"A"

 

 

• Food allergies in the U.S. affect approximately 3 million children. An 18 percent increase since 1997.

• Allergic rhinoconjunctivitis affects more than 115 million people worldwide.
• 30%-50% of people are genetically predisposed to develop Immunoglobulin E antibody (IgE) to common environmental allergens.

• 12% of U.S. children under 18 years of age suffered from respiratory allergies in the past 12 months.
• Children living in the South (15%) were more likely to have respiratory allergies than those living in the Midwest (11%), Northeast (10%), or West (8%).

• 50 million people suffer from allergies.
• Of these, 1/6 have allergic asthma.
• 6 million have non allergic asthma caused by exercise, chemical pollution, and smoking.

• Lavender (Lavendula augustifolia) 5 drops
• Bergamot (Citrus bergamia) 2 drops
• Lemon (Citrus Limonum) 1 drop
• Juniper (Juniperus communis) 1 drop
• Peppermint (Mentha piperta) 1 drop

• Avoid allergens as much as possible. There are a variety of air filtration devices for the home. Ozone purifiers and HEPA filtration are state of the art for home use in reducing mold, pollen, dander, and dust mites indoors.
• Reduce exposure to environmental pollutants, cigarette smoke, and other pollutants.
• Use hypoallergenic products whenever possible.
• Drink quality water, either filtered, reverse osmosis, or bottled.

Reduce intake of foods that increase arachidonic acid cascade such as meat.

 

Alopecia

• Male pattern hair loss: Thinning or complete loss of hair at the hairline and top of the head.
• Female diffuse hair loss: A gradual thinning of hair, especially on the top of the head. The hairline usually stays the same.
• Alopecia areata: Broken hairs, or hairs easily removed; one or more round or oval bald patches.

• Aging
• Genetics
• Illness
• Some medications (such as chemotherapy)
• Malnutrition
• Autoimmune disorder (alopecia areata)

Complementary and Alternative Therapies

Nutrition and Supplements

• Biotin (300 mcg per day) and trace minerals, such as those found in blue-green algae (2 - 6 tablets per day), may promote hair growth. Biotin and zinc aspartate have been used to treat alopecia areata in children. However, there is no evidence that biotin will help if you are already getting enough biotin in your diet. Biotin is found in chard, romaine lettuce, carrots, and tomatoes.

• Beta-sitosterol (50 mg two times per day) and saw palmetto (200 mg two times per day) appear to help hair growth in men with male pattern hair loss. In one study, men who took this combination had greater hair growth than men who took placebo. If you take other medications -- particularly hormone therapy -- talk to your doctor before taking this combination.

Herbs

• Saw palmetto (Serenoa repens), 200 mg and beta-sitosterol, 50 mg, two times per day (see Nutrition and Supplements).

• Aromatherapy -- One study found that massaging the scalp with a combination of several essential oils improved hair growth. The oils used were lavender, rosemary, thyme, and cedarwood. Because essential oils can be toxic, they are mixed with a “carrier” oil -- in this case, jojoba or grapeseed oil -- before applying to skin. Add 3 - 6 drops of essential oil to 1 tbs. of jojoba or grapeseed oil. Massage into scalp daily.

Massage

Alzheimer's disease

Signs and Symptoms

• Increasing memory loss, starting with forgetting recent events and new information, and progressing to not recognizing friends and family members
• Difficulty concentrating
• Difficulty understanding words, completing sentences, or finding the right words
• Getting lost in familiar surroundings
• Restlessness
• Depression
• Aggression, agitation, anxiety, restlessness
• Distrusting others
• Withdrawal, disinterest, hostility, loss of inhibitions

• Impaired movement or coordination
• Muscle stiffness, shuffling or dragging feet while walking
• Insomnia or change in sleep patterns
• Weight loss
• Incontinence
• Muscle twitching or seizures

• Family history of Alzheimer's
• Older age -- the risk of developing Alzheimer's doubles every five years after age 65
• Long-term high blood pressure
• Heart disease
• History of head trauma -- one or more serious blows to the head may put a person at an increased risk.
• Down syndrome
• Education level -- people with higher levels of education are less likely to develop Alzheimer's

• Mental status evaluation, to test memory and attention span. It can also reveal difficulties in problem-solving, social, and language skills.
• Genetic test, using a blood test for the APOE-e4 gene. The presence of the gene in the blood may suggest Alzheimer's, but it does not always make an accurate diagnosis.
• Imaging tests such as CT, MRI, or PET scans.

• Eating more fatty, cold-water fish (such as tuna, salmon, and mackerel) may be associated with a lower risk of dementia. This may be because these fish have high levels of omega-3 fatty acids, which benefit the heart and the brain. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids.
• Antioxidants, such as vitamins A, E, and C (found in darkly colored fruits and vegetables), may help prevent damage caused by free radicals.
• Maintaining normal blood pressure levels may reduce the risk for Alzheimer's.
• Some studies suggest that certain medications may prevent Alzheimer's, including statin drugs (such as pravastatin or lovastatin, used to lower cholesterol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. More research is needed to see how effective these medications are in reducing risk of the disease.
• Keeping mentally and socially active may help delay the onset or slow the progression of Alzheimer's.

• Slow progression of the disease.
• Manage behavior problems, confusion, and agitation.
• Change the home environment to be safe.
• Support family members and other caregivers.

Lifestyle

• A regular walk with a caregiver or trusted companion may improve communication skills and lessen the chance of wandering.
• Bright light therapy may reduce insomnia and wandering.
• Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
• Pets can increase appropriate social behaviors.
• Relaxation training and other exercises that require focused attention can improve social interaction and the ability to perform tasks.

Nutrition and Dietary Supplements

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables such as kelp and dulce.
• Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

• Phosphatidylserine, 100 mg three times per day, a substance occurring naturally in the brain, shows promise in several studies. This supplement may increase levels of brain chemicals that deal with memory, according to several studies. Do not take phosphatidylserine if you are taking anticoagulants (blood-thinners), and use caution if combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. You should consider spending more for a more expensive brand, as they tend to be better than cheaper brands.
• Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some, but not all, studies, vitamin E (400 - 800 IU per day) combined with Aricept may slow cognitive decline in people with Alzheimer’s disease. Another antioxidant, coenzyme Q10 (10 - 50 mg three times per day), may also help the brain get more oxygen. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented physicians recommend eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the berries' skin more easily absorbed.
• Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer's patients. Injections of B12 may have the best results.
• Zinc (30 - 50 mg per day) is often deficient in elderly people, and may help improve memory.

Herbs

• Ginkgo (Ginkgo biloba), standardized extract, 40 - 50 mg three times per day, shows the best evidence for treating early Alzheimer's disease and vascular dementia. If you are taking blood-thinning medication, use ginkgo only under the supervision of your doctor.
• Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia.
• American Ginseng (Panax quinquefolium) increases endurance and improves blood flow to the brain. Use with caution if you have high blood pressure, and talk to your doctor before combining ginseng with gingko.
• One study showed that lemon balm (Melissa officinalis), 60 drops per day, helped improve cognitive function in people with mild-to-moderate Alzheimer's.
• Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might help lessen symptoms of dementia. One study found that 300 mg per day for 12 weeks seemed to improve cognition in healthy people.
• Vinpocetine (isolated from Vinca minor), 10 - 40 mg twice daily, may increase blood flow to the brain and help the brain better use oxygen. However, most of the studies done so far have been of poor quality. More research is needed.

Acupuncture

Massage and Physical Therapy

Mind-Body Medicine

• Falls
• "Sundowning" (withdrawal or agitation in the evening)
• Malnutrition and dehydration
• Infection (from urinary tract infections or pneumonia)
• Asphyxiation (stopped breathing)
• Harmful or violent behavior toward self or others
• Suicide
• Poor health and support due to caregiver burnout
• Physical and emotional abuse, including neglect
• Heart disease

Amenorrhea

Signs and Symptoms

• Headaches
• Abnormal blood pressure
• Vision problems
• Acne
• Excessive hair growth

• Nausea
• Swollen breasts
• Headaches
• Vision problems
• Being very thirsty
• Goiter (an enlarged thyroid gland)
• Darkening skin

What Causes It?

• Lack of reproductive organs (such as uterus, cervix, or vagina)
• Problems with the pituitary gland
• Anorexia
• Stress
• Too much exercise
• Abnormal chromosones

• Pregnancy or breast-feeding
• Using some kinds of birth control
• Taking some types of medication (such as corticosteroids)
• Hormone imbalance
• Low body weight
• Too much exercise
• Thyroid problems
• Pituitary tumor
• Stress
• Premature menopause (menopause before age 40)

What to Expect at Your Provider's Office

Treatment Options

Complementary and Alternative Therapies

Nutrition and Supplements

• Calcium (1,000 mg per day), magnesium (600 mg per day), vitamin D (200 - 400 IU per day), vitamin K (1 mg per day), and boron (1 to 3 mg per day). Women who don’t have periods are at higher risk of osteoporosis, and these vitamins and minerals may help keep bones strong.
• B6 (200 mg per day) may reduce high prolactin levels. Prolactin is a hormone released by the pituitary gland, and women with amenorrhea often have higher levels of prolactin.
• Essential fatty acids: Evening primrose or borage oil (1,000 - 1,500 mg one to two times per day).

Herbs

• For high prolactin levels: Chaste tree (Vitex agnus-castus) may help the pituitary gland function normally and may reduce prolactin levels, but it must be taken for 12 - 18 months. One very small study found that 10 of 15 women with amenorrhea started having periods after taking chaste tree for 6 months. If you already use hormone therapy, do not use chaste tree except under your doctor's supervision.
• These herbs have estrogen-like effects and are sometimes used to treat menopausal symptoms, although there are no clinical trials that show whether they work or are safe: Black cohosh (Cimicifuga racemosa), licorice, (Glycyrrhiza glabra), and squaw vine (Mitchella repens). Do not take licorice if you have high blood pressure or heart failure.
• Other herbs that may help stimulate menstrual flow include lady's mantle (Alchemilla vulgaris) and vervain (Verbena officinalis). Do not take these herbs without your doctor’s supervision. Your doctor should monitor your liver function if you take lady's mantle.
• Kelp (Laminaria hyperborea), oatstraw (Avena sativa), and horsetail (Equisetum arvense) are rich in minerals that may help promote thyroid function.

Homeopathy

Physical Medicine

• Castor oil pack. Apply oil to a soft, clean cloth, place on abdomen, and cover with plastic wrap. Place a hot water bottle or heating pad over the pack and let sit on your abdomen for 30 - 60 minutes. You can safely use this treatment for 3 days, although it may be beneficial to use for longer; talk to your health care provider to determine how long to use it.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this three times to complete one "set." Do one to two sets per day, 3 - 4 days per week.

Acupuncture

Special Considerations

Anaphylaxis

Signs and Symptoms

• Itching (often the first symptom), redness, hives, swelling, sweating
• Swelling in the nose or throat, hoarseness, wheezing, difficulty speaking, trouble breathing, chest tightness
• Abnormal heart rate or rhythm, shock, heart attack
• Stomach cramps, nausea, vomiting, diarrhea
• Dizziness, fainting

What Causes It?

• Antibiotics (especially penicillin)
• Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), and prescription opiate pain medications (such as codeine)
• Foods, such as nuts, shellfish, milk, eggs, and berries
• Insect bites or stings
• Egg-based vaccines
• Latex (as in condoms, rubber gloves)
• Food coloring and preservatives (such as tartrazine, also known as FDC yellow dye No. 5)

• Known allergies
• Cardiovascular disease
• Women
• Substance abuse
• Asthma
• Initial exposure to the allergen by injection (intravenous medication)
• Frequent exposure to the allergen, particularly if frequent exposure is followed by a long delay and then a re-exposure

What to Expect at Your Provider's Office

Treatment Options

Prevention

• Avoid any substances that have triggered a previous allergic response.
• If you have allergies or suspect you do, see a specialist to be tested.
• Take medicines by mouth instead of by injection whenever possible.
• If you have a history of anaphylaxis, your doctor should coach you and your family members on how to use self-injectable epinephrine. You should carry a syringe loaded with adrenaline (epinephrine) to inject immediately after exposure to a known allergen, or at the first sign of a reaction. Also, wear a Medic Alert bracelet to alert others that you have a history of this condition. One study suggested that patients at risk of food-induced anaphylaxis carry 2 doses of epinephrine.

Treatment Plan

Drug Therapies

Surgical and Other Procedures

Complementary and Alternative Therapies

Nutrition and Supplements

• Quercetin (400 - 500 mg per day in divided doses) -- a flavonoid and antioxidant found in many plants that may help reduce allergic reactions. Some people may get more benefit from the water-soluble form of quercetin, called quercetin chalcone.
• Vitamin C (1,000 mg 2 - 6 times per day for a short period) -- Supports immune system function and also enhances the effect of quercetin. Lower the dose if diarrhea develops.
• Zinc (30 mg per day) -- Animal studies suggest that zinc may help protect against gastrointestinal symptoms (stomach cramps, nausea, vomiting, or diarrhea) that sometimes accompany anaphylaxis.

Herbs

• Alpinia galanga (2 - 4 g per day) -- One of several plants commonly called galangal used as a spice in Thai food, Alpinia galanga is a member of the ginger family. Preliminary animal studies suggest it may have some antihistamine properties. Take capsules or drink tea. To make tea, steep 1 g in 1 cup boiling water for 10 minutes, strain, and cool.
• Ashwagandha (Withania somnifera, 1 - 6 g per day) -- An antioxidant that supports immune system function and may have antihistamine properties. Ashwagandha can interact with other herbs and prescription medications, so take it only under your doctor's supervision. Do not take ashwagandha if you are pregnant or trying to become pregnant, or if you take thyroid medication or corticosteroids (prednisone).
• Chinese skullcap (Scutellaria baicalensis, 1 - 2 g per day) -- May have antihistamine properties
• Licorice (Glycyrrhiza glabra, 100 - 300 mg per day) -- Has been used traditionally to support the immune system and may have antihistamine properties. Do not take licorice if you have high blood pressure or heart disease.
• Stinging nettle (Urtica dioica, 300 mg 4 times per day) -- Has anti-inflammatory and antihistamine properties. Look for freeze-dried encapsulated nettles, which are believed to retain most of the antihistamine effects of the plant.

• Sweet chestnut tree (Castanea crenata) -- contains quercetin, and reduced skin and blood vessels reactions related to anaphylaxis in animal studies.
• Spreading sneezeweed (Centipeda minima) -- contains flavonoids, and is used in Traditional Chinese Medicine for its anti-inflammatory and antihistamine effects.
• Asian rose (Rosa davurica) -- traditionally used to support the immune system. It inhibited anaphylaxis in an animal study.
• Hardy orange (Poncirus trifoliata) -- used traditionally for treatment of allergies. Animal studies have shown inhibition of anaphylaxis.

 

Herbs to avoid

• Arnica flower (Arnica montana)
• Artichoke leaf (Cynara scolymus) -- in those with an allergy to artichokes
• Blessed thistle herb (Cnicus benedictus)
• Cayenne pepper (Capsicum spp.)
• Cinnamon bark (Cinnamomum verum)
• Dandelion root or herb (Taraxacum officinale) -- may trigger a reaction in those with latex allergy
• Echinacea (Echinacea purpurea)
• Fennel oil and fennel seed (Foeniculum vulgare)
• Feverfew (Tanacetum parthenium/Chrysanthemum parthenium)
• Ginkgo biloba leaf extract
• Poplar bud (Populus spp.) -- may trigger a reaction in those with salicylate (aspirin) sensitivity
• Psyllium seed (Plantago spp.) -- allergic response more common with powder or liquid form
• St. John's wort (Hypericum perforatum)
• Yarrow (Achillea millefolium)

Homeopathy

• Aconitum -- helps alleviate the tremendous anxiety and fear of dying that may occur during or immediately following an anaphylactic reaction
• Arnica montana -- may be used in the case of shock or following a traumatic experience
• Apis mellifica -- for puffy, rapidly swelling skin following an insect bite or sting.

Acupuncture

• Vitamin deficiency anemia, megaloblastic anemia -- caused by a lack of folic acid and vitamin B12 in your body.
• Anemia of chronic disease -- caused when certain chronic diseases (such as cancer, kidney failure, or Crohn’s disease) interfere with the production of red blood cells.
• Aplastic anemia -- caused when bone marrow loses its ability to produce all three types of blood cells. Aplastic anemia is life threatening.
• Hemolytic anemias -- caused when red blood cells are destroyed faster than the bone marrow can replace them.
• Sickle cell anemia -- caused by a defective type of hemoglobin that makes red blood cells form a crescent or sickle shape. These sickle cells die early, meaning the body is always short of red blood cells. The abnormal shape can block blood flow through small vessels, causing pain. Sickle cell anemia is an inherited condition that affects mainly people of African, Mediterranean, Arabic, or South American descent.

Signs and Symptoms

• Tiredness
• Weakness
• Shortness of breath
• Pale skin
• Lightheadedness
• Headache
• Feeling cold
• Rapid heartbeat and chest pain

What Causes It?

• Iron deficiency anemia -- Blood loss, such as from an ulcer or heavy menstruation or after surgery; not getting enough iron in your diet; pregnancy; side effect of medication
• Vitamin deficiency anemia -- Not getting enough folic acid and vitamin B12 in your diet, or being unable to absorb these vitamins (due to celiac disease, for example); side effect of medication
• Aplastic anemia -- may be caused by an autoimmune disorder
• Hemolytic anemia -- can be caused by medication, autoimmune disorders
• Sickle cell anemia – inherited

What to Expect at Your Provider's Office

Treatment Options

Complementary and Alternative Therapies

Nutrition and Supplements

Herbs

Homeopathy

• Ferrum phosphoricum -- for iron deficiency
• Calcarea phosphorica -- particularly for children with nighttime bone aches, cool hands and feet, lack of energy, or poor digestion

Following Up

Special Considerations

Signs and Symptoms

Causes

Risk Factors

• Age
• Male gender
• Menopause
• Family history of heart disease
• Diabetes
• Smoking or exposure to second hand smoke
• High cholesterol
• High blood pressure
• Obesity
• Sedentary lifestyle
• Stress
• Thyroid disease

Diagnosis

Preventive Care

• Stop smoking
• Maintain a proper weight
• Control blood pressure, diabetes, and cholesterol
• Eat a diet low in saturated fats, and high in whole grains, fiber, fruits, and vegetables
• Exercise at least 30 minutes per day, 5 days per week
• Reduce stress

Lifestyle

• Eat a variety of nutritious foods from all the food groups, especially whole grains, fruits and vegetables, and low fat dairy products.
• Eat at least 2 servings of fish per week
• Limit sodium intake to 2,300 mg per day.
• Limit alcohol intake to 2 drinks per day for men and 1 drink per day for women.
• Burn as many calories as you take in. Get at least 30 minutes of exercise most days (or, better still, every day).

Nutrition and Dietary Supplements

• L-carnitine (1 g 2 times per day), an amino acid, may help reduce symptoms of angina, according to several clinical trials.
• Coenzyme Q10 or CoQ10 (150 mg per day) is important for heart health and several studies suggest that taking it may allow people with angina to exercise more without pain. High doses of CoQ10 may interfere with some anticoagulants (blood thinners), so talk to your doctor before taking CoQ10 if you take anticoagulants.
• Arginine or l-arginine (2 g 3 times per day) is another amino acid that may improve blood flow and increase exercise tolerance in people with angina.
• Magnesium (365 mg 2 times per day) acts similar to a calcium-channel blocker in the body, although it is much weaker. One study suggested it may help reduce chest pain caused by exercise. Magnesium can lower blood pressure and cause diarrhea, so talk to your doctor before taking it.

Herbs

• Hawthorn (Crataegus monogyna, 60 mg 3 times per day) has been used traditionally as a to treat heart disease. One small clinical trial suggested that people with angina who took hawthorn improved blood flow to the heart and were better able to exercise without pain. However, the trial was small and more studies are needed. Hawthorn can cause side effects and interact with other drugs, so do not take it without your doctor's supervision.
• Kudzu (Pueria lobota, 30 mg - 120 mg per day) has been used in Chinese medicine for centuries to treat heart disease. A few clinical trials have indicated that kudzu may reduce the frequency of angina in people, but the trials were poorly designed. More research is needed. Kudzu can cause side effects and interact with other drugs, so do not take it without your doctor's supervision.
• Terminalia arjuna, an herb used in Ayurvedic medicine, was shown in one study to be as effective as isosorbide mononitrate (Imdur) in reducing the number of angina attacks and increasing exercise capacity. However, more studies are needed.
• Suxiao jiuxin wan is widely used in China for angina. One study found that suxiao jiuxin wan improved ECG measurements and reduced symptoms and frequency of acute angina attacks compared with nitroglycerin.

Homeopathy

Acupuncture

Anorexia nervosa

Signs and Symptoms

• Excessive weight loss
• Scanty or absent menstrual periods
• Thinning hair
• Dry skin
• Cold or swollen hands and feet
• Bloated or upset stomach
• Downy hair covering the body
• Low blood pressure
• Fatigue
• Abnormal heart rhythms
• Osteoporosis

• Distorted perception of self (insisting they are overweight when they are thin)
• Being preoccupied with food
• Refusing to eat
• Inability to remember things
• Refusing to acknowledge the seriousness of the illness
• Obsessive-compulsive behavior
• Depression

• Skipping meals or making excises not to eat
• Eating only a few foods
• Refusing to eat in public
• Planning and preparing elaborate meals for others but not eating
• Constantly weighing themselves
• Ritually cutting food into tiny pieces
• Compulsive exercising

Causes

• Severe trauma or emotional stress (such as the death of a loved one or sexual abuse) during puberty or prepuberty.
• Abnormalities in brain chemistry. Serotonin, a brain chemical that's involved in depression, may play a role
• A cultural environment that puts a high value on thin or lean bodies.
• A tendency toward perfectionism, fear of being ridiculed or humiliated, a desire to always be perceived as being "good." A belief that being perfect is necessary in order to be loved.
• Family history of anorexia. About one-fifth of those with anorexia have a relative with an eating disorder.

Risk Factors

• Age and gender -- anorexia is most common in teens and young adult women.
• Dieting
• Weight gain
• Unintentional weight loss
• Puberty
• Living in an industrialized country
• Having depression, obsessive-compulsive disorder (OCD) or other anxiety disorders -- OCD is present in up to two-thirds of people with anorexia. OCD associated with an eating disorder is often accompanied by a compulsive ritual around food (such as cutting it into tiny pieces).
• Participation in sports and professions that prize a lean body (such as dance, gymnastics, running, figure skating, horse racing, modeling, wrestling, acting)
• Difficulty dealing with stress (pessimism, tendency to worry, refusal to confront difficult or negative issues)
• History of sexual abuse or other traumatic event
• Experiencing a big life change, such as moving or going to a new school

Diagnosis

• S: "Do you feel sick because you feel full?"
• C: "Do you lose control over how much you eat?"
• O:"Have you lost more than 13 pounds recently?"
• F: "Do you believe that you are fat when others say that you are thin?"
• F: "Does food and thoughts of food dominate your life?"

Preventive Care

• Family and friends should be urged not to focus on the person's condition or on food or weight. Don't discuss anorexia at mealtimes, for example. Instead, devote mealtimes to social interaction and relaxation.
• Watch for signs of relapse. Careful and frequent monitoring of weight and other physical signs by your doctor can catch problems early.
• Cognitive behavioral therapy or other forms of psychotherapy can help the person develop coping skills and change unhealthy thought processes.
• Family therapy can help with any problems in the home that may contribute to the person's anorexia.

Treatment

• Continuing weight loss, in spite of outpatient treatment
• Body mass index (BMI) -- 30% below normal. The normal range is a BMI of 19 - 24. BMI is a measurement that takes into account a person's height and weight.
• Irregular heart rhythm
• Severe depression
• Suicidal tendencies
• Low potassium levels
• Low blood pressure

• Friends or family who admire how thin the person is
• Dance instructors or athletic coaches who put a premium on having a very lean body
• Denial on the part of parents or other family members
• The person's belief that extreme thinness is not only normal but also attractive, and that purging is the only way to avoid becoming overweight

Lifestyle

• Establishing regular eating habits and a healthy diet
• Sticking with your treatment and meal plans
• Developing a support system and participating in a support group for help with stress and emotional issues
• Ignoring the urge to weigh yourself or check your appearance constantly
• Cutting back on exercise if obsessive exercise has been part of the disease. Once the person has gained weight, the doctor may set a controlled exercise program to help overall health.

Nutrition and Dietary Supplements

• Avoid caffeine, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Use quality protein sources -- such as meat and eggs, whey, and vegetable protein shakes -- as part of a balanced program aimed at gaining muscle mass and preventing wasting.
• Avoid refined sugars, such as candy and soft drinks.

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, phosphorus, copper, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources; eat two servings of fish per week.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• 5-hydroxytryptophan (5-HTP), 50 mg two to three times daily, for mood stabilization. Talk with your health care provider if you are on prescription medications before taking 5-HTP. Do not take 5-HTP if you are taking antidepressants.
• Creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting.
• Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results.
• L-glutamine, 500 - 1000 mg three times daily, for support of gastrointestinal health and immunity.

Herbs

• Ashwagandha (Withania somniferum) standardized extract, 450 mg one to two times daily, for general health benefits and stress.
• Fenugreek (Trigonella foenum-graecum), 250 - 500 mg two to three times daily, to stimulate appetite.
• Cayenne pepper (Capsicum annuum) standardized extract, 400 mg three times daily, for help with digestion.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for liver health.
• Catnip (Nepeta spp.), as a tea two to three times per day, to calm the nerves and soothe the digestive system.

Homeopathy

Mind-Body Medicine

Signs and Symptoms

• Muscle tension, trembling
• Feeling restless or on edge
• Fast heartbeat (tachycardia)
• Fast or troubled breathing (dyspnea)
• Stomach upset
• Having a hard time concentrating
• Headache
• Sweating
• Fatigue
• Irritability
• Trouble falling asleep or staying asleep

What Causes It?

What to Expect at Your Provider's Office

• Excessive anxiety or worry most days for at least 6 months
• Difficulty controlling anxiety
• Anxiety associated with three or more of the following symptoms: feeling restless, being fatigues, having trouble concentrating, being irritable, having muscle tension, or having trouble sleeping
• Anxiety that interferes with your daily life
• Anxiety that is not related to another psychological condition, such as panic attacks
• Anxiety that is not related to another physical condition, such as substance abuse

Treatment Options

Complementary and Alternative Therapies

Exercise

Nutrition

Herbs

• Valerian (Valeriana officinalis, 150 mg 2 - 3 times per day) is an herbal treatment for insomnia that is sometimes used to treat anxiety as well, although evidence is mixed. Some studies show that valerian does help reduce anxiety, but one study found that valerian was no better at reducing social anxiety than placebo. Valerian is often combined with lemon balm (Melissa officinalis) or with St. John's wort (Hypericum perforatum) for treating mild-to-moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Passionflower (Passiflora incarnata) -- In a few studies, passionflower was as effective as some of the benzodiazepines in relieving anxiety. However, more studies are needed to know for sure whether passionflower is effective.
• Kava kava (Piper methysticum, 100 - 200 mg 2 - 4 times a day) is sometimes suggested for mild-to-moderate anxiety, but the Food and Drug Administration (FDA) has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. Talk to your doctor before taking kava, and don’t take it for more than a few days.
• Other herbs sometimes suggested for anxiety include ginger (Zingiber officinalis), chamomile (Matricaria chamomilla), and licorice (Glycyrrhiza glabra). Avoid licorice if you have heart failure, heart disease, kidney or liver disease, or high blood pressure. Do not take licorice if you take a diuretic (water pills), anticoagulant (blood thinner), or antidepressant such as Prozac.

Homeopathy

• Aconitum -- for anxiety accompanied by irregular or forceful heartbeat, shortness of breath, or fear of death.
• Arsenicum album-- for excessive anxiety that has no clear cause and is accompanied by restlessness, especially after midnight. It also may be used for perfectionists, including children, who worry about everything.
• Phosphorus-- for an impending sense of doom and anxiety when alone. It also may be used for impressionable adults and children who are easily influenced by the anxiety of others.
• Lycopodium-- for performance and other types of anxiety in those who are insecure, yet hide their low self-esteem with arrogance and bravado. It also may treat children with anxiety accompanied by bedwetting.
• Gelsemium-- for performance anxiety resulting in diarrhea, headache, dizziness, weakness, shakiness and trembling, or trouble speaking.
• Argentum nitricum-- for performance anxiety (such as before tests in school-age children) with rapid heart rate, feeling of faintness, diarrhea, or flatulence.

Acupuncture

Massage

Special Considerations

Atherosclerosis

Signs and Symptoms

• Chest pain (generally a heavy, squeezing, or crushing sensation with possible burning or stabbing pains)
• Abdominal, neck, back, jaw, or shoulder/arm pain
• Weakness
• Perspiration
• Shortness of breath

• Weakness or paralysis on one side of the body
• Trouble speaking or understanding speech
• Loss of vision in one eye
• Muscle weakness
• Sudden trouble walking
• Dizziness
• Loss of balance or coordination
• Sudden severe headache

• Pain, aching, cramps, numbness or sense of fatigue in the leg muscles (intermittent claudication)
• "Bruits" (blowing sounds your doctor can hear with a stethoscope that indicate turbulence in blood flow)
• Hair loss
• Thickened nails
• Smooth, shiny skin surface
• Skin that is cold to the touch
• Gangrene

What Causes It?

• High blood pressure
• Elevated LDL ("bad") cholesterol
• An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia)
• Smoking
• Diabetes
• Inflammation

Risk Factors

• Being male
• If female, being past menopause
• High blood pressure
• High LDL ("bad) cholesterol or triglycerides (fats in the blood)
• Diabetes
• Being overweight
• Smoking
• A family history of heart disease
• Elevated homocysteine levels
• Sedentary lifestyle
• Diets high in saturated fat and trans fatty acids (trans fats)
• Depression

What to Expect at Your Provider's Office

Preventive Care

• Stop smoking.
• Exercise at least 30 minutes a day, 6 days a week.
• Eat healthy foods, such as fruits, vegetables and whole grains that are low in saturated fat and high in fiber.
• Maintain a normal weight (or lose weight if you need to).
• Reduce stress.
• If you have high blood pressure, high cholesterol, diabetes or another chronic condition, work with your doctor to keep it in check.

Treatment Options

Complementary and Alternative Therapies

Nutrition and Supplements

• Grains: 6 - 8 servings per day (half should be whole grains)
• Vegetables: 3 - 5 servings per day
• Fruits: 4 - 5 servings per day
• Fat-free or low-fat dairy: 2 - 3 servings per day
• Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards)
• Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
• Nuts, seeds, legumes: 3 - 5 servings per week
• Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

• Beta-carotene -- While some studies suggest that eating a diet high in beta-carotene (found in yellow, orange, and dark green vegetables) may protect against atherosclerosis, other studies show it may increase the risk for people who smoke or drink a lot of alcohol. Researchers think that eating vegetables with beta-carotene also provides the body with other antioxidants that may have the protective effect, while just taking a supplement does not.
• Vitamin C -- Several studies suggest that eating a diet high in vitamin C can help protect against heart disease. But there is no evidence that taking extra vitamin C through a supplement will help.
• Vitamin E -- One randomized, placebo-controlled study failed to show any reduction in heart disease among people who took vitamin E. However, researchers are still studying the effects of vitamin E on heart disease risk.

Herbs

• Hawthorn (Crataegus monogyna, 160 - 1,800 mg per day in two or three divided doses) -- Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that help protect against the formation of plaques and may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
• Garlic (Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) -- Some clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, other studies show mixed evidence, and one 2007 study showed no effect at all. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.
• Olive leaf extract(Olea europaea, 1000 mg per day) -- One study found that people with mild high blood pressure (hypertension) lowered cholesterol and blood pressure by taking olive leaf extract, compared to those who took placebo. More research is needed to confirm this study's findings.
• Red yeast or red yeast rice (Monascus purpureus, 1,200 mg two times per day with meals) -- Several studies indicate that a proprietary form of red yeast (Cholestin) can lower cholesterol levels, and that the herb acts like the prescription drugs statins (See "Medications" section). For that reason, you should not take red yeast without a doctor's supervision, especially if you already take statins to lower cholesterol.
• Psyllium (Plantago psyllium, 10 - 30 g per day in divided doses taken 30 - 60 minutes after meals) -- Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
• Guggul (Commiphora mukul, 3 - 6 g per day) -- Guggul is used in Ayurvedic medicine to treat high cholesterol levels. Scientific studies have found mixed results -- guggul appears to work in Indian populations, but not in people who eat Western-style, high-fat diets.

Acupuncture

Homeopathy

Other Considerations

Prognosis and Complications

• Heart disease
• Heart failure
• Abnormal heart rhythms
• Stroke
• Heart attack
• Poor blood supply to certain parts of the body (such as the legs or intestines)
• Kidney failure
• Death

Signs and Symptoms

• Joint pain (often a deep, aching pain) that gets worse when you move and better when you rest the joint (in severe cases, a person may experience constant pain)
• Stiffness in the morning or after sitting or lying down for more than 15 minutes
• Joint swelling
• Joints that are warm to the touch
• Limited range of motion
• Muscle weakness (caused by favoring the painful joint)
• Growth of bony knobs near joints (such as Heberden's nodes, in which bumps appear on the outermost finger joints)

Causes

Risk Factors

• Being older
• Genetic predisposition
• Being overweight
• Injury to the joint
• History of inflammatory joint disease
• Metabolic or hormonal disorders (such as hemochromatosis and acromegaly)
• Bone and joint disorders present at birth
• Repetitive stressful joint use (such as athletes or construction workers might experience)
• Deposits of uric acid crystals in joints

Diagnosis

Preventive Care

• Protecting an injured joint from further damage
• Exercising
• Losing weight and maintaining a proper weight
• Avoiding repetitive motions

Treatment

• Eat more foods that decrease inflammation, including garlic, onions, watercress, horseradish, mustard, parsley, celery, rose hips tea, pickles, lemon, and anti-inflammatory oils (nuts, seeds, cold-water fish).
• Avoid refined foods, such as white breads, pastas, and sugars.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Eat more fruits, vegetables, and whole grains.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, for 30 minutes daily, 5 days a week.

• Glucosamine/chondroitin, 500 - 1,500 mg daily, for joint health. Results from several well-designed scientific studies suggest that glucosamine supplements may be an effective treatment for OA, particularly OA of the knee or hip. In general, these studies suggest that glucosamine reduces pain, improves function in people with hip or knee OA, reduces joint swelling and stiffness, and provides relief from OA symptoms for up to 3 months after treatment is stopped.

• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. oil daily, to help decrease inflammation. Higher doses may be used by health care providers.
• SAMe (s-adenosyl-L-methionine), 600 - 1200 mg daily. A number of studies suggest SAMe can help reduce OA pain. In one study, SAMe was as effective in relieving pain as NSAIDs. In another study of people with knee OA, SAMe was as effective as Celebrex in lessening pain and improving joint function, although it took longer to feel the benefits.
• Avocado soybean unsaponifiables (ASUs), 300 - 600 mg daily. A few preliminary studies suggest that this natural vegetable extract may help reduce the symptoms of OA and possible even slow progression of the disease. More research is needed to know whether ASUs can actually stop joint damage.
• Bromelain, 250 mg twice a day. This enzyme that comes from pineapples reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.

• Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood-thinnning medications or NSAIDs. Ask your doctor before taking turmeric.
• Cat's claw (Uncaria tomentosa) standardized extract, 30 mg three times a day, has been used traditionally for OA pain. In one study, 100 mg per day of cat’s claw taken for 4 weeks relieved pain better than a placebo. More research is needed. Do not take cat’s claw if you take medicine for high blood pressure or blood-thinning medications.
• Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily. Devil’s claw has also been used traditionally to relieve pain. One study found that more than 50% of people with OA of the knee or hip or low back pain who took devil’s claw reported less pain and better mobility after 8 weeks. Devil’s claw may increase the risk of bleeding and interact with diabetes medications, so tell your doctor before taking it if you also take blood-thinning medication or if you have diabetes.
• Ginger (Zingiber officinale), up to 2 g per day in divided doses, may reduce joint inflammation and pain. One study found that ginger extract inhibited COX-2, a chemical in the body that causes pain. Ginger may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take ginger without first talking to their doctor.
• Willow bark (Salix alba) standardized extract, 500 mg up to three times daily. Willow acts similar to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. Willow should not be given to children under the age of 18.
• Capsaicin (Capsicum frutescens) cream, applied to the skin (topically). Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain in arthritis. Several clinical studies have shown that capsaicin cream provided better pain relief than a placebo but no improvement in joint swelling, grip strength, or function for people with OA. Pain reduction generally starts 3 - 7 days after applying the capsaicin cream to the skin.

• Increase range of motion
• Restore normal movement of the spine
• Relax the muscles
• Improve joint coordination
• Reduce pain

• Less stiffness
• Reduced pain
• Improved functional ability
• Improved walking distance
• Less need for knee surgery 1 year later

• Improving range of joint motion
• Increasing muscle strength
• Eliminating muscle spasm
• Enhancing functional mobility
• Easing pain

• Reduce pain at rest
• Reduce stiffness
• Boost walking speed
• Increase quadriceps muscle strength
• Increase knee range of motion

• A topical homeopathic gel containing comfrey (Symphytum officinale), poison ivy (Rhus toxicodendron), and marsh-tea (Ledum palustre)
• A combination homeopathic preparation containing R. toxicodendron., Arnica montana (arnica), Solanum dulcamara (climbing nightshade), Sanguinarra canadensis (bloodroot), and Sulphur
• A liquid homeopathic preparation containing R. toxicodendron, Causticum (potassium hydrate), and Lac vaccinum (cow's milk)

• Calcarea carbonica (carbonate of lime or calcium carbonate)
• Bryonia (wild hops)
• Graphites
• Guaiacum

• Improved fitness
• Stronger muscles
• Better flexibility
• Reduced percentage of body fat
• Lowered risk of falls in the elderly

• Overall sense of quality of life
• Fewer feelings of stress/tension
• More satisfaction with general health
• Less fatigue
• Easier self management of arthritis symptoms

Other Considerations

• Inability to walk due to very advanced hip or knee OA
• Gastrointestinal bleeding and decreased kidney function resulting from long-term NSAID use

Signs and Symptoms

• Morning stiffness -- waking up with stiff joints (often the wrists and base of the fingers, ankles, balls of the feet, elbows, or knees)
• Joint pain with warmth, swelling, tenderness, and stiffness of the joint after resting
• Limited range of motion in the affected joints
• Fatigue
• Low grade fever (when having a flare)
• Small, round, firm bumps (called nodules) under the skin; you can feel these, but they are generally painless.

Causes

Risk Factors

• Age. Although the disease can occur at any age, RA generally starts in young adulthood usually between ages 25 and 55.
• Gender. Women get RA two and a half times more often than men, and are more likely to have severe symptoms.
• Family history. Having relatives with RA increases your risk of getting it yourself.
• Cigarette smoking. Smoking seems to increases your risk of getting RA.
• Medication. Interferon-alpha, a drug used to treat hepatitis, autoimmune diseases, and other diseases has triggered RA in rare cases

Diagnosis

Treatment Approach

• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise 30 minutes daily, 5 days a week.

• Omega-3 fatty acids, such as fish oil, up to 2.6 g daily -- Omega-3 fatty acids may help reduce inflammation. A review of studies where people with RA took omega-3 fatty acids found they had fewer tender joints but no difference in joint damage. In some studies, people who take omega-3s are able to reduce the dose of NSAIDs or corticosteroids they take for RA. Omega-3 fatty acids may also reduce the risk of heart disease, which is elevated in people with RA. Omega-3 fatty acid supplements may raise the risk of bleeding, so ask your doctor if they are right for you.
• Vitamin E -- One study suggests that taking vitamin E along with standard medications for rheumatoid arthritis may help reduce pain -- but not inflammation -- better than standard medications alone.
• Bromelain (500 mg - 2,000 mg three times daily) -- This enzyme derived from pineapples may help reduce inflammation and pain. It may increase the risk of bleeding, so ask your doctor before taking it.
• Gamma linolenic acid (GLA), found in borage oil, evening primrose oil, and black currant seed oil, 1.1 g - 2.6 g daily -- may help reduce pain, stiffness, and swelling. One study found that people with RA who took 2.8 g of GLA for six months reduced pain and swelling and improved their grip strength.
• Folic acid -- People who take methotrexate for RA may need additional folic acid, because methotrexate hinders the body’s ability to absorb folic acid. In addition, one study found that folic acid supplements helped reduce side effects (including liver problems) from methotrexate. High doses of folic acid can mask a vitamin B-12 deficiency, so ask your doctor if you need folic acid supplements -- don’t just start taking them on your own.

• Boswellia (Boswellia serrata), 400 mg - 800 mg three times daily -- Boswellia has been used traditionally to treat arthritis in Ayurvedic medicine. Studies using it to treat RA have been mixed. Some found that it relieved pain and swelling, but others found it was no better than placebo.
• Ginger (Zingiber officinale), up to 2 g per day in divided doses, may reduce joint inflammation and pain. One study found that ginger extract inhibited COX-2, a chemical in the body that causes pain. Ginger may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take ginger without first talking to their doctor.
• Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily -- Green tea is loaded with antioxidants, and test tube studies found that it may block inflammatory chemicals that are involved in RA. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day -- may help reduce inflammation. One study found that people with RA who took cat’s claw experienced a modest reduction in pain and swelling. Cat’s claw may stimulate the immune system, which could cause problems in a disease like RA where the immune system is already overactive. For that reason, do not take cat’s claw except without the supervision of your doctor.
• Turmeric (Curcuma longa) standardized extract, 400 mg three times a day -- may help reduce pain and inflammation. It is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, so ask your doctor before taking it.
• Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily -- may reduce inflammation. One study found that people with RA who took devil’s claw reduced pain and improved their mobility. But not all studies have found that devil’s claw was effective for RA; evidence is mixed.
• Capsaicin (Capsicum frutescens) cream, applied to the skin (topically) -- Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain in arthritis. Pain reduction generally starts 3 - 7 days after applying the capsaicin cream to the skin. Wash hands well with vinegar after use and avoid touching the eyes.

• Improving range of joint motion
• Increasing muscle strength
• Eliminating muscle spasm
• Enhancing functional mobility
• Easing pain

• Transcutaneous nerve stimulation (TENS) -- small clinical studies show that TENS, a technique used by many physical therapists, may provide short-term pain relief for people with RA.
• Heat and cold applications -- may reduce pain

• A topical homeopathic gel containing comfrey (Symphytum officinale), poison ivy (Rhus toxicodendron), and marsh-tea (Ledum palustre)
• A combination homeopathic preparation containing R. toxicodendron, Arnica montana (arnica), Solanum dulcamara (climbing nightshade), Sanguinarra canadensis (bloodroot), and Sulphur
• A liquid homeopathic preparation containing R. toxicodendron, Causticum (potassium hydrate), and Lac vaccinum (cow's milk)

• Better fitness
• Increased muscular strength
• Better flexibility
• Reduced percentage of body fat
• Reduced risk of falls in the elderly

Other Considerations

• Joint deformities
• Cervical spine problems (can be life threatening)
• Painless, hard, round or oval masses called nodules that appear under the skin
• Pleuritis (inflammation of the lungs)
• Anemia
• Rheumatoid vasculitis (inflammation of the blood vessels)
• Pericarditis (inflammation of the outer lining of the heart)
• Myocarditis (inflammation of the heart muscle)
• Heart failure
• Eye inflammation
• Osteoporosis
• Heart disease
• Diabetes

Signs and Symptoms

• Shortness of breath
• Wheezing -- usually begins suddenly; may be worse at night or early in the morning; can be made worse by cold air, exercise, and heartburn; is relieved by using bronchodilators (drugs that open the airways; see Medications)
• Chest tightness
• Cough (dry or with sputum) -- in cough-variant asthma, this may be the only symptom

• Extreme difficulty breathing or stopping breathing
• Bluish color to the lips and face (called cyanosis)
• Severe anxiety
• Rapid pulse
• Excessive sweating
• Decreased level of consciousness (such as drowsiness or confusion)

Causes

Risk Factors

• Having allergies
• Family history of asthma or allergies
• Being exposed to secondhand smoke
• Having upper respiratory infections as an infant
• Living in a large city
• Gender -- among younger children, asthma develops twice as often in boys as in girls, but after puberty it may be more common in girls
• Obesity
• Gastroesophageal reflux (heartburn)

• Sensitivity to allergens such as dust, cockroach waste, pet dander, indoor and outdoor mold, pollen
• Air pollutants, such as smoke, perfumes, diesel particles, sulfur dioxide, high ozone levels, and fumes from paint, cleaning products, and gas stoves
• Changes in the weather, especially in temperature (particularly cold) and humidity

• Activities that affect breathing (exercising, laughing, crying, yelling)
• Stress and anxiety

Diagnosis

• Mild intermittent: Having mild symptoms up to 2 days a week and 2 nights a month
• Mild persistent: Having symptoms more than 2 a week but not more than one time in a single day
• Moderate persistent: Having symptoms once a day and more than one night per week
• Severe persistent: Having symptoms throughout the day on most days and often at night.

• Avoid allergens and irritants as much as possible. For example, reduce your exposure to dust mites by using special mattress and pillow covers that keep allergens out and removing carpets from bedrooms. Clean your house frequently.
• Exercise. Even people with exercise-induced asthma can stay active, and exercise will help you by strengthening your lungs and helping you maintain a proper weight. Taking precautions when it’s cold outside -- such as wearing a face mask to warm the air that you’re breathing -- can help you avoid asthma symptoms. Talk to your doctor before starting an exercise regimen.
• Pay attention to your breathing. Watch for signs of an oncoming attack, such as wheezing. Your doctor may give you a machine called a peak flow meter that can detect slight differences in your breathing before you even notice them, so that you can take medication to ward off an attack.
• Treat attacks quickly. The sooner you treat an attack, the less severe it will be, and the less medication you’ll need.

Treatment

Lifestyle

Nutrition and Dietary Supplements

• Choline (3 g per day) -- Choline, a B vitamin, may help reduce the severity and frequency of asthma attacks.. Some evidence indicates that higher doses (3 g per day) may be most effective. More research is needed to say for sure whether choline helps.
• Magnesium -- The idea of using magnesium to treat asthma comes from the fact that people who have asthma often have low levels of magnesium, and from some (but not all) studies showing that intravenous (IV) magnesium can be effective as an emergency treatment for an asthma attack. However, studies that have looked at whether taking oral magnesium helped have shown mixed results. More research is needed.
• Omega-3 fatty acids -- The evidence for using omega-3 fatty acids (found in fish oil) to treat asthma is mixed. At least a few studies have found that fish oil supplements may reduce inflammation and symptoms in children and adults with asthma. But the studies have only included a small number of people, and one study found that fish oil might make aspirin-induced asthma worse. Ask your doctor whether a high quality fish oil supplement makes sense for you.
• Quercetin -- Quercetin, a kind of antioxidant called a flavonoid, stops the production and release of histamine and other allergic/inflammatory chemicals in the body. Histamine contributes to allergy symptoms such as a runny nose, watery eyes, and hives. Because of that, quercetin has been proposed as a treatment for asthma. But no human studies have examined whether it works or not.
• Selenium -- Studies suggest that people with asthma tend to have low levels of selenium. In addition, a population-based study suggested that eating selenium-rich foods may reduce the risk of asthma. And in one small study of 24 people with asthma, those who received selenium supplements for 14 weeks had fewer symptoms than those who received placebo. However, another study indicated that people who took 200 mcg of selenium per day for about eight years were more likely to develop type 2 diabetes. You should not take selenium supplements without first talking to your doctor.
• Vitamin C (1 g per day) -- One preliminary study suggested that children with asthma had significantly less wheezing when they ate a diet rich in fruits with vitamin C. Vitamin C does have anti-inflammatory and antioxidant properties, which may help you maintain good health overall. Some studies have indicated that taking a vitamin C supplement (1 g per day) may help keep airways open, but other studies have found no benefit.
• Other -- Other supplements that may help treat asthma include:
  • Coenzyme Q 10 (CoQ10) -- if you have asthma, you may have low levels of this antioxidant in your blood. Researchers don’t know, however, whether taking CoQ10 supplements will make any difference in your symptoms.
  • Lycopene and beta-carotene -- preliminary data suggests that these two antioxidants, found in many fruits and vegetables, may help prevent exercise-induced asthma.
  • Vitamin B6 -- may be needed if you are taking theophylline because this medication can lower blood levels of B6.
  • Potassium -- levels in the body also may be lowered if you take theophylline.

Herbs

• Boswellia (Boswellia serrata, 3 mg three times per day) -- Boswellia (also known as Salai guggal), an herb commonly used in Ayurvedic medicine (a traditional Indian system of health care), has shown promise in treating asthma. In one double-blind, placebo-controlled study, people who took boswellia had fewer attacks and improved lung function. Boswellia may help leukotreine modifiers work better. However, more research is needed. People who take medication to lower their cholesterol, or people who take nonsteroidal anti-inflammatory drugs (NSAIDs) should talk to their doctor before taking boswellia.
• Coleus forskohlii -- Coleus forskohlii is another herb used in Ayurvedic medicine to treat asthma. A few preliminary studies suggest that inhaled coleus powder seemed to relieve symptoms, but more research is needed to know for sure. People who have diabetes or thyroid conditions should not take coleus. If you take an anticoagulant (blood thinner), taking coleus may increase your risk of bleeding. Pregnant women should not take coleus.
• Tylophora (Tylophora indica, 250 mg one to three times per day) -- Tylophora has also been used historically to treat asthma. Some modern scientific studies show that it can help reduce symptoms, but the studies were not the best quality. More research is needed. Tylophora may cause serious side effects at high doses, so talk to your doctor before taking it. Do not take tylophora if you are pregnant, have diabetes, high blood pressure, or congestive heart failure.
• Pycnogenol (Pinus pinaster, 1 mg per pound of body weight, up to 200 mg) -- A 2002 review of studies on a standardized extract from French maritime pine bark, called pycnogenol, suggests that it may reduce symptoms and improve lung function in people with asthma. Do not use pycnogenol if you have diabetes or take medication for high blood pressure. Taking pycnogenol with an anticoagulant (blood thinner) -- including aspirin -- can increase your risk of bleeding; talk to your doctor first.
• Saiboku-to -- A traditional Japanese herbal mixture called Saiboku-to has helped reduce symptoms and allowed study participants to reduce doses of corticosteroids in three preliminary trials. In test tubes, Saiboku-to has shown anti-inflammatory effects. Saiboku-to contains several herbs, including Asian ginseng (Panax ginseng), Chinese skullcap (Baikal scutellaria), licorice (Glycyrrhiza glabra), and ginger (Zingiber officinale). Talk to your healthcare provider before taking Saiboku-to as the herbs it contains can interact with other herbs and medications.

Acupuncture

Homeopathy

• Arsenicum album -- for asthma that generally worsens between midnight and 2 am and is accompanied by restlessness, anxiety, chills, and thirst.
• Ipecacuanha -- for those with asthma, particularly children, who have significant tightness in the chest, a chronic cough with lots of phlegm that may lead to vomiting, and worsening of symptoms in hot, humid weather.
• Pulsatilla -- for asthma with yellow or greenish phlegm that gets worse in the evening, in warm, stuffy rooms, or after consuming rich, fatty foods; this remedy is most appropriate for adults or children who are tearful and clingy or sweet and affectionate.
• Sambucus -- for asthma that awakens a person at night with a sensation of suffocation; symptoms worsen when the person is lying down .

Mind-Body Medicine

• Hypnosis -- may be especially useful for children, who can readily learn the technique.
• Yoga -- in addition to general relaxation and stress reduction, several studies of people with asthma have suggested that lung function improve with the regular practice of yoga. Any benefits in breathing appear to be slight, however.
• Journaling -- A study published in the New England Journal of Medicine documented the positive effect of daily journaling on people with asthma. Some people think that journaling allows for the release of pent-up emotions and helps reduce stress overall.

Other Considerations

Warnings and Precautions

Prognosis and Complications

Attention deficit hyperactivity disorder

Signs and Symptoms

• Fails to pay close attention to details or makes careless mistakes
• Has difficulty sustaining attention in tasks or play activities
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish tasks
• Has difficulty organizing tasks and activities
• Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work, homework)
• Loses things needed for tasks or activities
• Is easily distracted
• Is forgetful in daily activities

• Fidgets with hands or feet or squirms in seat
• Does not remain seated when expected to
• Runs or climbs excessively in inappropriate situations (in teens or adults, may be feelings of restlessness)
• Has difficulty playing or engaging in leisure activities quietly
• Acts as if "driven by a motor"
• Talks excessively
• Blurts out answers before questions are completed
• Has difficulty waiting his or her turn
• Interrupts or intrudes on others

What Causes It?

• Altered brain function -- Brain scans have shown differences in the brains of ADHD children compared to those of non-ADHD children. For example, many children with ADHD tend to have altered brain activity in the prefrontal cortex, a part of the brain thought to be the command center. This may affect their ability to control impulsive and hyperactive behaviors. Researchers also believe hyperactive behavior in children can be caused by too much slow-wave (or theta) activity in certain regions of the brain.
• Genetics -- ADHD seems to run in families.
• Maternal or childhood exposure to certain toxins -- Women who smoke, drink, and are exposed to PCBs during pregnancy are more likely to have children with ADHD. Children who are exposed to lead or PCBs are more likely to develop the disorder.

Risk Factors

• Heredity -- children with ADHD usually have at least one first-degree relative who also has the disorder.
• Gender -- ADHD is four to nine times more common in boys than in girls. Some experts believe that the disorder is underdiagnosed in girls, however.
• Prenatal and early postnatal health -- maternal drug, alcohol, and cigarette use; exposure of the fetus or infant to toxins, including lead and PCBs; nutritional deficiencies and imbalances.
• Other behavioral disorders, especially those that involve too much aggression (such as oppositional defiant or conduct disorder).

What to Expect at Your Provider's Office

Preventive Care

Treatment Options

Lifestyle

• Setting rules that are easily understood, developmentally appropriate, and not unduly harsh
• Avoiding repeated commands once the child has been reminded of the consequences
• Disciplining the child before becoming too angry and frustrated
• Following discipline with praise when the child follows the rules and behaves appropriately

Complementary and Alternative Therapies

• Magnesium (200 mg per day) -- Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion. Some experts believe that children with ADHD may be showing the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.
• Vitamin B6 -- Adequate levels of vitamin B6 are needed for the body to make and use brain chemicals, including serotonin, dopamine, and norepinephrine, the chemicals affected in children with ADHD. One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children. However, the study used a high dose of B6, which could cause nerve damage (although none occurred in the study). Other studies have shown that B6 has no effect on behavior. Because high doses can be dangerous, do not give your child B6 without your doctor's supervision.
• Zinc (35 mg per day) -- Zinc regulates the activity of brain chemicals, fatty acids, and melatonin, all of which are related behavior. Several studies have found that zinc may help improve behavior, but only slightly. Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.
• Essential fatty acids -- Fatty acids, such as those found in fish and fish oil (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids), are "good fats" that play a key role in normal brain function. Experts have suggested them as a treatment for ADHD. The results of studies are mixed, but research continues. Omega-3 fatty acids are also good for heart health in adults, but high doses may increase the risk of bleeding. If you want to try fish oil to see if it reduces ADHD symptoms in you or your child, talk to your doctor about the best dose.
• L-carnitine -- L-carnitine is formed from an amino acid and helps cells in the body produce energy. One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine, but more research is needed to confirm any benefit. Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

• Roman chamomile (Chamaemelum nobile)
• Valerian (Valerian officinalis)
• Lemon balm (Melissa officinalis)
• Passionflower (Passiflora incarnata)

• Gingko (Gingko biloba) -- used to improve memory and mental sharpness.
• American ginseng (Panax quinquefolium ) and gingko -- One study suggests that gingko in combination with ginseng may improve symptoms of ADHD.

• Stramonium -- for children who are fearful, especially at night
• Cina -- for children who are irritable and dislike being touched; whose behavior is physical and aggressive
• Hyoscyamus niger -- for children who have poor impulse control, talk excessively or act overly exuberant

Other Considerations

Prognosis and Complications

Autism

Signs and Symptoms

• Can’t start or sustain a social conversation
• Develops language slowly or not at all
• Repeats words or memorized passages, like commercials, but doesn’t understand them
• Doesn’t refer to self correctly (for example, says "you want water" when the child means "I want water")
• Uses nonsense rhyming
• Uses gestures instead of words

• Doesn’t seem aware of others’ feelings
• Is withdrawn
• Prefers to spend time alone, rather than with others
• May not respond to eye contact or smiles
• May avoid eye contact
• Doesn’t like to be held
• Doesn’t respond to his name

• Uses repetitive body movements
• May find normal noises painful and hold hands over ears
• May be sensitive to light
• May find even slight touch to be overstimulating
• Rubs surfaces, mouths or licks objects
• Doesn’t like even the smallest changes in routine; needs everything to be the same
• "Acts up" with intense tantrums

Causes

Risk Factors

Diagnosis

• Isn’t babbling by 12 months
• Doesn’t gesture (pointing, waving bye-bye) by 12 months
• Isn’t saying single words by 16 months
• Doesn’t say two-word spontaneous phrases by 24 months (not just echoing)
• Loses any language or social skills at any age

Treatment Approach

Treatment Options

Prognosis/Possible Complications

Following Up

Other Considerations

Viral infection during the first three months of pregnancy -- particularly with rubella -- is a suspected cause of autism.