high pressures in the vessels.

Lung transplantation is also done to treat PAH.  The most common method is a single lung transplant where only one lung is transplanted.  Double lung transplants are done, but are less common. There are fewer complications with a single lung transplant but some complications include rejection of the organ by the body and infection.  When you have an organ transplanted you will take anti rejection medications for the rest of your lift to reduce the chance that your body’s immune system will reject the organ.

What is Schizophrenia?

Schizophrenia is a disorder of the brain that interferes with the way in which the affected person thinks, how they feel and act or react. This interference causes them difficulty in distinguishing what is imagined and what is real.  Because of their inability to make this distinction they can become delusional about themselves and those around them.

This condition can interfere with the person’s ability to experience emotions others might come by naturally in social relationships.  This can lead to withdrawal from socialization. This condition impacts ordered thinking.  This causes inability to concentrate and decreased attention span.

Symptoms of Schizophrenia

Symptoms of Schizophrenia are separated into four categories which include:

• Hallucinations – This includes seeing, smelling, hearing or tasting what is not there. The most common example of schizophrenic hallucination is hearing voices and the voice telling them to do or not to do specific things.
• Delusions – This category includes false beliefs about either themselves or those around them.  Thinking that someone is out to get them or harm them, watching them even when there is evidence to prove this is not the case. False beliefs about themselves such as believing they are from another planet or that they are someone other than themselves is a sign of delusion.
• Disorganized thinking and nonsensical speech – This disorder can cause communication problems.  The conversation can change from one topic to the next very rapidly.  Sentences may seem out of place or irrelevant, even contain made up words.
• Social Withdrawal and Apathy – Loss of interest in their surrounding or in life in general.  This is usually due to their emotional unresponsiveness and lack of motivation in social situations.

Treatment of Schizophrenia

This disorder is not curable, it is treatable however.  Symptoms can be managed with the use of antipsychotic medications.  Most patients respond rather quickly to the use of these medications.  If the patient is extremely depressed and withdrawn an antidepressant medication may be included in drug therapy to help reduce this symptom. Some patients are hospitalized initially until symptoms are manageable on an outpatient basis. It is important that the patient stay on the medication regimen as stopping the medications used to manage the symptoms will cause the return of the symptoms.

Individual talk and cognitive therapy is used in some cases to help teach coping strategies for stressful situations and thought processes. Family and social support is imperative and doctors can provide referrals to community support groups and services.

Although triglycerides are fats (a.k.a. lipids) are present in bloodstreams much like cholesterol, they differ from one another in that triglycerides provide energy while cholesterol is a crucial component in building cells and producing some hormones. Kept at appropriate levels, both, triglycerides and cholesterol are critical for good health. However, their access promotes heart disease and other health challenges.

Triglycerides and Health Issues

When individuals consume more calories than their bodies can use, triglycerides accumulate to unhealthful levels and high levels of triglycerides in the bloodstream has been directly associated with atherosclerosis. Atherosclerosis, which is a medical condition that is characterized by thickening of arterial walls due to the buildup of fatty matter, is then associated with heart disease, heart attack and stroke.

Also attributed to high levels of triglycerides is an inflammation of the pancreas (an organ of the digestive and endocrine systems) that is known as pancreatitis.

Triglycerides are, in a way, important measures of heart health and at high levels they are often manifested as obesity and the metabolic syndrome (a wide-scoping group of conditions such as surplus fat around the waist, high blood pressure (hypertension), high triglycerides, high blood sugar (diabetes) and high cholesterol levels.)

Often, high levels of triglycerides are directly caused by overeating of fatty foods but that is not always the case. In some patients, high triglycerides are caused by poorly controlled type 2 diabetes; an underactive thyroid (hypothyroidism); certain liver and/or kidney diseases; a genetic dysfunction which affects how the body converts fat to energy; or a side effect of some medications which may include beta blockers, birth control pills, diuretics, steroids or tamoxifen (a drug administered to breast cancer patients).

According to the American Heart Association and its guidelines for triglyceride levels; the normal levels of triglycerides are in ranges of less than 150 mg/dL and less than 1.69 mmol/L. Ranges of between 150 – 199 mg/dL and 1.70 – 2.25 mmol/L are borderline high levels of triglycerides. Anything beyond those borderline levels requires urgent attention.

Lowering Triglyceride Levels

The most effective ways for lowering triglyceride levels are:

1. Dieting. Weight loss and reduction of caloric intake by: (a) reducing or eliminating the intake of refined sugars and simple carbohydrates (processed sugars and white flour) which raise the production of insulin which, in turn, increases triglycerides; (b) reducing or eliminating the intake of foods which are high in cholesterol (red meats, saturated fats, egg yolks and dairy products); (c) replacing the consumption of saturated fats with monounsaturated which are found in olive, peanut and canola oils and fish; (d) staying away from trans fats that are found in fried foods and pre-packaged snacks; and (e) avoiding alcoholic beverage whose smallest amounts raise triglyceride levels significantly.

2. Participating in regular and routine daily exercise.

3. Controlling existing medical conditions, particularly diabetes and high blood pressure.

4. If all of the above are insufficient to lower high triglyceride levels, cholesterol lowering drugs such as niacin or fibrates may be prescribed.