Pathophysiology Mesothelioma

Pathophysiology


Diffuse pleural mesothelioma with extensive involvement of the pericardium.
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.
Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers). However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings. Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
•    Neurofibromatosis type 2 at 22q12
•    P16INK4A
•    P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
•    Inactivation of tumor suppressor genes
•    Activation of oncogenes
•    Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
•    Activation of DNA repair enzymes, which may be prone to error
•    Activation of telomerase
•    Prevention of apoptosis
Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
Treatment
The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.
Surgery
Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[31]
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[32] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
This technique is also used in patients with malignant pleural mesothelioma.

Multimodality Therapy
All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors. However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years) Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma. Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation. Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.

Epidemiology

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States. Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

Society and culture 

Famous victims
Mesothelioma, though rare, has had a number of notable patients.
•    Malcolm McLaren, former manager of New York Dolls and Sex Pistols, died on 8 April 2010.
•    Hamilton Jordan, Chief of Staff for U.S. President Jimmy Carter and lifelong cancer activist, died in 2008.
•    Richard J. Herrnstein, psychologist and co-author of The Bell Curve, died in 1994.
•    Australian anti-racism activist Bob Bellear died in 2005.
•    British science fiction writer Michael G. Coney, responsible for nearly 100 works, also died in 2005.
•    American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006.
•    Mickie Most, an English record producer, died of mesothelioma in 2003.
•    Paul Rudolph, American architect, died in 1997.
•    Bernie Banton, an Australian workers' rights activist, fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48 hours to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian federal election.
•    Actor Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen subsequently sought alternative treatments at clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in automobile racing suits (McQueen was an avid racing driver and fan).   United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder award is given yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
•    Rock and roll musician and songwriter Warren Zevon, after a long period of untreated illness and pain, was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments that he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind, including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
•    Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death. Hennessy's mesothelioma has been attributed to his younger years spent working on building sites in London.
•    Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation, died of mesothelioma in 1994.
•    Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years
•    Australian journalist and news presenter Peter Leonard of Canberra succumbed to the condition on September 23, 2008.
•    Terrence McCann, Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006, at his home in Dana Point, California.
•    Merlin Olsen, Pro Football Hall of Famer and television actor, died on March 10, 2010, from mesothelioma that had been diagnosed in 2009.
Notable people who have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote "The Median Isn't the Message"[45] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma. Author Paul Kraus was diagnosed with peritoneal mesothelioma in July 1997. He was given a prognosis of less than a year to live and used a variety of complementary modalities. He continues to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide" in which he presented his philosophy about healing and the decision making that led him to use integrative medicine.

Legal issues

Main article: Asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.[46] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.
History
The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. In 1960, an article published by Wagner et al. was seminal in establishing mesothelioma as a disease arising from exposure to asbestos. The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.[49] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker. The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.

Zoophobia: A Menagerie of Fears

The most common type of specific phobia is zoophobia or fear of animals. Zoophobia is actually a generic term that encompasses a group of phobias involving specific animals. Examples include arachnophobia -- fear of spiders; ophidiophobia -- fear of snakes; ornithophobia -- fear of birds, and apiphobia -- fear of bees. Such phobias often develop in childhood and sometimes go away as the child ages. But they can persist into adulthood.

Claustrophobia: Needing a Way Out

Claustrophobia, an abnormal fear of being in enclosed spaces, is a common specific phobia. A person with claustrophobia can't ride in elevators or go through tunnels without extreme anxiety. Afraid of suffocating or being trapped, the person will avoid tight spaces and often engage in "safety seeking behavior," such as opening windows or sitting near an exit. That may make the situation tolerable, but it doesn't relieve the fear.

Social Phobia: Beyond Being Shy

Someone with a social phobia is not just shy. That person feels extreme anxiety and fear about how he or she will perform in a social situation. Will her actions seem appropriate to others? Will others be able to tell he's anxious? Will the words be there when it's time to talk? Because untreated social phobia often leads to avoiding social contact, it can have a major negative impact on a person's relationships and professional life.

Agoraphobia: Fear of Public Places

The agora was a market and meeting place in ancient Greece. Someone with agoraphobia is afraid of being trapped in a public place or a place like a bridge or a line at the bank. The actual fear is of not being able to escape if anxiety gets too high. Agoraphobia affects twice as many women as men. Untreated, it can lead to someone becoming housebound. With treatment, nine out of every 10 people who follow through are helped.

The Three Kinds of Phobia

Hundreds of different phobias have been identified, including phobophobia or fear of phobias. But when talking about phobias, which are a kind of anxiety disorder, experts divide them into three categories -- agoraphobia, an intense anxiety in public places where an escape might be difficult; social phobia, a fear and avoidance of social situations; and specific phobia, an irrational fear of specific objects or situations.

Phobia

The Three Kinds of Phobia

Hundreds of different phobias have been identified, including phobophobia or fear of phobias. But when talking about phobias, which are a kind of anxiety disorder, experts divide them into three categories -- agoraphobia, an intense anxiety in public places where an escape might be difficult; social phobia, a fear and avoidance of social situations; and specific phobia, an irrational fear of specific objects or situations.

Omega-3 für gesündere Haut, Haare und Nägel

So viele wie ein Drittel der Menschen mit Diabetes haben ein Zustand der Haut im Zusammenhang mit ihrer Krankheit zu irgendeinem Zeitpunkt in ihrem Leben. In der Tat sind solche Probleme manchmal das erste Zeichen, dass eine Person Diabetes hat

Omega-3 könnte der Schlüssel zu einem gesünderen Haut, Haare und Nägel

Anzeichen dafür, dass Sie Omega-3-Mangel könnte trockene raue Flecken auf der Haut, trockenes Haar, weiche oder brüchige Nägel, kleine Unebenheiten auf der Rückseite der Oberarme und Beine, Ekzeme, Schuppen und trockene Augen sein. Omega-3-Mangel Symptome können von Ärzten übersehen werden, weil sie durch andere Krankheiten werden gemeinsam genutzt.

Wissenschaftler haben kürzlich einen Namen Omega-3-Mangel gegeben - es ist Modeerscheinungen oder Fatty Acid Deficiency Syndrome.

Arteriosklerose kann auch dazu führen, Hautprobleme

Atherosklerose ist die Verengung der Blutgefäße aus einer Verdickung der Gefäßwände durch Plaque-Bildung. Menschen mit Diabetes neigen dazu, Atherosklerose in jüngeren Jahren als andere Menschen zu tun bekommen. Während es betrifft oft die Blutgefäße in der Nähe des Herzens, können Arteriosklerose die Blutgefäße im ganzen Körper betreffen, einschließlich derer, die Blutversorgung der Haut.

Wenn die Blutgefäße der Haut eng werden, kommt es zu Veränderungen der Haut durch einen Mangel an Sauerstoff, wie Haarausfall, dünner und glänzende Haut besonders an den Schienbeinen, verdickt und verfärbt Zehennägel und kalte Haut. Weil Blut trägt den weißen Blutkörperchen, die Infektionen bekämpfen helfen, Beine und Füße von Atherosklerose betroffen langsamer heilen, wenn sie verletzt sind.

Omega-3 kann dazu beitragen, Atherosklerose

Die entzündungshemmende Wirkung von Omega-3-Fettsäuren können vor Arteriosklerose schützen. Mehrere Studien haben gezeigt, dass die tägliche Supplementierung mit so wenig wie 1 Gramm EPA und DHA kann deutlich verringert das Risiko der Entwicklung von Atherosklerose.  Neben der Verringerung des Risikos der Entwicklung von Atherosklerose, Omega-3-Fettsäuren, insbesondere DHA, auch das Fortschreiten der Erkrankung.

Halten Sie Ihren Diabetes unter Kontrolle ist der wichtigste Faktor bei der Verhinderung der Haut Komplikationen von Diabetes. Fügen Sie Omega-3-Fettsäuren zu Ihrem Arzt empfohlene tägliche Ernährung, Bewegung und Medikation Programm dazu beitragen, halten Sie Ihre Haut, Haare und Nägel suchen und sich gut anfühlt.

6 Common Depression Traps to Avoid

When Orion Lyonesse is getting depressed, she turns into a hermit. She doesn't want to leave the house (not even to pick up the mail), and she cuts off contact with her friends and family.

"The more I'm alone, the deeper the depression gets," Lyonesse, an artist and writer in Lake Stevens, Wash., tells WebMD in an email. "I don't even want to cuddle my cats!"

Avoiding social contact is a common pattern you might notice when falling into depression. Some people skip activities they normally enjoy and isolate themselves from the world. Others turn to alcohol or junk food to mask their pain and unhappiness.

Depression traps vary from person to person, but what they have in common is that they can serve to worsen your mood, perpetuating a vicious cycle. Here are six behavioral pitfalls that often accompany depression -- and how you can steer clear of them as you and your doctor or therapist work on getting back on track.

Battling Depression: Hope for the Holidays

Trap #1: Social Withdrawal

Social withdrawal is the most common telltale sign of depression.

"When we're clinically depressed, there's a very strong urge to pull away from others and to shut down," says Stephen Ilardi, PhD, author of books including The Depression Cure and associate professor of psychology at the University of Kansas. "It turns out to be the exact opposite of what we need."

"In depression, social isolation typically serves to worsen the illness and how we feel," Ilardi says. "Social withdrawal amplifies the brain's stress response. Social contact helps put the brakes on it."

The Fix: Gradually counteract social withdrawal by reaching out to your friends and family. Make a list of the people in your life you want to reconnect with and start by scheduling an activity.

Trap #2: Rumination

A major component of depression is rumination, which involves dwelling and brooding about themes like loss and failure that cause you to feel worse about yourself.

Rumination is a toxic process that leads to negative self-talk such as, "It's my own fault. Who would ever want me a friend?"

"There's a saying, 'When you're in your own mind, you're in enemy territory,'" says Mark Goulston, MD, psychiatrist and author of Get Out of Your Own Way. "You leave yourself open to those thoughts and the danger is believing them."

Rumination can also cause you to interpret neutral events in a negative fashion. For example, when you're buying groceries, you may notice that the checkout person smiles at the person in front of you but doesn't smile at you, so you perceive it as a slight.

 "When people are clinically depressed, they will typically spend a lot of time and energy rehearsing negative thoughts, often for long stretches of time," Ilardi says.

The Fix: Redirect your attention to a more absorbing activity, like a social engagement or reading a book.



Trap #3: Self-Medicating With Alcohol

Turning to alcohol or drugs to escape your woes is a pattern that can accompany depression, and it usually causes your depression to get worse.

Alcohol can sometimes relieve a little anxiety, especially social anxiety, but it has a depressing effect on the central nervous system, Goulston says. Plus, it can screw up your sleep.

"It's like a lot of things that we do to cope with feeling bad," he says. "They often make us feel better momentary, but in the long run, they hurt us."

The Fix: Talk to your doctor or health provider if you notice that your drinking habits are making you feel worse. Alcohol can interfere with antidepressants and anxiety medications.
 

Trap #4: Skipping Exercise

If you're the type of person who likes to go the gym regularly, dropping a series of workouts could signal that something's amiss in your life. The same goes for passing on activities -- such as swimming, yoga, or ballroom dancing -- that you once enjoyed.

When you're depressed, it's unlikely that you'll keep up with a regular exercise program, even though that may be just what the doctor ordered.

Exercise can be enormously therapeutic and beneficial, Ilardi says. Exercise has a powerful antidepressant effect because it boosts levels of serotonin and dopamine, two brain chemicals that often ebb when you're depressed.

"It's a paradoxical situation," Ilardi says. "Your body is capable of physical activity. The problem is your brain is not capable of initiating and getting you to do it."

The Fix: Ilardi recommends finding someone you can trust to help you initiate exercise -- a personal trainer, coach, or even a loved one. "It has to be someone who gets it, who is not going to nag you, but actually give you that prompting and encouragement and accountability," Ilardi says.\

Trap #5: Seeking Sugar Highs

When you're feeling down, you may find yourself craving sweets or junk food high in carbs and sugar.

Sugar does have mild mood-elevating properties, says Ilardi, but it's only temporary. Within two hours, blood glucose levels crash, which has a mood-depressing effect.

The Fix: Avoid sugar highs and the inevitable post-sugar crash. It's always wise to eat healthfully, but now more than ever, your mood can't afford to take the hit.

Trap #6: Negative Thinking

When you're depressed, you're prone to negative thinking and talking yourself out of trying new things.

You might say to yourself, "Well, even if I did A, B, and C, it probably wouldn't make me feel any better and it would be a real hassle, so why bother trying at all?"

"That's a huge trap," says Goulston. "If you race ahead and anticipate a negative result, which then causes you to stop trying at all, that is something that will rapidly accelerate your depression and deepen it."

The Fix: Don't get too attached to grim expectations. "You have more control over doing and not doing, than you have over what the result of actions will be," Goulston says. "But there is a much greater chance that if you do, then those results will be positive."


Further Reading:

    War Rougher on Young Soldiers
    Soldiers in Iraq Have More Migraines
    Iraq War Veterans Face Allergy Risks
    Soldiers' Concussions, PTSD Linked
    Iraq War Vets Note Mental Health Woes
    Iraq War Vets Return With Lung Disease
    Iraqi War Vets Face Mental Challenges
    See All Military Families Support Topics

Top Picks

    Learn to Manage Your Depression Better
    How Depression Affects Women
    Treatment-Resistant Depression: What Now?
    How to Cope With Antidepressant Side Effects
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Lung Treatments

Lung Treatments

• Thoracotomy : A surgery that enters the chest wall (thorax). Thoracotomy may be done to treat some serious lung conditions or to obtain a lung biopsy.
• Video-assisted thorascopic surgery (VATS): Less-invasive chest wall surgery using an endoscope (flexible tube with a camera on its end). VATS may be used to treat or diagnose various lung conditions.
• Chest tube (thoracostomy): A tube is inserted through an incision in the chest wall in order to drain fluid or air from around the lung.
• Pleurocentesis: A needle is placed into the chest cavity to drain fluid that's around the lung. A sample is usually examined to identify the cause.
• Antibiotics : Medicines that kill bacteria are used to treat most cases of pneumonia. Antibiotics are not effective against viruses.
• Antiviral drugs : When used soon after flu symptoms start, antiviral medicines can reduce the severity of influenza. Antiviral drugs are not effective against viral bronchitis.
• Bronchodilators : Inhaled medicines can help expand the airways (bronchi). This can reduce wheezing and shortness of breath in people with asthma or COPD.
• Corticosteroids : Inhaled or oral steroids can reduce inflammation and improve symptoms in asthma or COPD. Steroids can also be used to treat less common lung conditions caused by inflammation.
• Mechanical ventilation: People with severe attacks of lung disease may require a machine called a ventilator to assist breathing. The ventilator pumps in air through a tube inserted into the mouth or the neck.
• Continuous positive airway pressure ( CPAP): Air pressure applied by a machine through a mask keeps the airways open. It is used at night to treat sleep apnea, but it is also helpful for some people with COPD.
• Lung transplant : Surgical removal of diseased lungs and replacement with organ donor lungs. Severe COPD, pulmonary hypertension, and pulmonary fibrosis are sometimes treated with lung transplant.
• Lung resection: A diseased portion of the lung is removed through surgery. Most often, lung resection is used to treat lung cancer.
• Vasodilators: People with some forms of pulmonary hypertension may require long-term medicines to lower the pressure in their lungs. Often, these must be taken through a continuous infusion into the veins.
• Chemotherapy and radiation therapy: Lung cancer is often not curable with surgery. Chemotherapy and radiation therapy can help improve symptoms and sometimes extend life with lung cancer.

3 Steps to Take When You Quit Smoking

1.  Kick the Habit? How to Avoid Gaining Weight
   You don't have to gain a lot of weight when you quit smoking. Try these strategies to quit smoking without packing on pounds.
2.  Life without Cigarettes: The First Month
   Surviving Without Smoke: Your Survival Kit
   Quitting Smoking? How to get through the first 30 days.
3. Smoking Triggers
   Identify Your Personal Smoking Triggers
   Do you want a cigarette every time you have a drink? Or a cup of coffee? Find out how to avoid your personal smoking triggers.

Mobiltelefone können helfen unterentwickelten Nationen zu Diabetes zu überprüfen

"Telemedizin-Programme" könnte dazu beitragen, Patienten mit geringem Einkommen auf der ganzen Welt verwalten Diabetes und anderen chronischen Erkrankungen, eine neue Studie der Veterans Affairs Ann Arbor Healthcare System und der University of Michigan hat enthüllt. 

"Telemedizin-Programme haben gezeigt, dass sehr hilfreich sein in einer Vielzahl von Kontexten, aber eine der wichtigsten Einschränkungen für die Bereitstellung dieser Dienste in der Dritten Welt hat der Mangel an Infrastruktur," Autor John D. Piette, ein leitender Wissenschaftler bei der VA und Professor für Innere Medizin an der UM Medical School, gesagt hat. 

Cytos Biotechnology nutzt die breite Connectivity in Lateinamerika, stehen Forscher Handys mit Low-Cost-internet-basierte Telefongespräche in die Befragung durchführen. Der Dienst verwendet eine Cloud-Computing Ansatz, so dass das Programm von einem zentralen Standort kann auf Länder mit niedrigem Einkommen in der ganzen Welt, dass eine starke technologische Infrastruktur fehlt, bereitgestellt werden. Forscher mit dem eingeschriebenen Diabetikern aus einer Klinik in einem halb-ländlichen Gebiet von Honduras, auf wöchentlicher Basis, und half ihnen, ihre Fähigkeiten Diabetes-Management und allgemeine Gesundheit zu verbessern. 

Forscher angeblich bemerkt Verbesserung Patienten Hämoglobin A1C, ein Maß für die Blutzuckerkontrolle, während der sechsten Woche nach ihrer Studie. "Wir wollten zeigen, dass es möglich, einen High-Tech-Programm von UM zu sehr anfällig Patienten mit Diabetes liefern in Honduras, die nur lokale Handy-Service war", sagt Piette. Die Studie sagte der Dritten Welt steht vor einer Herz-Kreislauf-Krise wegen ihrer Abhängigkeit von Fast Food, und die Zahl der Menschen mit Diabetes in der ganzen Welt erwartet wachsen 285000000 bis 439000000 bis 2030. 

Piette Studie wurde beklatscht von vielen Veteranen. "Wir glauben, die Arbeit von Dr. Piette und seine Kollegen stellt einen wichtigen und nachhaltigen innovativen Meilenstein in der globalen Gesundheitspolitik Strategien zur Vorbeugung, Diagnose und Management von nicht-übertragbarer Krankheiten. Diese Arbeit steht wirklich die Chance, die Gesundheit von Millionen verbessern Menschen in einer relativ kurzen Zeit ", UM Global Health Director Sofia D. Merajver, sagte

Why Stress

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* Stress can be physical or mental.

* It can complicate diabetes by distracting you from proper care or affecting blood glucose levels directly.

* Learning to relax and making lifestyle changes can help reduce mental stress.

Stress results when something causes your body to behave as if it were under attack. Sources of stress can be physical, like injury or illness. Or they can be mental, like problems in your marriage, job, health, or finances.

When stress occurs, the body prepares to take action. This preparation is called the fight-or-flight response. In the fight-or-flight response, levels of many hormones shoot up. Their net effect is to make a lot of stored energy — glucose and fat — available to cells. These cells are then primed to help the body get away from danger.

In people who have diabetes, the fight-or-flight response does not work well. Insulin is not always able to let the extra energy into the cells, so glucose piles up in the blood.

How Stress Affects Diabetes

Many sources of stress are long-term threats. For example, it can take many months to recover from surgery. Stress hormones that are designed to deal with short-term danger stay turned on for a long time. As a result, long-term stress can cause long-term high blood glucose levels.

Many long-term sources of stress are mental. Your mind sometimes reacts to a harmless event as if it were a real threat. Like physical stress, mental stress can be short term: from taking a test to getting stuck in a traffic jam. It can also be long term: from working for a demanding boss to taking care of an aging parent. With mental stress, the body pumps out hormones to no avail. Neither fighting nor fleeing is any help when the "enemy" is your own mind.

In people with diabetes, stress can alter blood glucose levels in two ways:

* People under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals.

* Stress hormones may also alter blood glucose levels directly.

Scientists have studied the effects of stress on glucose levels in animals and people. Diabetic mice under physical or mental stress have elevated glucose levels. The effects in people with type 1 diabetes are more mixed. While most people's glucose levels go up with mental stress, others' glucose levels can go down. In people with type 2 diabetes, mental stress often raises blood glucose levels. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either type of diabetes.

It's easy to find out whether mental stress affects your glucose control. Before checking your glucose levels, write down a number rating your mental stress level on a scale of 1 to 10. Then write down your glucose level next to it. After a week or two, look for a pattern. Drawing a graph may help you see trends better. Do high stress levels often occur with high glucose levels, and low stress levels with low glucose levels? If so, stress may affect your glucose control.

Reducing Mental Stress

Making changes

You may be able to get rid of some stresses of life. If traffic upsets you, for example, maybe you can find a new route to work or leave home early enough to miss the traffic jams. If your job drives you crazy, apply for a transfer if you can, or possibly discuss with your boss how to improve things. As a last resort, you can look for another job. If you are at odds with a friend or relative, you can make the first move to patch things up. For such problems, stress may be a sign that something needs to change.

There are other ways to fight stress as well:

* Start an exercise program or join a sports team.

* Take dance lessons or join a dancing club.

* Start a new hobby or learn a new craft.

* Volunteer at a hospital or charity.

Coping Style

Something else that affects people's responses to stress is coping style. Coping style is how a person deals with stress. For example, some people have a problem-solving attitude. They say to themselves, "What can I do about this problem?" They try to change their situation to get rid of the stress.

Other people talk themselves into accepting the problem as okay. They say to themselves, "This problem really isn't so bad after all."

These two methods of coping are usually helpful. People who use them tend to have less blood glucose elevation in response to mental stress.

Learning to Relax

For some people with diabetes, controlling stress with relaxation therapy seems to help, though it is more likely to help people with type 2 diabetes than people with type 1 diabetes. This difference makes sense. Stress blocks the body from releasing insulin in people with type 2 diabetes, so cutting stress may be more helpful for these people. People with type 1 diabetes don't make insulin, so stress reduction doesn't have this effect. Some people with type 2 diabetes may also be more sensitive to some of the stress hormones. Relaxing can help by blunting this sensitivity.

There are many ways to help yourself relax:

* Breathing exercises

Sit or lie down and uncross your legs and arms. Take in a deep breath. Then push out as much air as you can. Breathe in and out again, this time relaxing your muscles on purpose while breathing out. Keep breathing and relaxing for 5 to 20 minutes at a time. Do the breathing exercises at least once a day.

* Progressive relaxation therapy

In this technique, which you can learn in a clinic or from an audio tape, you tense muscles, then relax them.

* Exercise

Another way to relax your body is by moving it through a wide range of motion. Three ways to loosen up through movement are circling, stretching, and shaking parts of your body. To make this exercise more fun, move with music.

* Replace bad thoughts with good ones

Each time you notice a bad thought, purposefully think of something that makes you happy or proud. Or memorize a poem, prayer, or quote and use it to replace a bad thought.

Whatever method you choose to relax, practice it. Just as it takes weeks or months of practice to learn a new sport, it takes practice to learn relaxation.

Dealing with Diabetes-Related Stress

Some sources of stress are never going to go away, no matter what you do. Having diabetes is one of those. Still, there are ways to reduce the stresses of living with diabetes. Support groups can help. Knowing other people in the same situation helps you feel less alone. You can also learn other people's hints for coping with problems. Making friends in a support group can lighten the burden of diabetes-related stresses.

Dealing directly with diabetes care issues can also help. Think about the aspects of life with diabetes that are the most stressful for you. It might be taking your medication, or checking your blood glucose levels regularly, or exercising, or eating as you should.

If you need help with any of these issues, ask a member of your diabetes team for a referral. Sometimes stress can be so severe that you feel overwhelmed. Then, counseling or psychotherapy might help. Talking with a therapist may help you come to grips with your problems. You may learn new ways of coping or new ways of changing your behavior.

What is a Pinched Nerve?

Many people think of a pinched nerve as that sharp discomfort in the neck or back that sometimes comes after a long day stooped in front of a computer screen, or after a long night sleeping with the head at an awkward angle on a less-than-supportive pillow. In most cases, though, this sharp pain – which can feel like someone is poking you with a meat thermometer – is nothing more than tight or strained muscles. Sometimes, the pain might be caused by a sprained ligament, as when the neck or back is jolted during a hard collision. While a muscle strain or ligament sprain might feel like a pinched nerve, the condition itself actually is much more complicated.

The Anatomy Of The Spine

An actual pinched nerve in the neck or back is exactly what it sounds like – compression, or impingement, of a spinal nerve by surrounding tissues. This can occur at any level of the spine and can cause localized pain, radiating pain, tingling, numbness, and muscle weakness, cramping, and spasms.

How does a pinched nerve happen? There are a number of potential causes, most of which involve the effect of the aging process on the spinal anatomy. Before delving into the potential causes of nerve compression, it’s important to have a basic knowledge of the spinal anatomy:

• Vertebrae – These are the bony building blocks of the spine, stacked from the neck (cervical region) to the lower back (lumbosacral region). There are a total of 33 vertebrae in the spine (seven cervical, 12 thoracic, five lumbar, five fused sacral, and four fused coccygeal). The vertebrae help keep the body upright and flexible while protecting spinal cord.

• Facet joints – Jutting off the sides of the vertebrae are joints where the vertebrae meet and move.

• Intervertebral discs – These sponge-like wedges provide cushioning between the vertebrae and serve as “springs” to allow for spinal flexibility. They are composed of a gel-like middle (nucleus pulposus) and a tough, cartilaginous outer wall (annulus fibrosus).

• Ligaments and muscles – These are connective tissues that hold everything together and support range of motion.

• The spinal cord – This long bundle of nerve tissue is part of the central nervous system and serves as a conduit between the brain and the peripheral nervous system.

• Nerve roots – At every level of the spine, nerve roots branch off the spinal cord and pass through openings in the vertebrae called foramina. These roots conduct sensory and motor signals between the peripheral nervous system and the spinal cord.

As the body ages, all of these anatomical components are subject to wear and tear. Discs lose water content and become brittle. The cartilage that lines the joints begins to deteriorate. Ligaments begin to thicken and ossify. As this happens, the structural integrity of the spine begins to break down. This places the spinal cord and nerve roots at risk for compression.

Why Does Spinal Degeneration Cause A Pinched Nerve?

Because the spinal column is such a tight fit for the spinal cord and nerve roots, any change in physical structure can produce nerve compression. Any number of age-related degenerative spine conditions could be the culprit – spinal stenosis, bulging or herniated intervertebral discs, osteoarthritis, bone spurs, and more. Nerve compression also can be caused by injury (such as a back or neck injury caused by a fall or car accident), although it is more frequently related to the natural aging process.

Sleep Apnea

Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain -- and the rest of the body -- may not get enough oxygen.  

There are two types of sleep apnea:

• Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
• Central sleep apnea: Unlike OSA, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

Am I at Risk for Sleep Apnea?

Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:

• Male gender
• Being overweight
• Being over the age of forty
• Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
• Having large tonsils, a large tongue, or a small jaw bone
• Having a family history of sleep apnea
• Gastroesophageal reflux, or GERD
• Nasal obstruction due to a deviated septum, allergies, or sinus problems
  

 What Are the Effects of Sleep Apnea?
If left untreated, sleep apnea can result in a growing number of health problems including:

• High blood pressure
• Stroke
• Heart failure, irregular heart beats, and heart attacks
• Diabetes
• Depression
• Worsening of ADHD 

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.

How common is lung cancer?

Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. The American Cancer Society estimates that 219,440 new cases of lung cancer in the U.S. will be diagnosed and 159,390 deaths due to lung cancer will occur in 2009. According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. will be diagnosed with cancer of the lung at some point in their lifetime.

Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age.

Lung cancer was not common prior to the 1930s but increased dramatically over the following decades as tobacco smoking increased. In many developing countries, the incidence of lung cancer is beginning to fall following public education about the dangers of cigarette smoking and the introduction of effective smoking-cessation programs. Nevertheless, lung cancer remains among the most common types of cancers in both men and women worldwide. In the U.S., lung cancer has surpassed breast cancer as the most common cause of cancer-related deaths in women.

What causes lung cancer?

Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked and the time over which smoking has occurred; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10-pack-year smoking history, those with 30-pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.

Pipe and cigar smoking also can cause lung cancer, although the risk is not as high as with cigarette smoking. Thus, while someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.

Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking.

Passive smoking

Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or working quarters with smokers, also is an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with nonsmokers who do not reside with a smoker. An estimated 3,000 lung cancer deaths that occur each year in the U.S. are attributable to passive smoking.

Asbestos fibers

Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following exposure to asbestos. The workplace is a common source of exposure to asbestos fibers, as asbestos was widely used in the past as both thermal and acoustic insulation. Today, asbestos use is limited or banned in many countries, including the U.S. Both lung cancer and mesothelioma (cancer of the pleura of the lung as well as of the lining of the abdominal cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking drastically increases the chance of developing an asbestos-related lung cancer in workers exposed to asbestos. Asbestos workers who do not smoke have a fivefold greater risk of developing lung cancer than nonsmokers, but asbestos workers who smoke have a risk that is 50- to 90-fold greater than nonsmokers.

Radon gas

Radon gas is a natural, chemically inert gas that is a natural decay product of uranium. Uranium decays to form products, including radon, that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung-cancer deaths attributable to radon gas, or about 20,000 lung-cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatly increases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. The U.S. Environmental Protection Agency estimates that one out of every 15 homes in the U.S. contains dangerous levels of radon gas. Radon gas is invisible and odorless, but it can be detected with simple test kits.

Familial predisposition

While the majority of lung cancers are associated with tobacco smoking, the fact that not all smokers eventually develop lung cancer suggests that other factors, such as individual genetic susceptibility, may play a role in the causation of lung cancer. Numerous studies have shown that lung cancer is more likely to occur in both smoking and non-smoking relatives of those who have had lung cancer than in the general population. Recently, the largest genetic study of lung cancer ever conducted, involving over 10,000 people from 18 countries and led by the International Agency for Research on Cancer (IARC), identified a small region in the genome (DNA) that contains genes that appear to confer an increased susceptibility to lung cancer in smokers. The specific genes, located the q arm of chromosome 15, code for proteins that interact with nicotine and other tobacco toxins (nicotinic acetylcholine receptor genes).

Lung diseases

The presence of certain diseases of the lung, notably chronic obstructive pulmonary disease (COPD), is associated with an increased risk (four- to sixfold the risk of a nonsmoker) for the development of lung cancer even after the effects of concomitant cigarette smoking are excluded.

Prior history of lung cancer

Survivors of lung cancer have a greater risk of developing a second lung cancer than the general population has of developing a first lung cancer. Survivors of non-small cell lung cancers (NSCLCs, see below) have an additive risk of 1%-2% per year for developing a second lung cancer. In survivors of small cell lung cancers (SCLCs, see below), the risk for development of second lung cancers approaches 6% per year.

Air pollution

Air pollution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged exposure to highly polluted air can carry a risk for the development of lung cancer similar to that of passive smoking.

What Is Stroke?

What is a stroke?

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.
What are the symptoms?

Symptoms of a stroke happen quickly. A stroke may cause:

    * Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
    * Sudden vision changes.
    * Sudden trouble speaking.
    * Sudden confusion or trouble understanding simple statements.
    * Sudden problems with walking or balance.
    * A sudden, severe headache that is different from past headaches.

If you have any of these symptoms, call911or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.
What causes a stroke?

There are two types of stroke:

    * An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say "iss-KEE-mick") strokes. They are the most common type of stroke in older adults.
    * A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic (say "heh-muh-RAH-jick") strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

You need to see a doctor right away. If a stroke is diagnosed quickly-right after symptoms start-doctors may be able to use medicines that can help you recover better.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

What Increases Your Risk

Risk factors for stroke include those you can change and those you can't change.

Certain diseases or conditions increase your risk of stroke. These include:

* High blood pressure (hypertension). High blood pressure is the second most important stroke risk factor after age. It is a risk factor you can change.

* Diabetes. Having diabetes doubles your risk of stroke because of the circulation problems associated with the disease.

* High cholesterol. High cholesterol can lead to hardening of your arteries (atherosclerosis). Hardening of the arteries can cause coronary artery disease and heart attack, which can damage the heart muscle and increase your risk for stroke.

* Coronary artery disease, which can lead to heart attack and stroke.

* Other heart conditions, such as atrial fibrillation, endocarditis, heart valve conditions, patent foramen ovale, or heart failure.

* Peripheral arterial disease, for example narrowing of the carotid artery (carotid artery stenosis).

Certain behaviors can increase your risk of stroke. These include:

* Smoking, including secondhand smoke.

* Physical inactivity.

* Being overweight.

* Diet with few fruits and vegetables. Research suggests that people who eat more fruits, vegetables, fish, and whole grains (for example, brown rice) may have a lower risk of stroke than people who eat lots of red meat, processed foods such as lunch meat, and refined grains (for example, white flour).2

* Diet with too much salt. A healthy diet includes less than 2,300 mg of sodium a day (about one teaspoon).

* Use of some medicines, such as birth control pills-especially by women who smoke or have a history of blood-clotting problems. In postmenopausal women, hormone replacement therapy has been shown to slightly increase the risk of stroke.3

* Heavy use of alcohol. People who drink alcohol excessively, especially people who binge drink, are more likely to have a stroke. Binge drinking is defined as drinking more than 5 drinks in a short period of time.

* Illegal drug use (such as a stimulant, like cocaine).

Risk factors you cannot change include:

* Age. The risk of stroke increases with age.

* Race. African Americans, Native Americans, and Alaskan Natives have a higher risk than those of other races. Compared with whites, African Americans have about 2 times the risk of a first ischemic stroke. And African-American men and women are more likely to die from stroke.4

* Gender. Stroke is more common in men than women until age 75, when more women than men have strokes. Because women live longer than men, more women than men die of stroke.4

* Family history. The risk for stroke is greater if a parent, brother, or sister has had a stroke or transient ischemic attack (TIA). For more information, see the topic Transient Ischemic Attack (TIA).

* History of stroke or TIA.

Diagnosing menopause

Diagnosis & Tests


Diagnosing menopause isn't always easy. Learn about how menopause is sometimes diagnosed, and about tests you'll want to take as your body changes.
Diagnosis
Diagnosing Menopause

How do you know you're entering menopause? Are there tests that diagnose menopause? Find out here.
Tests
Home Menopause Testing Kits: Are They Worth It?

Home menopause test kits help you measure your body's follicle-stimulating hormone (FSH) levels, with the goal of helping you check for symptoms of perimenopause and menopause. Do they work? One expert tells why she doesn't think so.
Related Guide: Menopause and FSH Tests

A follicle stimulating hormone (FSH) test measures the amount of FSH in a woman's blood and may help determine whether she has gone through menopause. Learn more in this in-depth article.
Related Web Site: Evaluation of Premature Ovarian Failure

See what needs to be looked at and why if you have early menopause. This link will take you to another site.
Bone Mineral Density Testing During Menopause

Your osteoporosis risks increase after menopause. A bone mineral density test, or bone densitometry, can quickly measure the amount of calcium in your bones. Find out why you need this test, how to prepare for it, and the several ways it can be performed.
Breast Self-exam and Menopause

Age increases our breast cancer risks. The most effective way to fight breast cancer is to detect it early, through breast self-exams and mammograms. This article offers easy-to-follow tips on performing a breast self-exam.
Menopause and Mammogram Testing

Breast cancer risks increase as we age, so the best way to fight back is through early detection via mammograms and breast self-exams. Mammography uses special X-ray images to detect changes in breast tissue. Learn how to prepare for a mammogram, how often to get one, and what happens after the test.
Why Do You Need a Pelvic Exam?

The risk of cancer increases with age, so regular pelvic exams may help in early detection of certain cancers like ovarian cancer. Find out how often you need a pelvic exam, how the test is performed, and what other tests may be taken at the same time.
Menopause and Pap Tests

A pap smear is your best tool to detect precancerous conditions and hidden tumors that may lead to cervical cancer. How often should you have a pap smear after menopause? What symptoms should you watch for between tests? Learn here.

Study Suggests Exposure to Chemicals Called PFCs May Be Associated With Earlier Menopause

Women exposed to high levels of chemicals called perfluorocarbons (PFCs) may enter menopause earlier, new research suggests.

PFCs are man-made chemicals found in many household products such as food containers and stain-resistant clothing as well as in water, soil, and plants.

''Before this study, there was strong evidence from animal research that PFCs were endocrine disruptors," says researcher Sarah Knox, PhD, professor of epidemiology at the West Virginia University School of Medicine, Morgantown.

For the study, she evaluated the levels of two PFCs, called PFOS (perfluorooctane sulfonate) and PFOA (perfluorooctanoate) in nearly 26,000 women, ages 18 to 65.

Overall, she found, ''the higher the perfluorocarbons, the earlier the menopause." Women between ages 42 and 64 with the highest blood levels of the PFCs were more likely to have experienced menopause than those with the lowest levels.

One of the chemicals, PFOS, affected levels of the hormone estradiol, a form of estrogen. "The higher the levels of PFOS, the lower the levels of estradiol," she says. As estradiol declines, menopause approaches.

The research is published in the Journal of Clinical Endocrinology & Metabolism.

PFCs and Menopause

The 26,000 women were participants in the C8 Health Project. It collected information on more than 69,000 people from six public water districts contaminated by PFOAs from the DuPont Washington Works Plant near Parkersburg, W. Va., between August 2005 and August 2006. (C8 is another name for PFOA).

The work was funded by the settlement agreement arising from the water contamination case, Leach vs. E.I.Dupont de Nemours & Co.

Knox asked each woman about her menopausal status and then looked at blood levels of the PFCs. She found an association between high blood levels and menopause onset, she says, but not cause and effect.

For instance, women in the over 42 to 51 age group with the highest levels of PFCs were 40% more likely to have experienced menopause compared to those women in the same age group with the lowest levels of PFCs.

She also compared their blood levels of PFCs with those in the general population, using data from the NHANES survey (National Health and Nutrition Examination Survey), which reflects the U.S. population.

While PFOA levels were higher in her research participants, their PFOS levels were similar to those in the general population.

The median age of menopause is 51 (half of women go through earlier, half later), Knox says. Early menopause before the age of 40 is linked with increased risks of heart disease and with bone loss, which can raise the risk of osteoporosis.

A reverse association is possible, Knox says. Monthly menstruation eliminates some of the PFCs from the body. Early menopause may cause PFC levels in the blood to rise, she says, as monthly menstruation stops.

However, she says, even if the association is reversed, the levels are a concern, she says.

Among the study limitations is its ''snapshot in time'' factor, as it looked only at exposure at one point.

PFCs have been a concern of environmentalists for years, says Olga Naidenko, PhD, a senior scientist at the Environmental Working Group, Washington. She reviewed the study findings for WebMD.

''This is the first study to our knowledge that looks specifically at menopause timing. It really demonstrates that these kinds of chemical are very toxic."

One strength of the study is its size, says Jennifer Sass, PhD, senior scientist for the Natural Resources Defense Council, who also reviewed the findings.

"This study raises some red flags regarding a common chemical pollutant that is found in the bodies of most Americans," says Sass. "I hope that more research can be done to understand the effect better."

Industry Perspective

A spokeswoman for DuPont took exception with using the term PFCs. The term PFCs ''is not well defined and is overly broad," says Janet E. Smith of DuPont. "There are many chemicals that could potentially fall under that umbrella and they have very different properties and health profiles."

DuPont does not make PFOS or use it in its processes or product, she says. She points out that Knox found no link between PFOA and hormone levels. The company does make products with PFOA, she says.

3M decided in May 2000 to phase out production of PFOA, PFOS and PFOS-related products after research found PFOS was widely dispersed in wildlife and found in low levels in people, according to the company’s web site.

To avoid exposure, Knox suggests avoiding stain-resistant, water-resistant, and fire-retardant products. Some food containers may also have PFCs.

"Eventually we are going to have to have a policy about reducing these," she says.  However, ''we need more data before setting policy.