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<s>[INST] What is (are) Prevent diabetes problems: Keep your kidneys healthy ? [/INST] Blood pressure is the force of blood flow inside your blood vessels. Blood pressure is written with two numbers separated by a slash. For example, a blood pressure result of 130/80 is said as 130 over 80. The first number is the pressure in your blood vessels as your heart beats and pushes blood through your blood vessels. The second number is the pressure as your blood vessels relax between heartbeats. High blood pressure forces your heart to work harder to pump blood. High blood pressure can strain your heart, damage your blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems. </s></s>

<s>[INST] What are the symptoms of Prevent diabetes problems: Keep your kidneys healthy ? [/INST] In the early stages, diabetic kidney disease does not have any symptoms. Kidney disease happens so slowly that you may not feel sick at all for many years. You may not feel sick even when your kidneys do only half the job of healthy kidneys. Only your doctor can tell if you have kidney disease by checking the protein, or albumin, level in your urine at least once a year. The first symptom of diabetic kidney disease is often swelling in parts of your body, such as your hands, face, feet, or ankles. Also, large amounts of protein in your urine may cause urine to look foamy. Once your kidney function starts to decrease, other symptoms may include - increased or decreased urination - feeling drowsy or tired - feeling itchy or numb - dry skin - headaches - weight loss - not feeling hungry - feeling sick to your stomach - vomiting - sleep problems - trouble staying focused - darkened skin - muscle cramps </s></s>

<s>[INST] What to do for Prevent diabetes problems: Keep your kidneys healthy ? [/INST] Your dietitian or doctor may suggest a special eating plan for you. You may have to avoid a diet high in protein, fat, sodium, and potassium. - Cut back on protein, especially animal products such as meat. Damaged kidneys may fail to remove protein waste products from your blood. Diets high in protein make your kidneys work harder and fail sooner. - Avoid a high-fat diet. High-fat diets are high in cholesterol. Cholesterol is a type of fat found in your bodys cells, blood, and many foods. Your body needs some cholesterol to work the right way. For example, your body uses cholesterol to make certain essential hormones and maintain nerve function. However, your body makes all the cholesterol it needs. If you often eat foods that are high in cholesterol, or if high cholesterol runs in your family, extra cholesterol in your blood can build up over time in the walls of your blood vessels and arteries. High blood cholesterol can lead to heart disease and stroke, some of the biggest health problems for people with diabetes. - Avoid high-sodium foods. Sodium is a mineral found in salt and other foods. High levels of sodium may raise your blood pressure. Some high-sodium foods include canned food, frozen dinners, and hot dogs. The amount of sodium is listed on the food label, so you can see which foods have the highest levels. Try to limit your sodium to less than a teaspoon a day, or about 2,300 milligrams (mg) a day. If you have high blood pressure or are African American, middle-aged, or older, aim for no more than 1,500 mg of sodium per day. Ask your doctor or your dietitian about how much sodium you can have. - Ask your doctor about the amount of potassium you need. Potassium is a mineral that helps your heartbeat stay regular and muscles work right. Healthy kidneys keep the right amount of potassium in your body. However, if you have severe kidney damage, high levels of potassium may cause an abnormal heart rhythm or even make your heart stop, called cardiac arrest. Some high-potassium foods include apricots, bananas, oranges, and potatoes. More information about healthy eating and kidney disease is provided in the NIDDK health topics: - Eat Right to Feel Right on Hemodialysis - Nutrition for Advanced Chronic Kidney Disease in Adults - Nutrition for Early Chronic Kidney Disease in Adults - What I need to know about Eating and Diabetes </s></s>

<s>[INST] What is (are) Prevent diabetes problems: Keep your kidneys healthy ? [/INST] Kidney failure, also called end-stage kidney disease or ESRD, means your kidneys no longer work well enough to do their job. You will need treatment to replace the work your kidneys have stopped doing. </s></s>

<s>[INST] What is (are) Crohn's Disease ? [/INST] Crohn's disease is a chronic, or long lasting, disease that causes inflammationirritation or swellingin the gastrointestinal (GI) tract. Most commonly, Crohn's affects the small intestine and the beginning of the large intestine. However, the disease can affect any part of the GI tract, from the mouth to the anus. Crohn's disease is a chronic inflammatory disease of the GI tract, called inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are the other common IBDs. More information is provided in the NIDDK health topics, Ulcerative Colitis and Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis. Crohn's disease most often begins gradually and can become worse over time. Most people have periods of remissiontimes when symptoms disappearthat can last for weeks or years. Some people with Crohn's disease receive care from a gastroenterologist, a doctor who specializes in digestive diseases. </s></s>

<s>[INST] What is (are) Crohn's Disease ? [/INST] The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusa 1-inch-long opening through which stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestinewhich includes the appendix, cecum, colon, and rectumand anus. The last part of the GI tractcalled the lower GI tractconsists of the large intestine and anus. The intestines are sometimes called the bowel. </s></s>

<s>[INST] What causes Crohn's Disease ? [/INST] The exact cause of Crohn's disease is unknown. Researchers believe the following factors may play a role in causing Crohn's disease: - autoimmune reaction - genes - environment Autoimmune reaction. Scientists believe one cause of Crohn's disease may be an autoimmune reactionwhen a person's immune system attacks healthy cells in the body by mistake. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the intestines. This immune system response causes the inflammation, leading to symptoms. Genes. Crohn's disease sometimes runs in families. Research has shown that people who have a parent or sibling with Crohn's disease may be more likely to develop the disease. Researchers continue to study the link between genes and Crohn's disease. Environment. Some studies suggest that certain things in the environment may increase the chance of a person getting Crohn's disease, although the overall chance is low. Nonsteroidal anti-inflammatory drugs,1 antibiotics,2 and oral contraceptives2 may slightly increase the chance of developing Crohn's disease. A high-fat diet may also slightly increase the chance of getting Crohn's disease.3 Some people incorrectly believe that eating certain foods, stress, or emotional distress can cause Crohn's disease. Emotional distress and eating certain foods do not cause Crohn's disease. Sometimes the stress of living with Crohn's disease can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms. </s></s>

<s>[INST] What are the symptoms of Crohn's Disease ? [/INST] The most common signs and symptoms of Crohn's disease are - diarrhea - abdominal cramping and pain - weight loss Other general signs and symptoms include - feeling tired - nausea or loss of appetite - fever - anemiaa condition in which the body has fewer red blood cells than normal Signs and symptoms of inflammation outside of the intestines include - joint pain or soreness - eye irritation - skin changes that involve red, tender bumps under the skin The symptoms a person experiences can vary depending on the severity of the inflammation and where it occurs. </s></s>

<s>[INST] How to diagnose Crohn's Disease ? [/INST] A health care provider diagnoses Crohn's disease with the following: - medical and family history - physical exam - lab tests - upper GI series - computerized tomography (CT) scan - intestinal endoscopy The health care provider may perform a series of medical tests to rule out other bowel diseases, such as irritable bowel syndrome, ulcerative colitis, or celiac disease, that cause symptoms similar to those of Crohn's disease. Medical and Family History Taking a medical and family history can help a health care provider diagnose Crohn's disease and understand a patient's symptoms. He or she will ask the patient to describe his or her - family history - symptoms - current and past medical conditions - current medications Physical Exam A physical exam may help diagnose Crohn's disease. During a physical exam, the health care provider most often - checks for abdominal distension, or swelling - listens to sounds within the abdomen using a stethoscope - taps on the abdomen to check for tenderness and pain and establish if the liver or spleen is abnormal or enlarged Lab Tests A health care provider may order lab tests, including blood and stool tests. Blood tests. A blood test involves drawing blood at a health care provider's office or a lab. A lab technologist will analyze the blood sample. A health care provider may use blood tests to look for changes in - red blood cells. When red blood cells are fewer or smaller than normal, a patient may have anemia. - white blood cells. When the white blood cell count is higher than normal, a person may have inflammation or infection somewhere in his or her body. Stool tests. A stool test is the analysis of a sample of stool. A health care provider will give the patient a container for catching and storing the stool at home. The patient returns the sample to the health care provider or to a lab. A lab technologist will analyze the stool sample. Health care providers commonly order stool tests to rule out other causes of GI diseases. Upper Gastrointestinal Series An upper GI series, also called a barium swallow, uses x-rays and fluoroscopy to help diagnose problems of the upper GI tract. Fluoroscopy is a form of x-ray that makes it possible to see the internal organs and their motion on a video monitor. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. This test does not require anesthesia. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should ask their health care provider about how to prepare for an upper GI series. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and a health care provider can see the shape of these organs more clearly on x-rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. Computerized Tomography Scan Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x-rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. CT scans can diagnose both Crohn's disease and the complications seen with the disease. Intestinal Endoscopy Intestinal endoscopies are the most accurate methods for diagnosing Crohn's disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include - upper GI endoscopy and enteroscopy - capsule endoscopy - colonoscopy Upper GI endoscopy and enteroscopy. An upper GI endoscopy is a procedure that uses an endoscopea small, flexible tube with a lightto directly visualize the lining of the upper GI tract. A health care provider performs the procedure at a hospital or an outpatient center. A nurse or technician may give the patient a liquid anesthetic to gargle or will spray the anesthetic on the back of a patient's throat. The anesthetic numbs the throat and calms the gag reflex. The nurse or technician will then place an intravenous (IV) needle in the person's arm or hand to provide a sedative. The health care provider carefully feeds the endoscope down the patient's esophagus and into the stomach. A small camera on the endoscope sends a video image to a monitor, allowing close examination of the GI tract. During an enteroscopy, the health care provider examines the small intestine with a special, longer endoscope. The health care provider carefully feeds the endoscope into the small intestine using one of the following procedures: - push enteroscopy, which uses a long endoscope to examine the upper portion of the small intestine - single- or double-balloon enteroscopy, which use small balloons to help move the endoscope into the small intestine - spiral enteroscopy, which uses a tube attached to an endocope that acts as a cork screw to move the instrument into the small intestine The procedure most often takes between 15 and 60 minutes. The endoscope does not interfere with the patient's breathing, and many patients fall asleep during the procedure. Capsule endoscopy. Although this procedure can examine the entire digestive tract, health care providers use it mostly to examine the small intestine. The patient swallows a capsule containing a tiny camera. As the capsule passes through the GI tract, the camera will record and transmit images to a small receiver device worn by the patient. When the recording is done, the health care provider downloads the images and reviews them on a video monitor. The camera capsule leaves the patient's body during a bowel movement and is safely flushed down the toilet. Colonoscopy. Colonoscopy is a test that uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside a patient's rectum and entire colon. In most cases, light anesthesia and pain medication help patients relax for the test. The medical staff will monitor a patient's vital signs and try to make him or her as comfortable as possible. A nurse or technician will place an IV needle in a vein in the patient's arm or hand to give anesthesia. For the test, the patient will lie on a table or stretcher while the gastroenterologist inserts a colonoscope into the patient's anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with air to give the gastroenterologist a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the gastroenterologist to examine the tissues lining the colon and rectum. The gastroenterologist may move the patient several times and adjust the scope for better viewing. Once the scope has reached the opening to the small intestine, the gastroenterologist slowly withdraws it and examines the lining of the colon and rectum again. A colonoscopy can show inflamed and swollen tissue, ulcers, and abnormal growths such as polypsextra pieces of tissue that grow on the inner lining of the intestine. If the gastroenterologist suspects Crohn's disease, he or she will biopsy the patient's colon and rectum. A biopsy is a procedure that involves taking small pieces of tissue for examination with a microscope. A health care provider will give patients written bowel prep instructions to follow at home before the test. The health care provider will also give patients information about how to care for themselves following the procedure. </s></s>

<s>[INST] What are the treatments for Crohn's Disease ? [/INST] A health care provider treats Crohn's disease with - medications - bowel rest - surgery Which treatment a person needs depends on the severity of the disease and symptoms. Each person experiences Crohn's disease differently, so health care providers adjust treatments to improve the person's symptoms and induce, or bring about, remission. Medications While no medication cures Crohn's disease, many can reduce symptoms. The goals of medication therapy are - inducing and maintaining remission - improving the person's quality of life Many people with Crohn's disease require medication therapy. Health care providers will prescribe medications depending on the person's symptoms: - aminosalicylates - corticosteroids - immunomodulators - biologic therapies - other medications Aminosalicylates are medications that contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation. Health care providers use aminosalicylates to treat people newly diagnosed with Crohn's disease who have mild symptoms. Aminosalicylates include - balsalazide - mesalamine - olsalazine - sulfasalazinea combination of sulfapyridine and 5-ASA Some of the common side effects of aminosalicylates include - abdominal pain - diarrhea - headaches - heartburn - nausea and vomiting Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include - budesonide - hydrocortisone - methylprednisone - prednisone Side effects of corticosteroids include - acne - a higher chance of developing infections - bone mass loss - high blood glucose - high blood pressure - mood swings - weight gain In most cases, health care providers do not prescribe corticosteroids for long-term use. Immunomodulators reduce immune system activity, resulting in less inflammation in the GI tract. These medications can take several weeks to 3 months to start working. Immunomodulators include - 6-mercaptopurine, or 6-MP - azathioprine - cyclosporine - methotrexate Health care providers prescribe these medications to help people with Crohn's disease go into remission or to help people who do not respond to other treatments. People taking these medications may have the following side effects: - a low white blood cell count, which can lead to a higher chance of infection - fatigue, or feeling tired - nausea and vomiting - pancreatitis Health care providers most often prescribe cyclosporine only to people with severe Crohn's disease because of the medication's serious side effects. People should talk with their health care provider about the risks and benefits of cyclosporine. Biologic therapies are medications that target a protein made by the immune system. Neutralizing this protein decreases inflammation in the intestine. Biologic therapies work quickly to bring on remission, especially in people who do not respond to other medications. Biologic therapies include - adalimumab - certolizumab - infliximab - natalizumab - vedolizumab Health care providers most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medication and a higher chance of developing infections, particularly tuberculosis. Other medications to treat symptoms or complications may include - acetaminophen for mild pain. People with Crohn's disease should avoid using ibuprofen, naproxen, and aspirin since these medications can make symptoms worse. - antibiotics to prevent or treat infections and fistulas. - loperamide to help slow or stop severe diarrhea. In most cases, people only take this medication for short periods of time since it can increase the chance of developing megacolon. Bowel Rest Sometimes Crohn's disease symptoms are severe and a person may need to rest his or her bowel for a few days to several weeks. Bowel rest involves drinking only clear liquids or having no oral intake. To provide the patient with nutrition, a health care provider will deliver IV nutrition through a special catheter, or tube, inserted into a vein in the patient's arm. Some patients stay in the hospital, while other patients are able to receive the treatment at home. In most cases, the intestines are able to heal during bowel rest. Surgery Even with medication treatments, up to 20 percent of people will need surgery to treat their Crohn's disease.1 Although surgery will not cure Crohn's disease, it can treat complications and improve symptoms. Health care providers most often recommend surgery to treat - fistulas - bleeding that is life threatening - bowel obstructions - side effects from medications when they threaten a person's health - symptoms when medications do not improve a person's condition A surgeon can perform different types of operations to treat Crohn's disease: - small bowel resection - subtotal colectomy - proctocolectomy and ileostomy Patients will receive general anesthesia. Most patients will stay in the hospital for 3 to 7 days after the surgery. Full recovery may take 4 to 6 weeks. Small bowel resection. Small bowel resection is surgery to remove part of a patient's small intestine. When a patient with Crohn's disease has a blockage or severe disease in the small intestine, a surgeon may need to remove that section of intestine. The two types of small bowel resection are - laparoscopicwhen a surgeon makes several small, half-inch incisions in the patient's abdomen. The surgeon inserts a laparoscopea thin tube with a tiny light and video camera on the endthrough the small incisions. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of the intestine. - open surgerywhen a surgeon makes one incision about 6 inches long in the patient's abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of the intestine. Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of a patient's large intestine. When a patient with Crohn's disease has a blockage, a fistula, or severe disease in the large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by - laparoscopic colectomywhen a surgeon makes several small, half-inch incisions in the abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of the large intestine. The surgeon will reconnect the ends of the intestine. - open surgerywhen a surgeon makes one incision about 6 to 8 inches long in the abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove that section. The surgeon will reconnect the ends of the intestine. Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient's entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileumthe last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient's abdomen and attaches it to the skin, creating an opening outside of the patient's body. The stoma is about three-fourths of an inch to a little less than 2 inches wide and is most often located in the lower part of the patient's abdomen, just below the beltline. A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects intestinal contents outside the patient's body. Intestinal contents pass through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract. People who have this type of surgery will have the ileostomy for the rest of their lives. </s></s>

<s>[INST] What to do for Crohn's Disease ? [/INST] Researchers have not found that eating, diet, and nutrition cause Crohn's disease symptoms. Good nutrition is important in the management of Crohn's disease, however. Dietary changes can help reduce symptoms. A health care provider may recommend that a person make dietary changes such as - avoiding carbonated drinks - avoiding popcorn, vegetable skins, nuts, and other high-fiber foods - drinking more liquids - eating smaller meals more often - keeping a food diary to help identify troublesome foods Health care providers may recommend nutritional supplements and vitamins for people who do not absorb enough nutrients. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probiotics. Depending on a person's symptoms or medications, a health care provider may recommend a specific diet, such as a - high-calorie diet - lactose-free diet - low-fat diet - low-fiber diet - low-salt diet People should speak with a health care provider about specific dietary recommendations and changes. </s></s>

<s>[INST] What are the complications of Crohn's Disease ? [/INST] Complications of Crohn's disease can include - bowel obstruction. Crohn's disease can thicken the wall of the intestine. Over time, the thickened areas of the intestine can narrow, which can block the intestine. A partial or complete obstruction, also called a bowel blockage, can block the movement of food or stool through the intestines. A complete bowel obstruction is life threatening and requires immediate medical attention and often surgery. - fistulasabnormal passages, or tunnels, between two organs, or between an organ and the outside of the body. How a health care provider treats fistulas depends on their type and severity. For some people, fistulas heal with medication and diet changes, while other people will need to have surgery. - anal fissuressmall tears in the anus that may cause itching, pain, or bleeding. Most anal fissures heal with medical treatment, including ointments, warm baths, and dietary changes. - ulcers. Inflammation anywhere along the GI tract can lead to ulcers or open sores in a person's mouth, intestines, anus, and perineumthe area between the anus and the sex organs. In most cases, the treatment a health care provider prescribes for Crohn's disease will also treat the ulcers. - malnutritiona condition that develops when the body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function. Some people may need IV fluids or feeding tubes to replace lost nutrients and fluids. - inflammation in other areas of the body. The immune system can trigger inflammation in the - joints - eyes - skin Health care providers can treat inflammation by adjusting medications or prescribing new medications. Crohn's Disease and Colon Cancer People with Crohn's disease in the large intestine may be more likely to develop colon cancer. People who receive ongoing treatment and remain in remission may reduce their chances of developing colon cancer. People with Crohn's disease should talk with their health care provider about how often they should get screened for colon cancer. Screening can include colonoscopy with biopsies. Such screening does not reduce a person's chances of developing colon cancer. Instead, screening can help diagnose cancer early and improve chances for recovery. </s></s>

<s>[INST] What to do for Crohn's Disease ? [/INST] - Crohn's disease is a chronic, or long lasting, disease that causes inflammationirritation or swellingin the gastrointestinal (GI) tract. - The exact cause of Crohn's disease is unknown. Researchers believe that factors such as an autoimmune reaction, genes, and environment may play a role in causing Crohn's disease. - Crohn's disease can occur in people of any age. However, it is more likely to develop in people - between the ages of 20 and 29 - who have a family member, most often a sibling or parent, with inflammatory bowel disease (IBD) - who smoke cigarettes - The most common signs and symptoms of Crohn's disease are diarrhea, abdominal cramping and pain, and weight loss. - A health care provider diagnoses Crohn's disease with the following: - medical and family history - physical exam - lab tests - upper GI series - computerized tomography (CT) scan - intestinal endoscopy - Which treatment a person needs depends on the severity of the disease and symptoms. - Good nutrition is important in the management of Crohn's disease. A health care provider may recommend that a person make dietary changes. - People with Crohn's disease should talk with their health care provider about how often they should get screened for colon cancer. </s></s>

<s>[INST] What are the treatments for Financial Help for Diabetes Care ? [/INST] Diabetes management and treatment is expensive. According to the American Diabetes Association (ADA), the average cost of health care for a person with diabetes is $13,741 a yearmore than twice the cost of health care for a person without diabetes.1 Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources. </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include the following: - private health insurance, which includes group and individual health insurance - government health insurance, such as Medicare, Medicaid, the Childrens Health Insurance Program (CHIP), TRICARE, and veterans health care programs Starting in 2014, the Affordable Care Act (ACA) prevents insurers from denying coverage or charging higher premiums to people with preexisting conditions, such as diabetes. The ACA also requires most people to have health insurance or pay a fee. Some people may be exempt from this fee. Read more about the ACA at HealthCare.gov or call 18003182596, TTY 18558894325. </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] Insurance companies sell private health insurance plans. Two types of private health insurance are - Group health insurance. People may be eligible to purchase group health insurance through their employer or union or through a family members employer or union. Other organizations, such as professional or alumni organizations, may also offer group health insurance. - Individual health insurance. People may purchase individual health insurance for themselves and their families. The website HealthCare.gov provides information about individual insurance plans. The website also provides a search function, called the Health Insurance Marketplace, to find health insurance options by state. Depending on their income and family size, some people may qualify for lower-cost premiums through the Health Insurance Marketplace. People can select or change individual health insurance plans during the open enrollment period each year. HealthCare.gov lists open enrollment period dates. The website also provides information about life events that may allow people to enroll outside the open enrollment period. Employers may have a waiting period before an employee and his or her family members can enroll in the company health plan. Under the ACA, the waiting period can be no longer than 90 days. Certain health plans called health maintenance organizations (HMOs) may have an affiliation perioda time that must pass before health insurance coverage becomes effective. An affiliation period can be no longer than 3 months. The ACA expanded coverage of preventive services. For example, adults with sustained high blood pressure may have access to diabetes screening at no cost. Adults and children may have access to obesity screening and counseling at no cost. Each states insurance regulatory office, sometimes called the state insurance department or commission, provides more information about health insurance laws. This office can also help identify an insurance company that offers individual coverage. The National Association of Insurance Commissioners website, www.naic.org/state_web_map.htm , provides a membership list with contact information and a link to the website for each states insurance regulatory office. The ADA also provides information about health insurance options at www.diabetes.org/living-with-diabetes/health-insurance . Keeping Group Health Insurance after Leaving a Job When leaving a job, a person may be able to continue the group health insurance provided by his or her employer for up to 18 months under a federal law called the Consolidated Omnibus Budget Reconciliation Act, or COBRA. Although people pay more for group health insurance through COBRA than they did as employees, group coverage may be cheaper than individual coverage. People who have a disability before becoming eligible for COBRA or who are determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage may be able to extend COBRA coverage an additional 11 months, for up to 29 months of coverage. COBRA may also cover young adults who were insured under a parents policy after they have reached the age limit and are trying to obtain their own insurance. Read more at www.dol.gov/dol/topic/health-plans/cobra.htm or call the U.S. Department of Labor at 18664USADOL (18664872365). If a person doesnt qualify for coverage or if COBRA coverage has expired, other options may be available: - Some states require employers to offer conversion policies, in which people stay with their insurance company and buy individual coverage. - Some professional and alumni organizations offer group coverage for members. - Some insurance companies offer short-term stopgap policies designed for people who are between jobs. However, these policies may not meet ACA requirements. For example, they may not cover preexisting conditions. - People can purchase individual health insurance policies. Each states insurance regulatory office can provide more information about these and other options. Information about consumer health plans is also available at the U.S. Department of Labors website at www.dol.gov/dol/topic/health-plans/consumerinfhealth.htm. </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] Medicare is a federal health insurance program that pays health care costs for eligible people who are - age 65 or older - under age 65 with certain disabilities - of any age with end-stage renal diseasetotal and permanent kidney failure that requires a kidney transplant or blood-filtering treatments called dialysis What health plans does Medicare offer? Medicare has four parts: - Part A (hospital insurance) covers inpatient care, skilled nursing home residence, hospice care, and home health care. Part A has no premium for those who have paid enough Medicare taxes. A premium is an amount a person must pay periodicallymonthly or quarterlyfor Medicare, other health plan, or drug plan coverage. Part A does have a deductible, an amount a person must pay for health care or prescriptions before the health plan will pay. A person must pay a daily amount for hospital stays that last longer than 60 days. - Part B (medical insurance) covers services from health care providers, outpatient care, home health care, durable medical equipment, and some preventative services. Part B has a monthly premium based on a persons income. Rates change each year. After a person pays the deductible each year, Part B pays 80 percent for most covered services as a primary payer. The billing staff of the service providerhospital or cliniccan calculate how much a person will owe. - Part C (Medicare Advantage Plans) are part of Medicare and are sometimes called MA Plans. Medicare must approve Medicare Advantage Plans. Each Medicare Advantage Plan must cover Part A and Part B services and may cover other services, too. Medicare Advantage Plans may have Part D prescription coverage. If not, a person can buy a Part D plan separately. Medicare Advantage Plans are not all the same. A person who is thinking of choosing a Medicare Advantage Plan should ask about the rules of the plan. The rules may specify which health care providers or hospitals a person may use. The plan may require a referral from a primary care provider to see a specialist. The plan may not cover medical expenses incurred during travel. How much a person has to pay out-of-pocket each year will vary by plan. People who have a Medicare Advantage Plan cannot have a Medigap plan to help pay out of-pocket costs. See the section on Medigap. Four types of Medicare Advantage Plans are available: - HMOs - preferred provider organizations (PPOs) - private fee for service plans - special needs plans for certain groups - Part D (prescription drug coverage) has a premium and covers some medications. Private insurance companies offer different Part D plans approved by Medicare. Costs and coverage vary by plan. A person who has few assets and earns less than 150 percent of the federal poverty level may qualify for extra help to pay Part D premiums and medication costs. People can apply for this help by calling the Social Security Administration, visiting www.socialsecurity.gov to apply online, visiting their local Social Security office, or contacting their state medical assistance (Medicaid) office. People can find the current-year guidelines at www.aspe.hhs.gov/poverty or by calling Social Security at 18007721213, TTY 18003250778. People can find information and applications for Part D plans at www.medicare.gov. A person can also apply for Part D with an insurance company that sells one of these plans. Other Medicare health plans are for certain groups, such as frail people living in the community and people with multiple chronic illnesses, and include hospital and medical coverage. Some pay for prescribed medications, too. State health insurance programscalled Medicaidpartially finance and administer these services. The plans include the following: - Medicare Cost Plans are HMOs, like the ones offered as Medicare Advantage plans, only out-of-network providers are paid as if the policyholder had Original Medicare. Original Medicare is Medicare Part A and Part B. - Program of All-Inclusive Care for the Elderly (PACE) combines medical, social, and long-term care services for frail people who live and get health care in the community. - Medicare Innovation Projects are special projects that test improvements in Medicare coverage, payment, and quality of care. Read more about Medicare Cost Plans and Demonstration or Pilot Programs on the state Medicaid website at www.medicaid.gov or call 1800MEDICARE (18006334227). State Medicaid offices can provide more information about PACE. See the section on Medicaid. Does Medicare cover diabetes services and supplies? Medicare helps pay for the diabetes services, supplies, and equipment listed below and for some preventive services for people who are at risk for diabetes. However, coinsurance or deductibles may apply. A person must have Medicare Part B or Medicare Part D to receive these covered services and supplies. Medicare Part B helps pay for - diabetes screening tests for people at risk of developing diabetes - diabetes self-management training - diabetes supplies such as glucose monitors, test strips, and lancets - insulin pumps and insulin if used with an insulin pump - counseling to help people who are obese lose weight - flu and pneumonia shots - foot exams and treatment for people with diabetes - eye exams to check for glaucoma and diabetic retinopathy - medical nutrition therapy services for people with diabetes or kidney disease, when referred by a health care provider - therapeutic shoes or inserts, in some cases Medicare Part D helps pay for - diabetes medications - insulin, excluding insulin used with an insulin pump - diabetes supplies such as needles and syringes for injecting insulin People who are in a Medicare Advantage Plan or other Medicare health plan should check their plans membership materials and call for details about how the plan provides the diabetes services, supplies, and medications covered by Medicare. Read more at www.medicare.gov/publications/pubs/pdf/11022.pdf (PDF, 1,023 KB) or call 1800MEDICARE (18006334227) to request the free booklet Medicares Coverage of Diabetes Supplies & Services. Where can a person find more information about Medicare? A person can find more information about Medicare by - visiting the Medicare website - calling 1800MEDICARE Medicare website. Read more about Medicare at www.medicare.gov, the official U.S. Government website for people with Medicare. The website has a full range of information about Medicare, including free publications such as Medicare & You, which is the official Government handbook about Medicare, and Medicare BasicsA Guide for Families and Friends of People with Medicare. Through the Medicare website, people can also - find out if they are eligible for Medicare and when they can enroll - learn about their Medicare health plan options - find out what Medicare covers - find a Medicare Prescription Drug Plan - compare Medicare health plan options in their area - find a health care provider who participates in Medicare - get information about the quality of care provided by hospitals, home health agencies, and dialysis facilities Calling Medicare. Calling 1800MEDICARE (18006334227) is another way to get help with Medicare questions, order free publications, and more. Help is available 24 hours a day, every day, and is available in English, Spanish, and other languages. TTY users should call 18774862048. Access Personal Medicare Information People who enroll in Medicare can register with www.MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims and order history, and see a description of covered preventive services. What is Medigap? A Medigap plan, also known as a Medicare supplement plan, can help pay what Original Medicare does not pay for covered services. Insurance companies sell Medigap coverage. People who have a Medicare Advantage plan cannot also have a Medigap plan. A person can buy a Medigap policy from any insurance company licensed to sell the policy in the persons home state. For people who are 65 and older, federal law says that in the first 6 months a person has Part B, companies cannot deny an application or limit payment for anything Original Medicare covers. Some states make insurance companies sell at least one Medigap coverage plan to those under 65 with Medicare. State insurance offices can explain the plans in their state. Find local offices on a map at www.naic.org/state_web_map.htm . </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] People who enroll in Medicare can register with www.MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims and order history, and see a description of covered preventive services. </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] Medicaid is a state health insurance program for those with low incomes and few assets. Each state runs its own program. The Federal Government requires that Medicaid programs cover a specific set of services; however, states can choose to cover more services in addition to the ones required. A person may have Medicaid alone or Medicare and Medicaid. If a person has both types of coverage, Medicare pays first and Medicaid pays second. Medicaid may pay for things Medicare does not. A person can apply for Medicaid at a city or county department of social services office. The state medical assistance (Medicaid) office can help people find out whether they qualify for Medicaid and can provide more information about Medicaid programs. A social worker can also explain a states Medicaid program and help a person apply. To contact a state Medicaid office, people can - search for Medicaid information for a state at www.medicaid.gov or call 18772672323 - search online or check the government pages of the phone book for the local department of human services or department of social services CHIP gives free or low-cost Medicaid to children whose parents earn too much for Medicaid, though not enough to pay for a health plan. CHIP may also provide assistance to parents. CHIP is a federal and state program. Read more at www.insurekidsnow.gov or call 18775437669. </s></s>

<s>[INST] What is (are) Financial Help for Diabetes Care ? [/INST] Assistive technology is any device that assists, adapts, or helps to rehabilitate someone with a disability so he or she may function more safely, effectively, and independently at home, at work, and in the community. Assistive technology may include - computers with features that make them accessible to people with disabilities - adaptive equipment, such as wheelchairs - bathroom modifications, such as grab bars or shower seats The following organizations may be able to provide information, awareness, and training in the use of technology to assist people with disabilities: Alliance for Technology Access 1119 Old Humboldt Road Jackson, TN 38305 Phone: 18009143017 or 7315545ATA (7315545282) TTY: 7315545284 Fax: 7315545283 Email: atainfo@ataccess.org Internet: www.ataccess.org National Assistive Technology Technical Assistance Partnership 1700 North Moore Street, Suite 1540 Arlington, VA 222091903 Phone: 7035246686 Fax: 7035246630 TTY: 7035246639 Email: resnaTA@resna.org Internet: www.resnaprojects.org/nattap United Cerebral Palsy 1825 K Street NW, Suite 600 Washington, D.C. 20006 Phone: 18008725827 or 2027760406 Internet: www.ucp.org/resources/assistive-technology </s></s>

<s>[INST] What to do for Financial Help for Diabetes Care ? [/INST] - Diabetes management and treatment is expensive. Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. - Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include private health insurance and government health insurance. - Insurance companies sell private health insurance plans. Two types of private health insurance are group health insurance and individual health insurance. - Medicare is a federal health insurance program that pays health care costs for eligible people who are age 65 or older, under age 65 with certain disabilities, or of any age with end-stage renal disease. - Medicaid is a state health insurance program for those with low incomes and few assets. Each state runs its own program. - The Childrens Health Insurance Program (CHIP) gives free or low-cost Medicaid to children whose parents earn too much for Medicaid, though not enough to pay for a health plan. - Many local governments have public health departments that can help people who need medical care. Local resources such as charitable groups may offer financial help for some expenses related to diabetes. - People should talk with their health care providers if they have problems paying for diabetes medications. Less expensive generic medications for diabetes, blood pressure, and cholesterol are available. If a health care provider prescribes medications that a person cannot afford, the person should ask the health care provider about cheaper alternatives. - Health care providers may also be able to assist people who need help paying for their medications and diabetes testing supplies, such as glucose test strips, by providing free samples or referring them to local programs. Drug companies that sell insulin or diabetes medications often have patient assistance programs. </s></s>

<s>[INST] What is (are) Viral Hepatitis: A through E and Beyond ? [/INST] Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis. All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer. Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus. </s></s>

<s>[INST] What are the symptoms of Viral Hepatitis: A through E and Beyond ? [/INST] Symptoms include - jaundice, which causes a yellowing of the skin and eyes - fatigue - abdominal pain - loss of appetite - nausea - vomiting - diarrhea - low grade fever - headache However, some people do not have symptoms. </s></s>

<s>[INST] What to do for Viral Hepatitis: A through E and Beyond ? [/INST] - Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses. - Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth. - Vaccines offer protection from hepatitis A and hepatitis B. - No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection. - Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis. </s></s>

<s>[INST] What causes Viral Hepatitis: A through E and Beyond ? [/INST] Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus. These cases are called non-AE hepatitis. Scientists continue to study the causes of non-AE hepatitis. </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbnessloss of feelingin the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight. </s></s>

<s>[INST] What causes Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors: - metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin - neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves - autoimmune factors that cause inflammation in nerves - mechanical injury to nerves, such as carpal tunnel syndrome - inherited traits that increase susceptibility to nerve disease - lifestyle factors, such as smoking or alcohol use </s></s>

<s>[INST] What are the symptoms of Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Symptoms depend on the type of neuropathy and which nerves are affected. Some people with nerve damage have no symptoms at all. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomicor involuntarynervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. Symptoms of nerve damage may include - numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers - wasting of the muscles of the feet or hands - indigestion, nausea, or vomiting - diarrhea or constipation - dizziness or faintness due to a drop in blood pressure after standing or sitting up - problems with urination - erectile dysfunction in men or vaginal dryness in women - weakness Symptoms that are not due to neuropathy, but often accompany it, include weight loss and depression. </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways. - Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms. - Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels. - Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs. - Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected. Neuropathy Affects Nerves Throughout the Body Peripheral neuropathy affects - toes - feet - legs - hands - arms Autonomic neuropathy affects - heart and blood vessels - digestive system - urinary tract - sex organs - sweat glands - eyes - lungs Proximal neuropathy affects - thighs - hips - buttocks - legs Focal neuropathy affects - eyes - facial muscles - ears - pelvis and lower back - chest - abdomen - thighs - legs - feet </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Peripheral neuropathy, also called distal symmetric neuropathy or sensorimotor neuropathy, is nerve damage in the arms and legs. Feet and legs are likely to be affected before hands and arms. Many people with diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves. Symptoms of peripheral neuropathy may include - numbness or insensitivity to pain or temperature - a tingling, burning, or prickling sensation - sharp pains or cramps - extreme sensitivity to touch, even light touch - loss of balance and coordination These symptoms are often worse at night. Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If an infection occurs and is not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Many amputations are preventable if minor problems are caught and treated in time. </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning symptoms of hypoglycemia. Hypoglycemia Unawareness Normally, symptoms such as shakiness, sweating, and palpitations occur when blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia difficult to recognize. Problems other than neuropathy can also cause hypoglycemia unawareness. Heart and Blood Vessels The heart and blood vessels are part of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel light-headed or even to faint. Damage to the nerves that control heart rate can mean that the heart rate stays high, instead of rising and falling in response to normal body functions and physical activity. Digestive System Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly, a condition called gastroparesis. Severe gastroparesis can lead to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can also make blood glucose levels fluctuate widely, due to abnormal food digestion. Nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems with the digestive system can lead to weight loss. Urinary Tract and Sex Organs Autonomic neuropathy often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely, allowing bacteria to grow in the bladder and kidneys and causing urinary tract infections. When the nerves of the bladder are damaged, urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine. Autonomic neuropathy can also gradually decrease sexual response in men and women, although the sex drive may be unchanged. A man may be unable to have erections or may reach sexual climax without ejaculating normally. A woman may have difficulty with arousal, lubrication, or orgasm. Sweat Glands Autonomic neuropathy can affect the nerves that control sweating. When nerve damage prevents the sweat glands from working properly, the body cannot regulate its temperature as it should. Nerve damage can also cause profuse sweating at night or while eating. Eyes Finally, autonomic neuropathy can affect the pupils of the eyes, making them less responsive to changes in light. As a result, a person may not be able to see well when a light is turned on in a dark room or may have trouble driving at night. </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain in the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older adults with diabetes. Proximal neuropathy causes weakness in the legs and the inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage. </s></s>

<s>[INST] What is (are) Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause - inability to focus the eye - double vision - aching behind one eye - paralysis on one side of the face, called Bell's palsy - severe pain in the lower back or pelvis - pain in the front of a thigh - pain in the chest, stomach, or side - pain on the outside of the shin or inside of the foot - chest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitis Focal neuropathy is painful and unpredictable and occurs most often in older adults with diabetes. However, it tends to improve by itself over weeks or months and does not cause long-term damage. People with diabetes also tend to develop nerve compressions, also called entrapment syndromes. One of the most common is carpal tunnel syndrome, which causes numbness and tingling of the hand and sometimes muscle weakness or pain. Other nerves susceptible to entrapment may cause pain on the outside of the shin or the inside of the foot. </s></s>

<s>[INST] How to prevent Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] The best way to prevent neuropathy is to keep blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout the body. </s></s>

<s>[INST] How to diagnose Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] Doctors diagnose neuropathy on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch. Foot Exams Experts recommend that people with diabetes have a comprehensive foot exam each year to check for peripheral neuropathy. People diagnosed with peripheral neuropathy need more frequent foot exams. A comprehensive foot exam assesses the skin, muscles, bones, circulation, and sensation of the feet. The doctor may assess protective sensation or feeling in the feet by touching them with a nylon monofilamentsimilar to a bristle on a hairbrushattached to a wand or by pricking them with a pin. People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. The doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception. Other Tests The doctor may perform other tests as part of the diagnosis. - Nerve conduction studies or electromyography are sometimes used to help determine the type and extent of nerve damage. Nerve conduction studies check the transmission of electrical current through a nerve. Electromyography shows how well muscles respond to electrical signals transmitted by nearby nerves. These tests are rarely needed to diagnose neuropathy. - A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture. - Ultrasound uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can be used to assess the structure of these organs and show whether the bladder empties completely after urination. </s></s>

<s>[INST] What are the treatments for Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] The first treatment step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels. Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Good blood glucose control may also help prevent or delay the onset of further problems. As scientists learn more about the underlying causes of neuropathy, new treatments may become available to help slow, prevent, or even reverse nerve damage. As described in the following sections, additional treatment depends on the type of nerve problem and symptom. Pain Relief Doctors usually treat painful diabetic neuropathy with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments and should consider talking with a health care provider about treatment options. Medications used to help relieve diabetic nerve pain include - tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane) - other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa) - anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal) - opioids and opioidlike drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy. People do not have to be depressed for an antidepressant to help relieve their nerve pain. All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications. Treatments that are applied to the skintypically to the feetinclude capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Studies suggest that nitrate sprays or patches for the feet may relieve pain. Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil suggest they may help relieve symptoms and improve nerve function in some patients. A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs. Acupuncture, biofeedback, or physical therapy may help relieve pain in some people. Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful but need further study. Researchers are also studying several new therapies in clinical trials. Gastrointestinal Problems To relieve mild symptoms of gastroparesisindigestion, belching, nausea, or vomitingdoctors suggest eating small, frequent meals; avoiding fats; and eating less fiber. When symptoms are severe, doctors may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea, or other medications to help regulate digestion or reduce stomach acid secretion. To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate. Dizziness and Weakness Sitting or standing slowly may help prevent the light-headedness, dizziness, or fainting associated with blood pressure and circulation problems. Raising the head of the bed or wearing elastic stockings may also help. Some people benefit from increased salt in the diet and treatment with salt-retaining hormones. Others benefit from high blood pressure medications. Physical therapy can help when muscle weakness or loss of coordination is a problem. Urinary and Sexual Problems To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervalsevery 3 hours, for examplebecause they may not be able to tell when the bladder is full. To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy. Medicines are available to help men have and maintain erections by increasing blood flow to the penis. Some are oral medications and others are injected into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices can also increase blood flow to the penis. Another option is to surgically implant an inflatable or semirigid device in the penis. Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist. Foot Care People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. Smoking increases the risk of foot problems and amputation. A health care provider may be able to provide help with quitting smoking. More than 60 percent of all nontraumatic lower-limb amputations in the United States occur in people with diabetes. Nontraumatic amputations are those not caused by trauma such as severe injuries from an accident. In 2004, about 71,000 nontraumatic amputations were performed in people with diabetes. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent. Careful foot care involves - cleaning the feet daily using warmnot hotwater and a mild soap. Soaking the feet should be avoided. A soft towel can be used to dry the feet and between the toes. - inspecting the feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Using a mirrorhandheld or placed on the floormay be helpful in checking the bottoms of the feet, or another person can help check the feet. A health care provider should be notified of any problems. - using lotion to moisturize the feet. Getting lotion between the toes should be avoided. - filing corns and calluses gently with a pumice stone after a bath or shower. - cutting toenails to the shape of the toes and filing the edges with an emery board each week or when needed. - always wearing shoes or slippers to protect feet from injuries. Wearing thick, soft, seamless socks can prevent skin irritation. - wearing shoes that fit well and allow the toes to move. New shoes can be broken in gradually by first wearing them for only an hour at a time. - looking shoes over carefully before putting them on and feeling the insides to make sure the shoes are free of tears, sharp edges, or objects that might injure the feet. People who need help taking care of their feet should consider making an appointment to see a foot doctor, also called a podiatrist. </s></s>

<s>[INST] What to do for Diabetic Neuropathies: The Nerve Damage of Diabetes ? [/INST] - Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose. - Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, sex organs, and other body systems. - Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems. - Foot care is an important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation. - Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage. - Smoking increases the risk of foot problems and amputation. A health care provider may be able to provide help with quitting. </s></s>

<s>[INST] What is (are) What I need to know about Hepatitis A ? [/INST] Hepatitis* A is a virus, or infection, that causes liver disease and inflammation of the liver. Viruses can cause sickness. For example, the flu is caused by a virus. People can pass viruses to each other. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can cause organs to not work properly. </s></s>

<s>[INST] What is (are) What I need to know about Hepatitis A ? [/INST] The liver is an organ that does many important things. You cannot live without a liver. *See the Pronunciation Guide for tips on how to say the words in bold type. The liver - removes harmful chemicals from your blood - fights infection - helps digest food - stores nutrients and vitamins - stores energy </s></s>

<s>[INST] Who is at risk for What I need to know about Hepatitis A? ? [/INST] Anyone can get hepatitis A, but those more likely to are people who - travel to developing countries - live with someone who currently has an active hepatitis A infection - use illegal drugs, including noninjection drugs - have unprotected sex with an infected person - provide child care Also, men who have sex with men are more likely to get hepatitis A. </s></s>

<s>[INST] What are the symptoms of What I need to know about Hepatitis A ? [/INST] Most people do not have any symptoms of hepatitis A. If symptoms of hepatitis A occur, they include - feeling tired - muscle soreness - upset stomach - fever - loss of appetite - stomach pain - diarrhea - dark-yellow urine - light-colored stools - yellowish eyes and skin, called jaundice Symptoms of hepatitis A can occur 2 to 7 weeks after coming into contact with the virus. Children younger than age 6 may have no symptoms. Older children and adults often get mild, flulike symptoms. See a doctor right away if you or a child in your care has symptoms of hepatitis A. </s></s>

<s>[INST] How to diagnose What I need to know about Hepatitis A ? [/INST] A blood test will show if you have hepatitis A. Blood tests are done at a doctors office or outpatient facility. A blood sample is taken using a needle inserted into a vein in your arm or hand. The blood sample is sent to a lab to test for hepatitis A. </s></s>

<s>[INST] What are the treatments for What I need to know about Hepatitis A ? [/INST] Hepatitis A usually gets better in a few weeks without treatment. However, some people can have symptoms for up to 6 months. Your doctor may suggest medicines to help relieve your symptoms. Talk with your doctor before taking prescription and over-the-counter medicines. See your doctor regularly to make sure your body has fully recovered. If symptoms persist after 6 months, then you should see your doctor again. When you recover, your body will have learned to fight off a future hepatitis A infection. However, you can still get other kinds of hepatitis. </s></s>

<s>[INST] What to do for What I need to know about Hepatitis A ? [/INST] If you have hepatitis A, you should do things to take care of yourself, including eating a healthy diet. Avoid drinking alcohol, which can harm the liver. Talk with your doctor before taking vitamins and other supplements. </s></s>

<s>[INST] What to do for What I need to know about Hepatitis A ? [/INST] - Hepatitis A is a virus, or infection, that causes inflammation of the liver. - Anyone can get hepatitis A, but some people are more likely to than others. - You could get hepatitis A through contact with an infected persons stool. - Most people do not have any symptoms of hepatitis A. - Children younger than age 6 may have no symptoms of hepatitis A. - Hepatitis A may cause mild, flulike symptoms in older children and adults. - See a doctor right away if you or a child in your care has symptoms of hepatitis A. - A blood test will show if you have hepatitis A. - Hepatitis A usually gets better in a few weeks without treatment. - You can avoid getting hepatitis A by receiving the hepatitis A vaccine. - Tell your doctor and your dentist if you have hepatitis A. - See your doctor right away if you think you have been in contact with the hepatitis A virus. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] Before scientists learned how to make synthetic hormones, many animal hormones, such as insulin, were used to treat human disorders. Growth hormone from animals did not work in humans. Human growth hormone (pituitary hGH) was therefore made from human pituitary glands by the National Hormone and Pituitary Program (NHPP), funded by the U.S. Department of Health and Human Services (HHS). From 1963 to 1985, the NHPP sent pituitary hGH to hundreds of doctors across the country. As a part of research studies, doctors used the hormone to treat nearly 7,700 children for failure to grow. In 1985, the HHS learned that three young men treated with pituitary hGH died of Creutzfeldt-Jakob disease (CJD), a rare and incurable brain disease. The HHS believed these illnesses were related to pituitary hGH. The HHS immediately stopped the distribution of the hormone and began a national study to learn more about how pituitary hGH treatment may have caused this problem. The HHS continues to monitor individuals who received pituitary hGH through the NHPP for CJD. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] The HHS has identified 29 cases of CJD among the nearly 7,700 people in the United States who received NHPP pituitary hGH. None of the 29 people who got CJD began treatment with pituitary hGH after 1977, the year that the NHPP began producing pituitary hGH in a laboratory (headed by Dr. Albert Parlow) using a new purification step. Today, the growth hormone used to treat patients is made biosynthetically and not from human pituitary glands. Biosynthetic growth hormone (bGH), also known as recombinant human growth hormone (rhGH), poses no threat of infection with CJD. Based on NHPP records, the HHS estimated 7,700 people were treated with pituitary hGH from the NHPP. Of these, the HHS got the names and addresses of 6,272 from their doctors and treatment centers so that their health could be monitored. Another 1,400 people are believed to have been treated with pituitary hGH; however, the HHS does not have their names and addresses. The HHS hoped to learn about CJD and other health problems in the unmonitored group of 1,400 and notified many doctors about the problem of CJD, asking them to report CJD among people treated with pituitary hGH. The HHS has learned that five of the 29 people with confirmed CJD were among the 1,400 people the HHS was not able to identify and study. Some U.S. laboratories that made pituitary hGH for the NHPP also made hGH for use in other countries. The HHS learned that six people in New Zealand and two people in Brazil who received U.S.-made pituitary hGH may also have gotten CJD. A total of 37 people who were treated with pituitary hGH made in the United States may have gotten CJD. Before bGH was available, several pharmaceutical companies made pituitary hGH. Some children treated in the U.S. received hormone produced by these companies when NHPP hGH was not available to them. Some of the 29 people with confirmed CJD received hGH from both the NHPP and a pharmaceutical company. Recently, the HHS has learned of an individual treated in the U.S. who developed CJD and received only commercial pituitary hGH. That person was not eligible for NHPP hGH and received pituitary hGH made by two pharmaceutical companies. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] People treated with pituitary hGH in other countries also got CJD. HHS doctors share information with doctors around the world about health issues such as CJD and read reports about CJD and other health problems related to pituitary hGH treatment. Country Number of CJD Cases Reported* Number of Individuals Treated Source of hGH in Reported Cases New Zealand*** 6 159 United States France 119 1,700 France United Kingdom 75 1,849 United Kingdom Holland 2 unpublished Holland Brazil 2 unpublished United States Australia 1** 608 Australia Austria 1 unpublished pharmaceutical (commercial) Qatar 1 unpublished France Ireland 1 unpublished Not known *as of November 2014 **This case has been recognized by the Australian surveillance authorities as a "possible" (albeit unlikely) CJD case. ***New Zealand has reported six people with CJD among 159 who received pituitary hGH. All six were among 49 people who received pituitary hGH made by the U.S. lab that supplied most NHPP pituitary hGH before 1977. We don't know why this ratesix out of 49 (12.2 percent)is so high in those in New Zealand who received American hormone. HHS scientists believe that this U.S.-made hormone did not undergo the same filtering process used in the United States when the hormone was put into vials. In addition, some hormone preparations sent to New Zealand were not distributed in the United States. New Zealand has little information on the hormone preparations used to treat the people who got CJD. Information provided to the HHS from medical authorities in New Zealand indicated the following dates of pituitary hGH treatment for the six New Zealand patients who developed CJD: 1964 to 1966, 1964 to 1970, 1965 to 1972, 1966 to 1972, 1967 to 1969, and 1970 to 1973. With no common period of treatment, it is unlikely that a single preparation exposed all six patients to CJD. There is some information on the hormone sent to New Zealand from the lab that also produced hormone for the NHPP before 1977. Some preparations and components of preparations were used in both countries and others were distributed only in the United States or in New Zealand. The time between the start of pituitary hGH treatment and the first sign of CJD symptoms was similar in the 29 United States patients (14 to 44 years) and the six New Zealand patients (17 to 37 years). The New Zealand patients who got CJD were treated with pituitary hGH for an average of 4.3 years. In the United States, average treatment time was 8.4 years in patients who got CJD. In France, 119 people with CJD were among the 1,700 treated with pituitary hGH. The pattern of exposure to CJD in France is very different from the pattern in the United States. In France, people who received pituitary hGH in 1984 and 1985 appear to be at highest risk for CJD. We have learned from animal studies that when scientists injected a greater amount of CJD infectious agent into an animal, it took less time for CJD to develop. Because of the larger number of people with CJD and shorter times between treatment and CJD onset in France, the level of infection in French hormone was probably higher than in the U.S. hormone. The purification procedure used in France differed from that begun in 1977 in the United States. The United Kingdom has reported 75 people with CJD among 1,849 who received pituitary hGH. Experts have also found CJD in two people in Holland, two people in Brazil, and one each in Australia, Austria, Qatar, and Ireland. France, the United Kingdom, Holland, and Australia made their own hormone. The Brazilian patients got pituitary hGH from a U.S. lab that also made NHPP hormone before 1977. This was a different lab than the U.S. lab that made hormone for New Zealand. The Qatar patient received pituitary hGH made in France. The Austrian patient received pituitary hGH made by a pharmaceutical company. Four Australian women developed CJD after receiving other human pituitary hormones as fertility treatments. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] Most people were treated with pituitary hGH because their pituitary glands did not make enough of their own GH. Some of these people also had problems making other pituitary hormones. One of these hormones tells the adrenal glands to make cortisol, a hormone needed for life. People lacking this hormone are at risk of death from adrenal crisis, but adrenal crisis can be prevented. More pituitary hGH recipients have died from adrenal crisis than from CJD. Pituitary hGH did not cause adrenal problems, but some people who received hGH have a pituitary problem that puts them at risk for adrenal crisis. Please read the health alert and discuss this information with your doctor. Besides CJD, no other serious or fatal health risks from pituitary hGH treatment have been found. Mad Cow Disease Starting in 1996, reports of a new form of CJD in young people who lived in the United Kingdom have raised concerns worldwide. Since at least 1985, some cattle in the United Kingdom have developed a disease called bovine spongiform encephalopathy (BSE), or "mad cow" disease. "Mad cow" disease is a sickness in cattle that is caused by an agent that is similar, but not identical, to the agents that cause the most common forms of CJD in people. Individuals who consume products made from cattle infected with the agent that causes "mad cow" disease can become infected with the agent themselves and develop the human form of "mad cow" disease, called variant CJD (vCJD). In humans, vCJD and the more common forms of CJD (those without the word "variant") are separate diseases. As of November 2012, 227 cases of vCJD were confirmed worldwide, mostly from the United Kingdom. Researchers believe all but three of these 227 individuals got vCJD by eating beef from animals with "mad cow" disease. The three exceptions were persons who are believed to have developed vCJD because they received infected blood from a donor who had acquired the agent by eating beef from animals with "mad cow" disease. In the United States, three cases of vCJD have been found. According to the Centers for Disease Control and Prevention (CDC), the investigation of these three cases indicated that they most likely acquired their infection in the United Kingdom (two cases) and Saudi Arabia (one case). People who received pituitary hGH are not at higher risk for vCJD. AIDS HIV, also known as the human immunodeficiency virus, causes AIDS. Pituitary hGH does not cause AIDS. HIV is destroyed by the methods used to make pituitary hGH. People who have been treated with pituitary hGH do not have a higher risk for AIDS. Low Levels of GH in Adults Some people who received pituitary hGH as children may have low levels of GH as adults and might therefore benefit from bGH as adults. People with low levels of growth hormone as adults may have symptoms or changes like these: - more body fat - less muscle - less bone mass - less strength - less energy If you lacked GH as a child and have these problems as an adult, ask your doctor whether they might be due to low GH. Because these conditions are common in many people, they are not always due to low GH. Studies have shown that GH treatment in adults with low GH reduces fat and increases muscle mass. Effects on strength, energy, and bone fractures in GH-deficient adults receiving GH replacement are not as clear. Today, GH is completely synthetic. It is not made from human pituitaries. It poses no threat of contamination. The Human Growth Foundation (HGF) is one source of information about growth-related disorders. The Foundation can be reached at 18004516434. Cancer HHS studies of people treated with pituitary hGH supplied by the NHPP show no increased risk of cancer in those who did not have tumors before pituitary hGH treatment. Many people who received NHPP pituitary hGH had brain tumors that caused their lack of GH. People who have had one tumor have an increased risk for getting other tumors. In previous updates, we reported that in 1988, Japanese doctors reported an increased risk of leukemia in people treated with GH. Subsequent studies of individuals who were given pituitary hGH in the United States, Japan, and the United Kingdom found no higher rate of leukemia among those who did not have tumors and/or radiation before treatment with pituitary hGH. Emotional Problems No studies have shown that pituitary hGH causes changes in personality, emotional problems, or suicide. </s></s>

<s>[INST] What are the symptoms of National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] CJD does not cause the same symptoms in everyone. In most people who got CJD from pituitary hGH, the first signs they noticed were difficulty with walking and balance, dizziness, and/or clumsiness. Later, some began to slur words and have jerky movements. They also had trouble seeing, remembering, and/or thinking clearly. The disease becomes worse very quickly. When individuals have symptoms like these over a long period of time (such as a year) without getting much worse, they do not have CJD. Occasional forgetfulness, clumsiness, or headaches do not mean one has CJD. You should discuss concerns with your doctor if you are not sure. CJD is a rare disease. Most cases of CJD are not linked to pituitary hGH. When CJD is not linked to pituitary hGH, the first symptoms are usually mental changes such as confusion, problems thinking clearly, memory loss, behavior changes, and dementia. Though symptoms may differ, there are similar changes in the brain tissue of all patients with CJD. </s></s>

<s>[INST] Who is at risk for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report)? ? [/INST] No one can say what an individual person's risk is. Of the approximately 7,700 people who received NHPP pituitary hGH, 29 people got CJD. The two things that seem to be connected with getting CJD after pituitary hGH treatment are 1. How long a person was treated: - In the United States, the average length of time for pituitary hGH treatment through the NHPP was about 3 years. For those individuals who developed CJD, the average length of treatment was about 8.4 years. - Even though longer treatment time increased the risk for CJD in the United States, in other countries CJD has developed after shorter treatment periods. 2. When a person was treated: - All of the 29 individuals treated with NHPP hGH who got CJD in the United States started pituitary hGH before 1977. No CJD has been reported in Americans who began treatment with NHPP hormone after 1977, when production of NHPP hormone was moved to a laboratory (headed by Dr. Albert Parlow) that used a new method of purifying pituitary hGH. Research in animals showed the newer purification steps introduced in 1977 reduced the risk of CJD transmission. Recently, an analysis of NHPP hGH recipients was completed taking into account the differences in follow-up time and the duration of treatment of recipients starting treatment before or after 1977. That analysis found that the new purification steps greatly reduced and may have eliminated the risk for CJD infection. - Two cases of CJD have been reported in individuals who received commercially prepared pituitary hGH. An Austrian person was treated with pituitary hGH (Crescormon, from Kabi Pharma) for 14 months and died from CJD 22 years later. An American who was too tall to be eligible for NHPP hormone was treated with pituitary hGH made by two pharmaceutical companies (Asellacrin, from Serono, and Crescormon, from Kabi Pharma). This individual was treated with commercial hGH for 23 months and died just over 26 years later. The methods used to produce these commercial hormone preparations were not identical to the method used in Dr. Parlow's laboratory but did include a version of the important new purification step that has been shown to reduce CJD infectivity. - Overall, one out of about 265 people (29 out of about 7,700 people) who were treated with NHPP pituitary hGH got CJD. - However, one in about 91 people who began treatment before 1977 got CJD. - People who started treatment before 1970 are at even higher risk. In that early group, one in about every 48 people (about 2.1 percent) got CJD. - The appearance of new cases is decreasing, as there has only been one new case in the past 5 years. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] The best source for details on your treatment is the doctor or center that gave you pituitary hGH. To protect patient privacy, the HHS did not ask for the names of those treated with pituitary hGH until 1985, when the first CJD cases were reported. In 1985, the HHS asked doctors and treatment centers for the names and addresses of recipients to inform them of the risk of CJD. We know which pituitary hGH preparations were sent to each treatment center and when they were sent. However, because individual doctors administered the pituitary hGH, we don't know which preparation each person might have gotten. We have tried to find this information in the medical records of patients who developed CJD, but many doctors did not note the specific preparation in their records. When records were incomplete, it was assumed that patients who got CJD might have been exposed to all preparations sent to their treatment center during the time they were treated. Since it is impossible to confidently identify high-risk or risk-free hormone, we do not think that details on the hormone preparations that individuals received will help to clarify individual level of risk. </s></s>

<s>[INST] What causes National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] We have not found any particular preparation of pituitary hGH that is especially likely to carry CJD. We believe that CJD did not come from a single infected pituitary gland or preparation. Prior to 1977, in an effort to extract as much hormone as possible from the pituitary glands, the glands were often processed repeatedly. Hormone extracted from the same pituitaries was often included in many hormone preparations. Also, patients who got CJD were treated on average for 8.4 years and received many different hormone preparations. This makes it very difficult to identify any preparation associated with transmitting CJD. Doctors wanted to see if a specific preparation of pituitary hGH could transmit CJD. To try to find the pituitary hGH that could have caused CJD, HHS researchers did two things: 1. They set up a test in animals, injecting samples of all available preparations of pituitary hGH directly into the brains of monkeys. CJD develops more rapidly if injected into the brain than under the skin, as hGH was used in people. The animals were watched for 10 years. The brains of all animals were examined for signs of CJD. If an animal got sick with CJD, it would help researchers to understand which vials of pituitary hGH were contaminated with the agent that causes CJD. 2. They studied people treated with pituitary hGH to see who got CJD and which hormone preparation they might have received based on which preparations were sent to their doctor. Results: - The animal tests did not help find the pituitary hGH that might have caused CJD. One animal developed the disease 5 years after injection of pituitary hGH. Two other animals that received injections from different vials of the same pituitary hGH preparation did not develop CJD. - None of the people who developed CJD are known to have received the hormone preparation that made the animal sick. At most, two patients (whose records are incomplete) may have received this pituitary hGH preparation. Because of this, we do not believe that the patients who received the hormone preparation that transmitted CJD to the animal have a greater risk of developing CJD than others treated with pituitary hGH. Because each preparation of pituitary hGH was used to fill multiple vials, it is not known if CJD contamination was spread evenly among all vials of pituitary hGH that came from a particular preparation. It's possible that one vial got more contamination and another got little or none from the same preparation of pituitary hGH. It is believed that multiple preparations of pituitary hGH probably had very low levels of the CJD infectious agent. With such low levels of contamination, some vials of a preparation might carry CJD while other vials would not. Further, most of the people who got CJD received pituitary hGH for long periods of time and received many different preparations. </s></s>

<s>[INST] How to diagnose National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] CJD is usually diagnosed based on signs and symptoms of the illness, how severe they are, and how quickly they become worse. However, doctors must study brain tissue from a biopsy or autopsy in order to make a definite diagnosis of CJD. Other tests can suggest CJD. In 1996, researchers developed a test that helps doctors diagnose CJD in patients with symptoms. This test detects an abnormal protein in a sample of spinal fluid. When this protein is found, it helps make a diagnosis of CJD. It is much easier and safer to take a sample of spinal fluid than to do a brain biopsy. Unfortunately, this test cannot identify CJD in patients who do not have symptoms. The test cannot predict who may develop CJD in the future. Researchers from many countries, including the United States, have reported success using MRI to diagnose CJD and vCJD in people with symptoms of the disease. MRI is a safe and painless tool that allows doctors to look at images of the brain and does not involve the collection of brain or spinal fluid samples. </s></s>

<s>[INST] what research (or clinical trials) is being done for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] Although CJD is a rare disorder, some of the world's leading researchers are working hard to learn more about this disease. About 10 percent of the people who get CJD have the inherited type. Some people have gotten CJD from medical procedures such as pituitary hGH injections, tissue grafts, or corneal transplants. Scientists don't fully understand what causes CJD. Evidence suggests that a unique infectious agent called a prion [PREE-on] may be the cause. A prion is an unusual infectious agent because it contains no genetic material. It is a protein that takes on different forms. In its normal, harmless form, the protein is curled into a spiral. In its infectious form, the protein folds into an abnormal shape. Somehow, these abnormal proteins change the shape of normal proteins. This change begins a serious chain reaction that results in brain problems. People with inherited CJD have an abnormal gene that leads to changes in their prion protein. This gene makes the protein likely to assume the abnormal shape. Exposure to the abnormal form of the protein can also occur through injection of contaminated pituitary hGH, tissue grafts, and corneal transplants and through exposures to infected brain tissue. If CJD results from a defect in protein folding, it may be possible to identify drugs that can help the prion protein assume its proper shape. Such drugs would slow or stop the progress of the disease. Treatments like these are being studied by researchers. Researchers in both Europe and the United States are also trying to develop a test that will identify CJD before symptoms appear. More information and medical journal articles about CJD and growth hormone therapy can be found on the National Endocrine and Metabolic Diseases Information Service web page Human Growth Hormone and Creutzfeldt-Jakob Disease Resource List. </s></s>

<s>[INST] What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] Some parents did not tell their children about receiving treatment with pituitary hGH and the possible risk of CJD. These children are now adults. Although the HHS no longer sends annual information about the problem of CJD in pituitary hGH recipients, the HHS does maintain a mailing list should any important new information become available. If parents are no longer available to receive HHS mailings, their adult children may not have access to important new information. Some pituitary hGH recipients have learned about the risk of CJD from newspaper stories. Others heard about it when they tried to give blood. Those who were not told by their parents are often angry when they hear about it outside the family. Any parent of an individual who received pituitary hGH who has not received any mailings from the HHSthe last correspondence was sent in June 1999should contact the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) with the adult child's current address. Knowledgeable staff members are glad to answer any questions that parents or recipients may have. </s></s>

<s>[INST] What is (are) National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? [/INST] The Creutzfeldt-Jakob Disease Foundation, Inc. (www.cjdfoundation.org) was created in 1993 by two families who lost relatives to CJD and the neurologist who treated their family members. This nonprofit corporation seeks to promote awareness of CJD through research and education and to reach out to people who have lost loved ones to this illness. For information on CJD from the NIH, see www.ninds.nih.gov. The Human Growth Foundation (HGF) (www.hgfound.org) is a nonprofit organization concerned with children's growth disorders and adult GH deficiency. The HGF has information available online and through its toll-free number, 18004516434. The HGF also supports an Internet mailing list to help the exchange of information about adult GH deficiency and adult GH replacement therapy. </s></s>

<s>[INST] What is (are) Foodborne Illnesses ? [/INST] Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Common symptoms of foodborne illnesses include vomiting, diarrhea, abdominal pain, fever, and chills. Most foodborne illnesses are acute, meaning they happen suddenly and last a short time, and most people recover on their own without treatment. Rarely, foodborne illnesses may lead to more serious complications. Each year, an estimated 48 million people in the United States experience a foodborne illness. Foodborne illnesses cause about 3,000 deaths in the United States annually.1 </s></s>

<s>[INST] What causes Foodborne Illnesses ? [/INST] The majority of foodborne illnesses are caused by harmful bacteria and viruses.2 Some parasites and chemicals also cause foodborne illnesses. Bacteria Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans. Some harmful bacteria may already be present in foods when they are purchased. Raw foods including meat, poultry, fish and shellfish, eggs, unpasteurized milk and dairy products, and fresh produce often contain bacteria that cause foodborne illnesses. Bacteria can contaminate foodmaking it harmful to eatat any time during growth, harvesting or slaughter, processing, storage, and shipping. Foods may also be contaminated with bacteria during food preparation in a restaurant or home kitchen. If food preparers do not thoroughly wash their hands, kitchen utensils, cutting boards, and other kitchen surfaces that come into contact with raw foods, cross-contaminationthe spread of bacteria from contaminated food to uncontaminated foodmay occur. If hot food is not kept hot enough or cold food is not kept cold enough, bacteria may multiply. Bacteria multiply quickly when the temperature of food is between 40 and 140 degrees. Cold food should be kept below 40 degrees and hot food should be kept above 140 degrees. Bacteria multiply more slowly when food is refrigerated, and freezing food can further slow or even stop the spread of bacteria. However, bacteria in refrigerated or frozen foods become active again when food is brought to room temperature. Thoroughly cooking food kills bacteria. Many types of bacteria cause foodborne illnesses. Examples include - Salmonella, a bacterium found in many foods, including raw and undercooked meat, poultry, dairy products, and seafood. Salmonella may also be present on egg shells and inside eggs. - Campylobacter jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk. - Shigella, a bacterium spread from person to person. These bacteria are present in the stools of people who are infected. If people who are infected do not wash their hands thoroughly after using the bathroom, they can contaminate food that they handle or prepare. Water contaminated with infected stools can also contaminate produce in the field. - Escherichia coli (E. coli), which includes several different strains, only a few of which cause illness in humans. E. coli O157:H7 is the strain that causes the most severe illness. Common sources of E. coli include raw or undercooked hamburger, unpasteurized fruit juices and milk, and fresh produce. - Listeria monocytogenes (L. monocytogenes), which has been found in raw and undercooked meats, unpasteurized milk, soft cheeses, and ready-to-eat deli meats and hot dogs. - Vibrio, a bacterium that may contaminate fish or shellfish. - Clostridium botulinum (C. botulinum), a bacterium that may contaminate improperly canned foods and smoked and salted fish. Viruses Viruses are tiny capsules, much smaller than bacteria, that contain genetic material. Viruses cause infections that can lead to sickness. People can pass viruses to each other. Viruses are present in the stool or vomit of people who are infected. People who are infected with a virus may contaminate food and drinks, especially if they do not wash their hands thoroughly after using the bathroom. Common sources of foodborne viruses include - food prepared by a person infected with a virus - shellfish from contaminated water - produce irrigated with contaminated water Common foodborne viruses include - norovirus, which causes inflammation of the stomach and intestines - hepatitis A, which causes inflammation of the liver Parasites Parasites are tiny organisms that live inside another organism. In developed countries such as the United States, parasitic infections are relatively rare. Cryptosporidium parvum and Giardia intestinalis are parasites that are spread through water contaminated with the stools of people or animals who are infected. Foods that come into contact with contaminated water during growth or preparation can become contaminated with these parasites. Food preparers who are infected with these parasites can also contaminate foods if they do not thoroughly wash their hands after using the bathroom and before handling food. Trichinella spiralis is a type of roundworm parasite. People may be infected with this parasite by consuming raw or undercooked pork or wild game. Chemicals Harmful chemicals that cause illness may contaminate foods such as - fish or shellfish, which may feed on algae that produce toxins, leading to high concentrations of toxins in their bodies. Some types of fish, including tuna and mahi mahi, may be contaminated with bacteria that produce toxins if the fish are not properly refrigerated before they are cooked or served. - certain types of wild mushrooms. - unwashed fruits and vegetables that contain high concentrations of pesticides. </s></s>

<s>[INST] Who is at risk for Foodborne Illnesses? ? [/INST] Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including - infants and children - pregnant women and their fetuses - older adults - people with weak immune systems These groups also have a greater risk of developing severe symptoms or complications of foodborne illnesses. </s></s>

<s>[INST] What are the symptoms of Foodborne Illnesses ? [/INST] Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include - vomiting - diarrhea or bloody diarrhea - abdominal pain - fever - chills Symptoms can range from mild to serious and can last from a few hours to several days. C. botulinum and some chemicals affect the nervous system, causing symptoms such as - headache - tingling or numbness of the skin - blurred vision - weakness - dizziness - paralysis </s></s>

<s>[INST] What are the complications of Foodborne Illnesses ? [/INST] Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems. Dehydration When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly. Infants, children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated. Signs of dehydration are - excessive thirst - infrequent urination - dark-colored urine - lethargy, dizziness, or faintness Signs of dehydration in infants and young children are - dry mouth and tongue - lack of tears when crying - no wet diapers for 3 hours or more - high fever - unusually cranky or drowsy behavior - sunken eyes, cheeks, or soft spot in the skull Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released. Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. HUS Hemolytic uremic syndrome is a rare disease that mostly affects children younger than 10 years of age. HUS develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells, which help the blood to clot, and the lining of the blood vessels. In the United States, E. coli O157:H7 infection is the most common cause of HUS, but infection with other strains of E. coli, other bacteria, and viruses may also cause HUS. A recent study found that about 6 percent of people with E. coli O157:H7 infections developed HUS. Children younger than age 5 have the highest risk, but females and people age 60 and older also have increased risk.3 Symptoms of E. coli O157:H7 infection include diarrhea, which may be bloody, and abdominal pain, often accompanied by nausea, vomiting, and fever. Up to a week after E. coli symptoms appear, symptoms of HUS may develop, including irritability, paleness, and decreased urination. HUS may lead to acute renal failure, which is a sudden and temporary loss of kidney function. HUS may also affect other organs and the central nervous system. Most people who develop HUS recover with treatment. Research shows that in the United States between 2000 and 2006, fewer than 5 percent of people who developed HUS died of the disorder. Older adults had the highest mortality rateabout one-third of people age 60 and older who developed HUS died.3 Studies have shown that some children who recover from HUS develop chronic complications, including kidney problems, high blood pressure, and diabetes. Other Complications Some foodborne illnesses lead to other serious complications. For example, C. botulinum and certain chemicals in fish and seafood can paralyze the muscles that control breathing. L. monocytogenes can cause spontaneous abortion or stillbirth in pregnant women. Research suggests that acute foodborne illnesses may lead to chronic disorders, including - reactive arthritis, a type of joint inflammation that usually affects the knees, ankles, or feet. Some people develop this disorder following foodborne illnesses caused by certain bacteria, including C. jejuni and Salmonella. Reactive arthritis usually lasts fewer than 6 months, but this condition may recur or become chronic arthritis.4 - irritable bowel syndrome (IBS), a disorder of unknown cause that is associated with abdominal pain, bloating, and diarrhea or constipation or both. Foodborne illnesses caused by bacteria increase the risk of developing IBS.5 - Guillain-Barr syndrome, a disorder characterized by muscle weakness or paralysis that begins in the lower body and progresses to the upper body. This syndrome may occur after foodborne illnesses caused by bacteria, most commonly C. jejuni. Most people recover in 6 to 12 months.6 A recent study found that adults who had recovered from E. coli O157:H7 infections had increased risks of high blood pressure, kidney problems, and cardiovascular disease.7 </s></s>

<s>[INST] How to diagnose Foodborne Illnesses ? [/INST] To diagnose foodborne illnesses, health care providers ask about symptoms, foods and beverages recently consumed, and medical history. Health care providers will also perform a physical examination to look for signs of illness. Diagnostic tests for foodborne illnesses may include a stool culture, in which a sample of stool is analyzed in a laboratory to check for signs of infections or diseases. A sample of vomit or a sample of the suspected food, if available, may also be tested. A health care provider may perform additional medical tests to rule out diseases and disorders that cause symptoms similar to the symptoms of foodborne illnesses. If symptoms of foodborne illnesses are mild and last only a short time, diagnostic tests are usually not necessary. </s></s>

<s>[INST] What are the treatments for Foodborne Illnesses ? [/INST] The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration. Over-the-counter medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate) may help stop diarrhea in adults. However, people with bloody diarrheaa sign of bacterial or parasitic infectionshould not use these medications. If diarrhea is caused by bacteria or parasites, over-the-counter medications may prolong the problem. Medications to treat diarrhea in adults can be dangerous for infants and children and should only be given with a health care providers guidance. If the specific cause of the foodborne illness is diagnosed, a health care provider may prescribe medications, such as antibiotics, to treat the illness. Hospitalization may be required to treat lifethreatening symptoms and complications, such as paralysis, severe dehydration, and HUS. </s></s>

<s>[INST] What to do for Foodborne Illnesses ? [/INST] The following steps may help relieve the symptoms of foodborne illnesses and prevent dehydration in adults: - drinking plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes - sipping small amounts of clear liquids or sucking on ice chips if vomiting is still a problem - gradually reintroducing food, starting with bland, easy-to-digest foods such as rice, potatoes, toast or bread, cereal, lean meat, applesauce, and bananas - avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete Infants and children present special concerns. Infants and children are likely to become dehydrated more quickly from diarrhea and vomiting because of their smaller body size. The following steps may help relieve symptoms and prevent dehydration in infants and children: - giving oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte to prevent dehydration - giving food as soon as the child is hungry - giving infants breast milk or fullstrength formula, as usual, along with oral rehydration solutions Older adults and adults with weak immune systems should also drink oral rehydration solutions to prevent dehydration. </s></s>

<s>[INST] How to prevent Foodborne Illnesses ? [/INST] Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods. - Raw and cooked perishable foodsfoods that can spoilshould be refrigerated or frozen promptly. If perishable foods stand at room temperature for more than 2 hours, they may not be safe to eat. Refrigerators should be set at 40 degrees or lower and freezers should be set at 0 degrees. - Foods should be cooked long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses. A meat thermometer should be used to ensure foods are cooked to the appropriate internal temperature: - 145 degrees for roasts, steaks, and chops of beef, veal, pork, and lamb, followed by 3 minutes of rest time after the meat is removed from the heat source - 160 degrees for ground beef, veal, pork, and lamb - 165 degrees for poultry - Cold foods should be kept cold and hot foods should be kept hot. - Fruits and vegetables should be washed under running water just before eating, cutting, or cooking. A produce brush can be used under running water to clean fruits and vegetables with firm skin. - Raw meat, poultry, seafood, and their juices should be kept away from other foods. - People should wash their hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. People should also wash their hands after using the bathroom, changing diapers, or touching animals. - Utensils and surfaces should be washed with hot, soapy water before and after they are used to prepare food. Diluted bleach1 teaspoon of bleach to 1 quart of hot watercan also be used to sanitize utensils and surfaces. More information about preventing foodborne illnesses is available at www.foodsafety.gov. </s></s>

<s>[INST] What to do for Foodborne Illnesses ? [/INST] - Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. - Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including infants and children, pregnant women and their fetuses, older adults, and people with weakened immune systems. - Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include vomiting, diarrhea or bloody diarrhea, abdominal pain, fever, and chills. - Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems. - The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration. - Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods. </s></s>

<s>[INST] What are the treatments for Analgesic Nephropathy (Painkillers and the Kidneys) ? [/INST] If you have been taking analgesics regularly to control chronic pain, you may be advised to find new ways to treat your pain, such as behavior modification or relaxation techniques. Depending on how much your kidney function has declined, you may be advised to change your diet, limit the fluids you drink, or take medications to avoid anemia and bone problems caused by kidney disease. Your doctor will monitor your kidney function with regular urine and blood tests. </s></s>

<s>[INST] What is (are) Cyclic Vomiting Syndrome ? [/INST] Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacksalso called episodesof severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work. A person may need treatment at an emergency room or a hospital during episodes. After an episode, a person usually experiences symptom-free periods lasting a few weeks to several months. To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening. The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity. </s></s>

<s>[INST] What is (are) Cyclic Vomiting Syndrome ? [/INST] The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anusthe opening through which stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum, the first part of the small intestine. The esophagus is the muscular tube that carries food and liquids from the mouth to the stomach. The stomach slowly pumps the food and liquids through the duodenum and into the rest of the small intestine, which absorbs nutrients from food particles. This process is automatic and people are usually not aware of it, though people sometimes feel food in their esophagus when they swallow something too large, try to eat too quickly, or drink hot or cold liquids. </s></s>

<s>[INST] What causes Cyclic Vomiting Syndrome ? [/INST] The cause of cyclic vomiting syndrome is unknown. However, some experts believe that some possible problems with bodily functions may contribute to the cause, such as the following: - gastrointestinal motilitythe way food moves through the digestive system - central nervous system functionincludes the brain, spinal cord, and nerves that control bodily responses - autonomic nervous system functionnerves that control internal organs such as the heart - hormone imbalanceshormones are a chemical produced in one part of the body and released into the blood to trigger or regulate particular bodily functions - in children, an abnormal inherited gene may also contribute to the condition Specific conditions or events may trigger an episode of cyclic vomiting: - emotional stress, anxiety, or panic attacksfor example, in children, common triggers of anticipatory anxiety are school exams or events, birthday parties, holidays, family conflicts, or travel - infections, such as a sinus infection, a respiratory infection, or the flu - eating certain foods, such as chocolate or cheese, or additives such as caffeine, nitritescommonly found in cured meats such as hot dogsand monosodium glutamate, also called MSG - hot weather - menstrual periods - motion sickness - overeating, fasting, or eating right before bedtime - physical exhaustion or too much exercise </s></s>

<s>[INST] How many people are affected by Cyclic Vomiting Syndrome ? [/INST] Cyclic vomiting syndrome is more common in children than adults, although reports of the syndrome in adults have increased in recent years.1 Usually, children are about 5 years old when diagnosed with cyclic vomiting syndrome, which occurs in every three out of 100,000 children.2 </s></s>

<s>[INST] What are the symptoms of Cyclic Vomiting Syndrome ? [/INST] The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days. A person may also experience one or more of the following symptoms: - retching, or making an attempt to vomit - heaving or gagging - lack of appetite - abdominal pain - diarrhea - fever - dizziness - headache - sensitivity to light Intensity of symptoms will vary as a person cycles through four distinct phases of an episode: - Prodrome phase. During the prodrome phase, the person feels that an episode of nausea and vomiting is about to start. Often marked by intense sweating and nauseawith or without abdominal painthis phase can last from a few minutes to several hours. The person may appear unusually pale. - Vomiting phase. This phase consists of intense nausea, vomiting, and retching. Periods of vomiting and retching can last 20 to 30 minutes at a time. The person may be subdued and responsive, immobile and unresponsive, or writhing and moaning with intense abdominal pain. An episode can last from hours to days. - Recovery phase. This phase begins when the vomiting and retching stop and the nausea subsides. Improvement of symptoms during the recovery phase can vary. Healthy color, appetite, and energy return gradually or right away. - Well phase. This phase occurs between episodes when no symptoms are present. </s></s>

<s>[INST] What are the complications of Cyclic Vomiting Syndrome ? [/INST] The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay. - Dehydration may occur when a person does not replace fluids that were lost because of vomiting and diarrhea. When dehydrated, the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly. Severe dehydration may require intravenous (IV) fluids and hospitalization. - Esophagitisinflammation or irritation of the esophaguscan result from the stomach acid that exits through the esophagus during vomiting. - A Mallory-Weiss teara tear in the lower end of the esophagusis caused by severe vomiting. A person with bloody vomit and stool should see a health care provider right away. - Tooth decay or corroding tooth enamel is damage caused by stomach acid. Seek Help for Signs or Symptoms of Severe Dehydration People who have any signs or symptoms of severe dehydration should call or see a health care provider right away: - excessive thirst - dark-colored urine - infrequent urination - lethargy, dizziness, or faintness - dry skin Infants, children, older adults, and people with weak immune systems have the greatest chance of becoming dehydrated. People should watch for the following signs and symptoms of dehydration in infants, young children, and people who are unable to communicate their symptoms: - dry mouth and tongue - lack of tears when crying - infants with no wet diapers for 3 hours or more - infants with a sunken soft spot - unusually cranky or drowsy behavior - sunken eyes or cheeks - fever If left untreated, severe dehydration can cause serious health problems, such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. </s></s>

<s>[INST] What are the symptoms of Cyclic Vomiting Syndrome ? [/INST] People who have any signs or symptoms of severe dehydration should call or see a health care provider right away: - excessive thirst - dark-colored urine - infrequent urination - lethargy, dizziness, or faintness - dry skin Infants, children, older adults, and people with weak immune systems have the greatest chance of becoming dehydrated. People should watch for the following signs and symptoms of dehydration in infants, young children, and people who are unable to communicate their symptoms: - dry mouth and tongue - lack of tears when crying - infants with no wet diapers for 3 hours or more - infants with a sunken soft spot - unusually cranky or drowsy behavior - sunken eyes or cheeks - fever If left untreated, severe dehydration can cause serious health problems, such as organ damage, shock, or comaa sleeplike state in which a person is not conscious. </s></s>

<s>[INST] How to diagnose Cyclic Vomiting Syndrome ? [/INST] A specific test to diagnose cyclic vomiting syndrome does not exist; instead, a health care provider will rule out other conditions and diagnose the syndrome based upon - a medical and family history - a physical exam - a pattern or cycle of symptoms - blood tests - urine tests - imaging tests - upper GI endoscopy - a gastric emptying test Often, it is suspected that one of the following is causing their symptoms: - gastroparesisa disorder that slows or stops the movement of food from the stomach to the small intestine - gastroenteritisinflammation of the lining of the stomach, small intestine, and large intestine A diagnosis of cyclic vomiting syndrome may be difficult to make until the person sees a health care provider. A health care provider will suspect cyclic vomiting syndrome if the person suffers from repeat episodes of vomiting. Medical and Family History Taking a medical and family history is one of the first things a health care provider may do to help diagnose cyclic vomiting syndrome. He or she will ask the patient to provide a medical and family history. Physical Exam A physical exam may help diagnose other conditions besides cyclic vomiting syndrome. During a physical exam, a health care provider usually - examines a patients body - taps on specific areas of the patients body Pattern or Cycle of Symptoms in Children3 A health care provider will often suspect cyclic vomiting syndrome in a child when the child - has at least five separate episodes, or at least three separate episodes over 6 months - has episodes of intense nausea and vomiting lasting 1 hour to 10 days and occurring at least 1 week apart - has episodes that are similar to previous onesthey tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity - vomits during episodes at least four times per hour for at least 1 hour - vomits and it is not attributed to another disorder - has absence of nausea and vomiting between episodes Pattern or Cycle of Symptoms in Adults4,5 A health care provider will often suspect cyclic vomiting syndrome in adults when the following is present for at least 3 months and the symptoms started more than 6 months ago: - Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day and last the same length of timeless than 1 week. - Three or more separate episodes in the past year. - Absence of nausea or vomiting between episodes. Blood Tests A nurse or technician will draw blood samples at a health care providers office or a commercial facility and send the samples to a lab for analysis. The blood test can tell the health care provider if the patient has any signs of dehydration or other problems. Urine Tests Urinalysis involves testing a urine sample. The patient collects a urine sample in a special container in a health care providers office or a commercial facility. A health care provider tests the sample in the same location or sends the sample to a lab for analysis. A urinalysis can rule out kidney problems or an infection. Imaging Tests The health care provider decides which test to order based on the symptoms, medical history, and physical exam. Upper GI series. A health care provider may order an upper GI series to look at the upper GI tract. A radiologista doctor who specializes in medical imagingperforms this test at a hospital or an outpatient center. This test does not require anesthesia. The patient should not eat or drink for 8 hours before the procedure, if possible. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Infants lie on a table and a health care provider gives them barium through a tiny tube placed in the nose that runs into the stomach. Barium coats the GI tract, making signs of obstruction or other problems that can cause vomiting show up more clearly on x rays. A patient may experience bloating and nausea for a short time after the test. The upper GI series can show other problems that may be causing symptoms, such as an ulcer or obstruction. Abdominal ultrasound. A health care provider may order an ultrasound to look at the organs in the abdomen. A technician uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The technician performs the procedure in a health care providers office, an outpatient center, or a hospital. A radiologist interprets the images. A patient does not need anesthesia. The abdominal ultrasound can show other problems that may be causing symptoms, such as gallstones. Upper Gastrointestinal Endoscopy This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patients throat. A nurse or technician will place an IV needle in a vein in the arm to administer sedation or anesthesia. Sedatives or anesthesia help a patient stay relaxed and comfortable. The gastroenterologist carefully inserts the endoscope into the mouth and feeds the endoscope down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. The upper GI endoscopy can show other problems that may be causing symptoms, such as an ulcer. A gastroenterologist may obtain a biopsya procedure that involves taking a small piece of tissue for examination with a microscopeof the small-intestinal lining during an upper GI endoscopy. The patient will not feel the biopsy. Gastric Emptying Test Also called gastric emptying scintigraphy, this test involves eating a bland mealsuch as eggs or an egg substitutethat contains a small amount of radioactive material. A specially trained technician performs the test in a radiology center or hospital, and a radiologist interprets the results; the patient does not need anesthesia. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. </s></s>

<s>[INST] What are the treatments for Cyclic Vomiting Syndrome ? [/INST] A health care provider may refer patients to a gastroenterologist for treatment. People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms. The health care team tailors treatment to the symptoms experienced during each of the four cyclic vomiting syndrome phases: - Prodrome phase treatment. The goal during the prodrome phase is to stop an episode before it progresses. Taking medication early in the phase can help stop an episode from moving to the vomiting phase or becoming severe; however, people do not always realize an episode is coming. For example, a person may wake up in the morning and begin vomiting. A health care provider may recommend the following medications for both children and adults: - ondansetron (Zofran) or lorazepam (Ativan) for nausea - ibuprofen for abdominal pain - ranitidine (Zantac), lansoprazole (Prevacid), or omeprazole (Prilosec, Zegerid) to control stomach acid production - sumatriptan (Imitrex)prescribed as a nasal spray, an injection, or a pill that dissolves under the tonguefor migraines - Vomiting phase treatment. Once vomiting begins, people should call or see a health care provider as soon as possible. Treatment usually requires the person to stay in bed and sleep in a dark, quiet room. A health care provider may recommend the following for both children and adults: - medication for pain, nausea, and reducing stomach acid and anxiety - anti-migraine medications such as sumatriptan to stop symptoms of a migraine or possibly stop an episode in progress - hospitalization for severe nausea and vomiting - IV fluids and medications to prevent dehydration and treat symptoms - IV nutrition if an episode continues for several days - Recovery phase treatment. During the recovery phase, drinking and eating will replace lost electrolytes. A person may need IV fluids for a period of time. Some people find their appetite returns to normal right away, while others start by drinking clear liquids and then moving slowly to other liquids and solid food. A health care provider may prescribe medications during the recovery phase and well phase to prevent future episodes. - Well phase treatment. During the well phase, a health care provider may use medications to treat people whose episodes are frequent and long lasting in an effort to prevent or ease future episodes. A person may need to take a medication daily for 1 to 2 months before evaluating whether it helps prevent episodes. A health care provider may prescribe the following medications for both children and adults during the well phase to prevent cyclic vomiting syndrome episodes, lessen their severity, and reduce their frequency: - amitriptyline (Elavil) - propranolol (Inderal) - cyproheptadine (Periactin) </s></s>

<s>[INST] How to prevent Cyclic Vomiting Syndrome ? [/INST] A person should stay away from known triggers, especially during the well phase, as well as - get adequate sleep to prevent exhaustion - treat sinus problems or allergies - seek help on reducing stress and anxiety - avoid foods that trigger episodes or foods with additives A health care provider may refer people with cyclic vomiting syndrome and anxiety to a stress management specialist for relaxation therapy or other treatments. A health care provider may prescribe medications to prevent migraines for people with cyclic vomiting syndrome. </s></s>

<s>[INST] What to do for Cyclic Vomiting Syndrome ? [/INST] During the prodrome and vomiting phases of cyclic vomiting syndrome, a person will generally take in little or no nutrition by mouth. During the recovery phase, the person may be quite hungry as soon as the vomiting stops. As eating resumes, a person or his or her family should watch for the return of nausea. In some cases, a person can start with clear liquids and proceed slowly to a regular diet. During the well phase, a balanced diet and regular meals are important. People should avoid any trigger foods and foods with additives. Eating small, carbohydrate-containing snacks between meals, before exercise, and at bedtime may help prevent future attacks. A health care provider will assist with planning a return to a regular diet. </s></s>

<s>[INST] What to do for Cyclic Vomiting Syndrome ? [/INST] - Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacksalso called episodesof severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. - The disorder can affect a person for months, years, or decades. - The cause of cyclic vomiting syndrome is unknown. - The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay. - Intensity of symptoms will vary as a person cycles through four distinct phases of an episode. - The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days. - People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms. - During the well phase, a balanced diet and regular meals are important. A health care provider will assist with planning a return to a regular diet. </s></s>

<s>[INST] What is (are) Causes of Diabetes ? [/INST] Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. Diabetes is a disorder of metabolismthe way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both. Insulin is made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood. If beta cells dont produce enough insulin, or the body doesnt respond to the insulin that is present, glucose builds up in the blood instead of being absorbed by cells in the body, leading to prediabetes or diabetes. Prediabetes is a condition in which blood glucose levels or A1C levelswhich reflect average blood glucose levelsare higher than normal but not high enough to be diagnosed as diabetes. In diabetes, the bodys cells are starved of energy despite high blood glucose levels. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other complications of diabetes may include increased susceptibility to other diseases, loss of mobility with aging, depression, and pregnancy problems. No one is certain what starts the processes that cause diabetes, but scientists believe genes and environmental factors interact to cause diabetes in most cases. The two main types of diabetes are type 1 diabetes and type 2 diabetes. A third type, gestational diabetes, develops only during pregnancy. Other types of diabetes are caused by defects in specific genes, diseases of the pancreas, certain drugs or chemicals, infections, and other conditions. Some people show signs of both type 1 and type 2 diabetes. </s></s>

<s>[INST] What causes Causes of Diabetes ? [/INST] Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the bodys own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time. Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type 1 diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus. Latent autoimmune diabetes in adults (LADA) may be a slowly developing kind of type 1 diabetes. Diagnosis usually occurs after age 30. In LADA, as in type 1 diabetes, the bodys immune system destroys the beta cells. At the time of diagnosis, people with LADA may still produce their own insulin, but eventually most will need insulin shots or an insulin pump to control blood glucose levels. Genetic Susceptibility Heredity plays an important part in determining who is likely to develop type 1 diabetes. Genes are passed down from biological parent to child. Genes carry instructions for making proteins that are needed for the bodys cells to function. Many genes, as well as interactions among genes, are thought to influence susceptibility to and protection from type 1 diabetes. The key genes may vary in different population groups. Variations in genes that affect more than 1 percent of a population group are called gene variants. Certain gene variants that carry instructions for making proteins called human leukocyte antigens (HLAs) on white blood cells are linked to the risk of developing type 1 diabetes. The proteins produced by HLA genes help determine whether the immune system recognizes a cell as part of the body or as foreign material. Some combinations of HLA gene variants predict that a person will be at higher risk for type 1 diabetes, while other combinations are protective or have no effect on risk. While HLA genes are the major risk genes for type 1 diabetes, many additional risk genes or gene regions have been found. Not only can these genes help identify people at risk for type 1 diabetes, but they also provide important clues to help scientists better understand how the disease develops and identify potential targets for therapy and prevention. Genetic testing can show what types of HLA genes a person carries and can reveal other genes linked to diabetes. However, most genetic testing is done in a research setting and is not yet available to individuals. Scientists are studying how the results of genetic testing can be used to improve type 1 diabetes prevention or treatment. Autoimmune Destruction of Beta Cells In type 1 diabetes, white blood cells called T cells attack and destroy beta cells. The process begins well before diabetes symptoms appear and continues after diagnosis. Often, type 1 diabetes is not diagnosed until most beta cells have already been destroyed. At this point, a person needs daily insulin treatment to survive. Finding ways to modify or stop this autoimmune process and preserve beta cell function is a major focus of current scientific research. Recent research suggests insulin itself may be a key trigger of the immune attack on beta cells. The immune systems of people who are susceptible to developing type 1 diabetes respond to insulin as if it were a foreign substance, or antigen. To combat antigens, the body makes proteins called antibodies. Antibodies to insulin and other proteins produced by beta cells are found in people with type 1 diabetes. Researchers test for these antibodies to help identify people at increased risk of developing the disease. Testing the types and levels of antibodies in the blood can help determine whether a person has type 1 diabetes, LADA, or another type of diabetes. Environmental Factors Environmental factors, such as foods, viruses, and toxins, may play a role in the development of type 1 diabetes, but the exact nature of their role has not been determined. Some theories suggest that environmental factors trigger the autoimmune destruction of beta cells in people with a genetic susceptibility to diabetes. Other theories suggest that environmental factors play an ongoing role in diabetes, even after diagnosis. Viruses and infections. A virus cannot cause diabetes on its own, but people are sometimes diagnosed with type 1 diabetes during or after a viral infection, suggesting a link between the two. Also, the onset of type 1 diabetes occurs more frequently during the winter when viral infections are more common. Viruses possibly associated with type 1 diabetes include coxsackievirus B, cytomegalovirus, adenovirus, rubella, and mumps. Scientists have described several ways these viruses may damage or destroy beta cells or possibly trigger an autoimmune response in susceptible people. For example, anti-islet antibodies have been found in patients with congenital rubella syndrome, and cytomegalovirus has been associated with significant beta cell damage and acute pancreatitisinflammation of the pancreas. Scientists are trying to identify a virus that can cause type 1 diabetes so that a vaccine might be developed to prevent the disease. Infant feeding practices. Some studies have suggested that dietary factors may raise or lower the risk of developing type 1 diabetes. For example, breastfed infants and infants receiving vitamin D supplements may have a reduced risk of developing type 1 diabetes, while early exposure to cows milk and cereal proteins may increase risk. More research is needed to clarify how infant nutrition affects the risk for type 1 diabetes. Read more in the Centers for Disease Control and Preventions (CDCs) publication National Diabetes Statistics Report, 2014 at www.cdc.gov for information about research studies related to type 1 diabetes. </s></s>

<s>[INST] What causes Causes of Diabetes ? [/INST] Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type 2 diabetes may develop gradually and can be subtle; some people with type 2 diabetes remain undiagnosed for years. Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes. Genetic Susceptibility Genes play a significant part in susceptibility to type 2 diabetes. Having certain genes or combinations of genes may increase or decrease a persons risk for developing the disease. The role of genes is suggested by the high rate of type 2 diabetes in families and identical twins and wide variations in diabetes prevalence by ethnicity. Type 2 diabetes occurs more frequently in African Americans, Alaska Natives, American Indians, Hispanics/Latinos, and some Asian Americans, Native Hawaiians, and Pacific Islander Americans than it does in non-Hispanic whites. Recent studies have combined genetic data from large numbers of people, accelerating the pace of gene discovery. Though scientists have now identified many gene variants that increase susceptibility to type 2 diabetes, the majority have yet to be discovered. The known genes appear to affect insulin production rather than insulin resistance. Researchers are working to identify additional gene variants and to learn how they interact with one another and with environmental factors to cause diabetes. Studies have shown that variants of the TCF7L2 gene increase susceptibility to type 2 diabetes. For people who inherit two copies of the variants, the risk of developing type 2 diabetes is about 80 percent higher than for those who do not carry the gene variant.1 However, even in those with the variant, diet and physical activity leading to weight loss help delay diabetes, according to the Diabetes Prevention Program (DPP), a major clinical trial involving people at high risk. Genes can also increase the risk of diabetes by increasing a persons tendency to become overweight or obese. One theory, known as the thrifty gene hypothesis, suggests certain genes increase the efficiency of metabolism to extract energy from food and store the energy for later use. This survival trait was advantageous for populations whose food supplies were scarce or unpredictable and could help keep people alive during famine. In modern times, however, when high-calorie foods are plentiful, such a trait can promote obesity and type 2 diabetes. Obesity and Physical Inactivity Physical inactivity and obesity are strongly associated with the development of type 2 diabetes. People who are genetically susceptible to type 2 diabetes are more vulnerable when these risk factors are present. An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes. Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin resistance and type 2 diabetes but also for heart and blood vessel disease, also called cardiovascular disease (CVD). This excess belly fat produces hormones and other substances that can cause harmful, chronic effects in the body such as damage to blood vessels. The DPP and other studies show that millions of people can lower their risk for type 2 diabetes by making lifestyle changes and losing weight. The DPP proved that people with prediabetesat high risk of developing type 2 diabetescould sharply lower their risk by losing weight through regular physical activity and a diet low in fat and calories. In 2009, a follow-up study of DPP participantsthe Diabetes Prevention Program Outcomes Study (DPPOS)showed that the benefits of weight loss lasted for at least 10 years after the original study began.2 Read more about the DPP, funded under National Institutes of Health (NIH) clinical trial number NCT00004992, and the DPPOS, funded under NIH clinical trial number NCT00038727 in Diabetes Prevention Program. Insulin Resistance Insulin resistance is a common condition in people who are overweight or obese, have excess abdominal fat, and are not physically active. Muscle, fat, and liver cells stop responding properly to insulin, forcing the pancreas to compensate by producing extra insulin. As long as beta cells are able to produce enough insulin, blood glucose levels stay in the normal range. But when insulin production falters because of beta cell dysfunction, glucose levels rise, leading to prediabetes or diabetes. Abnormal Glucose Production by the Liver In some people with diabetes, an abnormal increase in glucose production by the liver also contributes to high blood glucose levels. Normally, the pancreas releases the hormone glucagon when blood glucose and insulin levels are low. Glucagon stimulates the liver to produce glucose and release it into the bloodstream. But when blood glucose and insulin levels are high after a meal, glucagon levels drop, and the liver stores excess glucose for later, when it is needed. For reasons not completely understood, in many people with diabetes, glucagon levels stay higher than needed. High glucagon levels cause the liver to produce unneeded glucose, which contributes to high blood glucose levels. Metformin, the most commonly used drug to treat type 2 diabetes, reduces glucose production by the liver. The Roles of Insulin and Glucagon in Normal Blood Glucose Regulation A healthy persons body keeps blood glucose levels in a normal range through several complex mechanisms. Insulin and glucagon, two hormones made in the pancreas, help regulate blood glucose levels: - Insulin, made by beta cells, lowers elevated blood glucose levels. - Glucagon, made by alpha cells, raises low blood glucose levels. - Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels. - Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen. - Insulin also lowers blood glucose levels by reducing glucose production in the liver. - Glucagon signals the liver and muscle tissue to break down glycogen into glucose, which enters the bloodstream and raises blood glucose levels. - If the body needs more glucose, glucagon stimulates the liver to make glucose from amino acids. Metabolic Syndrome Metabolic syndrome, also called insulin resistance syndrome, refers to a group of conditions common in people with insulin resistance, including - higher than normal blood glucose levels - increased waist size due to excess abdominal fat - high blood pressure - abnormal levels of cholesterol and triglycerides in the blood Cell Signaling and Regulation Cells communicate through a complex network of molecular signaling pathways. For example, on cell surfaces, insulin receptor molecules capture, or bind, insulin molecules circulating in the bloodstream. This interaction between insulin and its receptor prompts the biochemical signals that enable the cells to absorb glucose from the blood and use it for energy. Problems in cell signaling systems can set off a chain reaction that leads to diabetes or other diseases. Many studies have focused on how insulin signals cells to communicate and regulate action. Researchers have identified proteins and pathways that transmit the insulin signal and have mapped interactions between insulin and body tissues, including the way insulin helps the liver control blood glucose levels. Researchers have also found that key signals also come from fat cells, which produce substances that cause inflammation and insulin resistance. This work holds the key to combating insulin resistance and diabetes. As scientists learn more about cell signaling systems involved in glucose regulation, they will have more opportunities to develop effective treatments. Beta Cell Dysfunction Scientists think beta cell dysfunction is a key contributor to type 2 diabetes. Beta cell impairment can cause inadequate or abnormal patterns of insulin release. Also, beta cells may be damaged by high blood glucose itself, a condition called glucose toxicity. Scientists have not determined the causes of beta cell dysfunction in most cases. Single gene defects lead to specific forms of diabetes called maturity-onset diabetes of the young (MODY). The genes involved regulate insulin production in the beta cells. Although these forms of diabetes are rare, they provide clues as to how beta cell function may be affected by key regulatory factors. Other gene variants are involved in determining the number and function of beta cells. But these variants account for only a small percentage of type 2 diabetes cases. Malnutrition early in life is also being investigated as a cause of beta cell dysfunction. The metabolic environment of the developing fetus may also create a predisposition for diabetes later in life. Risk Factors for Type 2 Diabetes People who develop type 2 diabetes are more likely to have the following characteristics: - age 45 or older - overweight or obese - physically inactive - parent or sibling with diabetes - family background that is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American - history of giving birth to a baby weighing more than 9 pounds - history of gestational diabetes - high blood pressure140/90 or aboveor being treated for high blood pressure - high-density lipoprotein (HDL), or good, cholesterol below 35 milligrams per deciliter (mg/dL), or a triglyceride level above 250 mg/dL - polycystic ovary syndrome, also called PCOS - prediabetesan A1C level of 5.7 to 6.4 percent; a fasting plasma glucose test result of 100125 mg/dL, called impaired fasting glucose; or a 2-hour oral glucose tolerance test result of 140199, called impaired glucose tolerance - acanthosis nigricans, a condition associated with insulin resistance, characterized by a dark, velvety rash around the neck or armpits - history of CVD The American Diabetes Association (ADA) recommends that testing to detect prediabetes and type 2 diabetes be considered in adults who are overweight or obese and have one or more additional risk factors for diabetes. In adults without these risk factors, testing should begin at age 45. </s></s>

<s>[INST] What causes Causes of Diabetes ? [/INST] Insulin Resistance and Beta Cell Dysfunction Hormones produced by the placenta and other pregnancy-related factors contribute to insulin resistance, which occurs in all women during late pregnancy. Insulin resistance increases the amount of insulin needed to control blood glucose levels. If the pancreas cant produce enough insulin due to beta cell dysfunction, gestational diabetes occurs. As with type 2 diabetes, excess weight is linked to gestational diabetes. Overweight or obese women are at particularly high risk for gestational diabetes because they start pregnancy with a higher need for insulin due to insulin resistance. Excessive weight gain during pregnancy may also increase risk. Family History Having a family history of diabetes is also a risk factor for gestational diabetes, suggesting that genes play a role in its development. Genetics may also explain why the disorder occurs more frequently in African Americans, American Indians, and Hispanics/Latinos. Many gene variants or combinations of variants may increase a womans risk for developing gestational diabetes. Studies have found several gene variants associated with gestational diabetes, but these variants account for only a small fraction of women with gestational diabetes. Future Risk of Type 2 Diabetes Because a womans hormones usually return to normal levels soon after giving birth, gestational diabetes disappears in most women after delivery. However, women who have gestational diabetes are more likely to develop gestational diabetes with future pregnancies and develop type 2 diabetes.3 Women with gestational diabetes should be tested for persistent diabetes 6 to 12 weeks after delivery and at least every 3 years thereafter. Also, exposure to high glucose levels during gestation increases a childs risk for becoming overweight or obese and for developing type 2 diabetes later on. The result may be a cycle of diabetes affecting multiple generations in a family. For both mother and child, maintaining a healthy body weight and being physically active may help prevent type 2 diabetes. </s></s>

<s>[INST] What causes Causes of Diabetes ? [/INST] Other types of diabetes have a variety of possible causes. Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin. The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes. Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors. Other Genetic Diseases Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes. The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs. Damage to or Removal of the Pancreas Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells. Endocrine Diseases Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels. Autoimmune Disorders Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes. Medications and Chemical Toxins Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis. Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes. Lipodystrophy Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. </s></s>

<s>[INST] What causes Causes of Diabetes ? [/INST] Other types of diabetes have a variety of possible causes. Genetic Mutations Affecting Beta Cells, Insulin, and Insulin Action Some relatively uncommon forms of diabetes known as monogenic diabetes are caused by mutations, or changes, in a single gene. These mutations are usually inherited, but sometimes the gene mutation occurs spontaneously. Most of these gene mutations cause diabetes by reducing beta cells ability to produce insulin. The most common types of monogenic diabetes are neonatal diabetes mellitus (NDM) and MODY. NDM occurs in the first 6 months of life. MODY is usually found during adolescence or early adulthood but sometimes is not diagnosed until later in life. More information about NDM and MODY is provided in the NIDDK health topic, Monogenic Forms of Diabetes. Other rare genetic mutations can cause diabetes by damaging the quality of insulin the body produces or by causing abnormalities in insulin receptors. Other Genetic Diseases Diabetes occurs in people with Down syndrome, Klinefelter syndrome, and Turner syndrome at higher rates than the general population. Scientists are investigating whether genes that may predispose people to genetic syndromes also predispose them to diabetes. The genetic disorders cystic fibrosis and hemochromatosis are linked to diabetes. Cystic fibrosis produces abnormally thick mucus, which blocks the pancreas. The risk of diabetes increases with age in people with cystic fibrosis. Hemochromatosis causes the body to store too much iron. If the disorder is not treated, iron can build up in and damage the pancreas and other organs. Damage to or Removal of the Pancreas Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells. Endocrine Diseases Endocrine diseases affect organs that produce hormones. Cushings syndrome and acromegaly are examples of hormonal disorders that can cause prediabetes and diabetes by inducing insulin resistance. Cushings syndrome is marked by excessive production of cortisolsometimes called the stress hormone. Acromegaly occurs when the body produces too much growth hormone. Glucagonoma, a rare tumor of the pancreas, can also cause diabetes. The tumor causes the body to produce too much glucagon. Hyperthyroidism, a disorder that occurs when the thyroid gland produces too much thyroid hormone, can also cause elevated blood glucose levels. Autoimmune Disorders Rare disorders characterized by antibodies that disrupt insulin action can lead to diabetes. This kind of diabetes is often associated with other autoimmune disorders such as lupus erythematosus. Another rare autoimmune disorder called stiff-man syndrome is associated with antibodies that attack the beta cells, similar to type 1 diabetes. Medications and Chemical Toxins Some medications, such as nicotinic acid and certain types of diuretics, anti-seizure drugs, psychiatric drugs, and drugs to treat human immunodeficiency virus (HIV), can impair beta cells or disrupt insulin action. Pentamidine, a drug prescribed to treat a type of pneumonia, can increase the risk of pancreatitis, beta cell damage, and diabetes. Also, glucocorticoidssteroid hormones that are chemically similar to naturally produced cortisolmay impair insulin action. Glucocorticoids are used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis. Many chemical toxins can damage or destroy beta cells in animals, but only a few have been linked to diabetes in humans. For example, dioxina contaminant of the herbicide Agent Orange, used during the Vietnam Warmay be linked to the development of type 2 diabetes. In 2000, based on a report from the Institute of Medicine, the U.S. Department of Veterans Affairs (VA) added diabetes to the list of conditions for which Vietnam veterans are eligible for disability compensation. Also, a chemical in a rat poison no longer in use has been shown to cause diabetes if ingested. Some studies suggest a high intake of nitrogen-containing chemicals such as nitrates and nitrites might increase the risk of diabetes. Arsenic has also been studied for possible links to diabetes. Lipodystrophy Lipodystrophy is a condition in which fat tissue is lost or redistributed in the body. The condition is associated with insulin resistance and type 2 diabetes. </s></s>

<s>[INST] What to do for Causes of Diabetes ? [/INST] - Diabetes is a complex group of diseases with a variety of causes. Scientists believe genes and environmental factors interact to cause diabetes in most cases. - People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both. - Insulin is a hormone made by beta cells in the pancreas. Insulin helps cells throughout the body absorb and use glucose for energy. If the body does not produce enough insulin or cannot use insulin effectively, glucose builds up in the blood instead of being absorbed by cells in the body, and the body is starved of energy. - Prediabetes is a condition in which blood glucose levels or A1C levels are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes can substantially reduce their risk of developing diabetes by losing weight and increasing physical activity. - The two main types of diabetes are type 1 diabetes and type 2 diabetes. Gestational diabetes is a third form of diabetes that develops only during pregnancy. - Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells. In type 1 diabetesan autoimmune diseasethe bodys immune system attacks and destroys the beta cells. - Type 2 diabetesthe most common form of diabetesis caused by a combination of factors, including insulin resistance, a condition in which the bodys muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. - Scientists believe gestational diabetes is caused by the hormonal changes and metabolic demands of pregnancy together with genetic and environmental factors. Risk factors for gestational diabetes include being overweight and having a family history of diabetes. - Monogenic forms of diabetes are relatively uncommon and are caused by mutations in single genes that limit insulin production, quality, or action in the body. - Other types of diabetes are caused by diseases and injuries that damage the pancreas; certain chemical toxins and medications; infections; and other conditions. </s></s>

<s>[INST] What is (are) Urinary Retention ? [/INST] Urinary retention is the inability to empty the bladder completely. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only a short time. People with acute urinary retention cannot urinate at all, even though they have a full bladder. Acute urinary retention, a potentially life-threatening medical condition, requires immediate emergency treatment. Acute urinary retention can cause great discomfort or pain. Chronic urinary retention can be a long-lasting medical condition. People with chronic urinary retention can urinate. However, they do not completely empty all of the urine from their bladders. Often people are not even aware they have this condition until they develop another problem, such as urinary incontinenceloss of bladder control, resulting in the accidental loss of urineor a urinary tract infection (UTI), an illness caused by harmful bacteria growing in the urinary tract. </s></s>

<s>[INST] What is (are) Urinary Retention ? [/INST] The urinary tract is the bodys drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order. Kidneys. The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. The kidneys work around the clock; a person does not control what they do. Ureters. Ureters are the thin tubes of muscleone on each side of the bladderthat carry urine from each of the kidneys to the bladder. Bladder. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. Although a person does not control kidney function, a person does control when the bladder empties. Bladder emptying is known as urination. The bladder stores urine until the person finds an appropriate time and place to urinate. A normal bladder acts like a reservoir and can hold 1.5 to 2 cups of urine. How often a person needs to urinate depends on how quickly the kidneys produce the urine that fills the bladder. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. During urination, the bladder empties through the urethra, located at the bottom of the bladder. Three sets of muscles work together like a dam, keeping urine in the bladder. The first set is the muscles of the urethra itself. The area where the urethra joins the bladder is the bladder neck. The bladder neck, composed of the second set of muscles known as the internal sphincter, helps urine stay in the bladder. The third set of muscles is the pelvic floor muscles, also referred to as the external sphincter, which surround and support the urethra. To urinate, the brain signals the muscular bladder wall to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincters to relax. As the sphincters relax, urine exits the bladder through the urethra. </s></s>

<s>[INST] What causes Urinary Retention ? [/INST] Urinary retention can result from - obstruction of the urethra - nerve problems - medications - weakened bladder muscles Obstruction of the Urethra Obstruction of the urethra causes urinary retention by blocking the normal urine flow out of the body. Conditions such as benign prostatic hyperplasiaalso called BPHurethral stricture, urinary tract stones, cystocele, rectocele, constipation, and certain tumors and cancers can cause an obstruction. Benign prostatic hyperplasia. For men in their 50s and 60s, urinary retention is often caused by prostate enlargement due to benign prostatic hyperplasia. Benign prostatic hyperplasia is a medical condition in which the prostate gland is enlarged and not cancerous. The prostate is a walnut-shaped gland that is part of the male reproductive system. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a mans life. Benign prostatic hyperplasia often occurs with the second phase of growth. As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. More information is provided in the NIDDK health topic, Prostate Enlargement: Benign Prostatic Hyperplasia. Urethral stricture. A urethral stricture is a narrowing or closure of the urethra. Causes of urethral stricture include inflammation and scar tissue from surgery, disease, recurring UTIs, or injury. In men, a urethral stricture may result from prostatitis, scarring after an injury to the penis or perineum, or surgery for benign prostatic hyperplasia and prostate cancer. Prostatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate. The perineum is the area between the anus and the sex organs. Since men have a longer urethra than women, urethral stricture is more common in men than women.1 More information is provided in the NIDDK health topic, Prostatitis: Inflammation of the Prostate. Surgery to correct pelvic organ prolapse, such as cystocele and rectocele, and urinary incontinence can also cause urethral stricture. The urethral stricture often gets better a few weeks after surgery. Urethral stricture and acute or chronic urinary retention may occur when the muscles surrounding the urethra do not relax. This condition happens mostly in women. Urinary tract stones. Urinary tract stones develop from crystals that form in the urine and build up on the inner surfaces of the kidneys, ureters, or bladder. The stones formed or lodged in the bladder may block the opening to the urethra. Cystocele. A cystocele is a bulging of the bladder into the vagina. A cystocele occurs when the muscles and supportive tissues between a womans bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina. The abnormal position of the bladder may cause it to press against and pinch the urethra. More information is provided in the NIDDK health topic, Cystocele. Rectocele. A rectocele is a bulging of the rectum into the vagina. A rectocele occurs when the muscles and supportive tissues between a womans rectum and vagina weaken and stretch, letting the rectum sag from its normal position and bulge into the vagina. The abnormal position of the rectum may cause it to press against and pinch the urethra. Constipation. Constipation is a condition in which a person has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass. A person with constipation may feel bloated or have pain in the abdomen the area between the chest and hips. Some people with constipation often have to strain to have a bowel movement. Hard stools in the rectum may push against the bladder and urethra, causing the urethra to be pinched, especially if a rectocele is present. More information is provided in the NIDDK health topic, Constipation. Tumors and cancers. Tumors and cancerous tissues in the bladder or urethra can gradually expand and obstruct urine flow by pressing against and pinching the urethra or by blocking the bladder outlet. Tumors may be cancerous or noncancerous. Nerve Problems Urinary retention can result from problems with the nerves that control the bladder and sphincters. Many events or conditions can interfere with nerve signals between the brain and the bladder and sphincters. If the nerves are damaged, the brain may not get the signal that the bladder is full. Even when a person has a full bladder, the bladder muscles that squeeze urine out may not get the signal to push, or the sphincters may not get the signal to relax. People of all ages can have nerve problems that interfere with bladder function. Some of the most common causes of nerve problems include - vaginal childbirth - brain or spinal cord infections or injuries - diabetes - stroke - multiple sclerosis - pelvic injury or trauma - heavy metal poisoning In addition, some children are born with defects that affect the coordination of nerve signals among the bladder, spinal cord, and brain. Spina bifida and other birth defects that affect the spinal cord can lead to urinary retention in newborns. More information is provided in the NIDDK health topics, Nerve Disease and Bladder Control and Urine Blockage in Newborns. Many patients have urinary retention right after surgery. During surgery, anesthesia is often used to block pain signals in the nerves, and fluid is given intravenously to compensate for possible blood loss. The combination of anesthesia and intravenous (IV) fluid may result in a full bladder with impaired nerve function, causing urinary retention. Normal bladder nerve function usually returns once anesthesia wears off. The patient will then be able to empty the bladder completely. Medications Various classes of medications can cause urinary retention by interfering with nerve signals to the bladder and prostate. These medications include - antihistamines to treat allergies - cetirizine (Zyrtec) - chlorpheniramine (Chlor-Trimeton) - diphenhydramine (Benadryl) - fexofenadine (Allegra) - anticholinergics/antispasmodics to treat stomach cramps, muscle spasms, and urinary incontinence - hyoscyamine (Levbid) - oxybutynin (Ditropan) - propantheline (Pro-Banthine) - tolterodine (Detrol) - tricyclic antidepressants to treat anxiety and depression - amitriptyline (Elavil) - doxepin (Adapin) - imipramine (Tofranil) - nortriptyline (Pamelor) Other medications associated with urinary retention include - decongestants - ephedrine - phenylephrine - pseudoephedrine - nifedipine (Procardia), a medication to treat high blood pressure and chest pain - carbamazepine (Tegretol), a medication to control seizures in people with epilepsy - cyclobenzaprine (Flexeril), a muscle relaxant medication - diazepam (Valium), a medication used to relieve anxiety, muscle spasms, and seizures - nonsteroidal anti-inflammatory drugs - amphetamines - opioid analgesics Over-the-counter cold and allergy medications that contain decongestants, such as pseudoephedrine, and antihistamines, such as diphenhydramine, can increase symptoms of urinary retention in men with prostate enlargement. Weakened Bladder Muscles Aging is a common cause of weakened bladder muscles. Weakened bladder muscles may not contract strongly enough or long enough to empty the bladder completely, resulting in urinary retention. </s></s>

<s>[INST] How many people are affected by Urinary Retention ? [/INST] Urinary retention in men becomes more common with age. - In men 40 to 83 years old, the overall incidence of urinary retention is 4.5 to 6.8 per 1,000 men.2 - For men in their 70s, the overall incidence increases to 100 per 1,000 men.2 - For men in their 80s, the incidence of acute urinary retention is 300 per 1,000 men.2 Urinary retention in women is less common, though not rare.3 The incidence of urinary retention in women has not been well studied because researchers have primarily thought of urinary retention as a mans problem related to the prostate.4 </s></s>

<s>[INST] What are the symptoms of Urinary Retention ? [/INST] The symptoms of acute urinary retention may include the following and require immediate medical attention: - inability to urinate - painful, urgent need to urinate - pain or discomfort in the lower abdomen - bloating of the lower abdomen The symptoms of chronic urinary retention may include - urinary frequencyurination eight or more times a day - trouble beginning a urine stream - a weak or an interrupted urine stream - an urgent need to urinate with little success when trying to urinate - feeling the need to urinate after finishing urination - mild and constant discomfort in the lower abdomen and urinary tract Some people with chronic urinary retention may not have symptoms that lead them to seek medical care. People who are unaware they have chronic urinary retention may have a higher chance of developing complications. When to Seek Medical Care A person who has any of the following symptoms should see a health care provider right away: - complete inability to urinate - great discomfort or pain in the lower abdomen and urinary tract </s></s>

<s>[INST] How to diagnose Urinary Retention ? [/INST] A health care provider diagnoses acute or chronic urinary retention with - a physical exam - postvoid residual measurement A health care provider may use the following medical tests to help determine the cause of urinary retention: - cystoscopy - computerized tomography (CT) scans - urodynamic tests - electromyography Physical Exam A health care provider may suspect urinary retention because of a patients symptoms and, therefore, perform a physical exam of the lower abdomen. The health care provider may be able to feel a distended bladder by lightly tapping on the lower belly. Postvoid Residual Measurement This test measures the amount of urine left in the bladder after urination. The remaining urine is called the postvoid residual. A specially trained technician performs an ultrasound, which uses harmless sound waves to create a picture of the bladder, to measure the postvoid residual. The technician performs the bladder ultrasound in a health care providers office, a radiology center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The patient does not need anesthesia. A health care provider may use a cathetera thin, flexible tubeto measure postvoid residual. The health care provider inserts the catheter through the urethra into the bladder, a procedure called catheterization, to drain and measure the amount of remaining urine. A postvoid residual of 100 mL or more indicates the bladder does not empty completely. A health care provider performs this test during an office visit. The patient often receives local anesthesia. Medical Tests Cystoscopy. Cystoscopy is a procedure that requires a tubelike instrument, called a cystoscope, to look inside the urethra and bladder. A health care provider performs cystoscopy during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. However, in some cases, the patient may receive sedation and regional or general anesthesia. A health care provider may use cystoscopy to diagnose urethral stricture or look for a bladder stone blocking the opening of the urethra. More information is provided in the NIDDK health topic, Cystoscopy and Ureteroscopy. CT scans. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where a technician takes the x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The patient does not need anesthesia. A health care provider may give infants and children a sedative to help them fall asleep for the test. CT scans can show - urinary tract stones - UTIs - tumors - traumatic injuries - abnormal, fluid-containing sacs called cysts Urodynamic tests. Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. A health care provider may use one or more urodynamic tests to diagnose urinary retention. The health care provider will perform these tests during an office visit. For tests that use a catheter, the patient often receives local anesthesia. - Uroflowmetry. Uroflowmetry measures urine speed and volume. Special equipment automatically measures the amount of urine and the flow ratehow fast urine comes out. Uroflowmetry equipment includes a device for catching and measuring urine and a computer to record the data. The equipment creates a graph that shows changes in flow rate from second to second so the health care provider can see the highest flow rate and how many seconds it takes to get there. A weak bladder muscle or blocked urine flow will yield an abnormal test result. - Pressure flow study. A pressure flow study measures the bladder pressure required to urinate and the flow rate a given pressure generates. A health care provider places a catheter with a manometer into the bladder. The manometer measures bladder pressure and flow rate as the bladder empties. A pressure flow study helps diagnose bladder outlet obstruction. - Video urodynamics. This test uses x rays or ultrasound to create real-time images of the bladder and urethra during the filling or emptying of the bladder. For x rays, a health care provider passes a catheter through the urethra into the bladder. He or she fills the bladder with contrast medium, which is visible on the video images. Video urodynamic images can show the size and shape of the urinary tract, the flow of urine, and causes of urinary retention, such as bladder neck obstruction. More information is provided in the NIDDK health topic, Urodynamic Testing. Electromyography. Electromyography uses special sensors to measure the electrical activity of the muscles and nerves in and around the bladder and sphincters. A specially trained technician places sensors on the skin near the urethra and rectum or on a urethral or rectal catheter. The sensors record, on a machine, muscle and nerve activity. The patterns of the nerve impulses show whether the messages sent to the bladder and sphincters coordinate correctly. A technician performs electromyography in a health care providers office, an outpatient center, or a hospital. The patient does not need anesthesia if the technician uses sensors placed on the skin. The patient will receive local anesthesia if the technician uses sensors placed on a urethral or rectal catheter. </s></s>

<s>[INST] What are the treatments for Urinary Retention ? [/INST] A health care provider treats urinary retention with - bladder drainage - urethral dilation - urethral stents - prostate medications - surgery The type and length of treatment depend on the type and cause of urinary retention. Bladder Drainage Bladder drainage involves catheterization to drain urine. Treatment of acute urinary retention begins with catheterization to relieve the immediate distress of a full bladder and prevent bladder damage. A health care provider performs catheterization during an office visit or in an outpatient center or a hospital. The patient often receives local anesthesia. The health care provider can pass a catheter through the urethra into the bladder. In cases of a blocked urethra, he or she can pass a catheter directly through the lower abdomen, just above the pubic bone, directly into the bladder. In these cases, the health care provider will use anesthesia. For chronic urinary retention, the patient may require intermittentoccasional, or not continuousor long-term catheterization if other treatments do not work. Patients who need to continue intermittent catheterization will receive instruction regarding how to selfcatheterize to drain urine as necessary. Urethral Dilation Urethral dilation treats urethral stricture by inserting increasingly wider tubes into the urethra to widen the stricture. An alternative dilation method involves inflating a small balloon at the end of a catheter inside the urethra. A health care provider performs a urethral dilation during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. In some cases, the patient will receive sedation and regional anesthesia. Urethral Stents Another treatment for urethral stricture involves inserting an artificial tube, called a stent, into the urethra to the area of the stricture. Once in place, the stent expands like a spring and pushes back the surrounding tissue, widening the urethra. Stents may be temporary or permanent. A health care provider performs stent placement during an office visit or in an outpatient center or a hospital. The patient will receive local anesthesia. In some cases, the patient will receive sedation and regional anesthesia. Prostate Medications Medications that stop the growth of or shrink the prostate or relieve urinary retention symptoms associated with benign prostatic hyperplasia include - dutasteride (Avodart) - finasteride (Proscar) The following medications relax the muscles of the bladder outlet and prostate to help relieve blockage: - alfuzosin (Uroxatral) - doxazosin (Cardura) - silodosin (Rapaflo) - tadalafil (Cialis) - tamsulosin (Flomax) - terazosin (Hytrin) Surgery Prostate surgery. To treat urinary retention caused by benign prostatic hyperplasia, a urologista doctor who specializes in the urinary tractmay surgically destroy or remove enlarged prostate tissue by using the transurethral method. For transurethral surgery, the urologist inserts a catheter or surgical instruments through the urethra to reach the prostate. Removal of the enlarged tissue usually relieves the blockage and urinary retention caused by benign prostatic hyperplasia. A urologist performs some procedures on an outpatient basis. Some men may require a hospital stay. In some cases, the urologist will remove the entire prostate using open surgery. Men will receive general anesthesia and have a longer hospital stay than for other surgical procedures. Men will also have a longer rehabilitation period for open surgery. More information is provided in the NIDDK health topic, Prostate Enlargement: Benign Prostatic Hyperplasia. Internal urethrotomy. A urologist can repair a urethral stricture by performing an internal urethrotomy. For this procedure, the urologist inserts a special catheter into the urethra until it reaches the stricture. The urologist then uses a knife or laser to make an incision that opens the stricture. The urologist performs an internal urethrotomy in an outpatient center or a hospital. The patient will receive general anesthesia. Cystocele or rectocele repair. Women may need surgery to lift a fallen bladder or rectum into its normal position. The most common procedure for cystocele and rectocele repair involves a urologist, who also specializes in the female reproductive system, making an incision in the wall of the vagina. Through the incision, the urologist looks for a defect or hole in the tissue that normally separates the vagina from the other pelvic organs. The urologist places stitches in the tissue to close up the defect and then closes the incision in the vaginal wall with more stitches, removing any extra tissue. These stitches tighten the layers of tissue that separate the organs, creating more support for the pelvic organs. A urologist or gynecologista doctor who specializes in the female reproductive systemperforms the surgery to repair a cystocele or rectocele in a hospital. Women will receive anesthesia. Tumor and cancer surgery. Removal of tumors and cancerous tissues in the bladder or urethra may reduce urethral obstruction and urinary retention. </s></s>

<s>[INST] What are the treatments for Urinary Retention ? [/INST] Complications of urinary retention and its treatments may include - UTIs - bladder damage - kidney damage - urinary incontinence after prostate, tumor, or cancer surgery UTIs. Urine is normally sterile, and the normal flow of urine usually prevents bacteria from infecting the urinary tract. With urinary retention, the abnormal urine flow gives bacteria at the opening of the urethra a chance to infect the urinary tract. Bladder damage. If the bladder becomes stretched too far or for long periods, the muscles may be permanently damaged and lose their ability to contract. Kidney damage. In some people, urinary retention causes urine to flow backward into the kidneys. This backward flow, called reflux, may damage or scar the kidneys. Urinary incontinence after prostate, tumor, or cancer surgery. Transurethral surgery to treat benign prostatic hyperplasia may result in urinary incontinence in some men. This problem is often temporary. Most men recover their bladder control in a few weeks or months after surgery. Surgery to remove tumors or cancerous tissue in the bladder, prostate, or urethra may also result in urinary incontinence. </s></s>

<s>[INST] How to prevent Urinary Retention ? [/INST] People can prevent urinary retention before it occurs by treating some of the potential causes. For example, men with benign prostatic hyperplasia should take prostate medications as prescribed by their health care provider. Men with benign prostatic hyperplasia should avoid medications associated with urinary retention, such as over-the-counter cold and allergy medications that contain decongestants. Women with mild cystocele or rectocele may prevent urinary retention by doing exercises to strengthen the pelvic muscles. In most cases, dietary and lifestyle changes will help prevent urinary retention caused by constipation. People whose constipation continues should see a health care provider. More information about exercises to strengthen the pelvic muscles is provided in the NIDDK health topic, Kegel Exercise Tips. </s></s>

<s>[INST] What to do for Urinary Retention ? [/INST] Researchers have not found that eating, diet, and nutrition play a role in causing or preventing urinary retention. </s></s>

<s>[INST] What to do for Urinary Retention ? [/INST] - Urinary retention is the inability to empty the bladder completely. - Urinary retention can be acute or chronic. - Urinary retention can result from - obstruction of the urethra - nerve problems - medications - weakened bladder muscles - The symptoms of acute urinary retention may include the following and require immediate medical attention: - inability to urinate - painful, urgent need to urinate - pain or discomfort in the lower abdomen - bloating of the lower abdomen - The symptoms of chronic urinary retention may include - urinary frequencyurination eight or more times a day - trouble beginning a urine stream - a weak or an interrupted urine stream - an urgent need to urinate with little success when trying to urinate - feeling the need to urinate after finishing urination - mild and constant discomfort in the lower abdomen and urinary tract - A health care provider diagnoses acute or chronic urinary retention with - a physical exam - postvoid residual measurement - A health care provider may use the following medical tests to help determine the cause of urinary retention: - cystoscopy - computerized tomography (CT) scans - urodynamic tests - electromyography - A health care provider treats urinary retention with - bladder drainage - urethral dilation - urethral stents - prostate medications - surgery - Complications of urinary retention and its treatments may include - urinary tract infections (UTIs) - bladder damage - kidney damage - urinary incontinence after prostate, tumor, or cancer surgery - People can prevent urinary retention before it occurs by treating some of the potential causes. </s></s>

<s>[INST] What is (are) Proteinuria ? [/INST] Proteinuriaalso called albuminuria or urine albuminis a condition in which urine contains an abnormal amount of protein. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions. They protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body. As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most proteins are too big to pass through the kidneys' filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney, called glomeruli, are damaged. Proteinuria is a sign of chronic kidney disease (CKD), which can result from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys. For this reason, testing for albumin in the urine is part of a routine medical assessment for everyone. Kidney disease is sometimes called renal disease. If CKD progresses, it can lead to end-stage renal disease (ESRD), when the kidneys fail completely. A person with ESRD must receive a kidney transplant or regular blood-cleansing treatments called dialysis. </s></s>

<s>[INST] Who is at risk for Proteinuria? ? [/INST] People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. In the United States, diabetes is the leading cause of ESRD.1 In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases. Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure. African Americans are more likely than Caucasians to have high blood pressure and to develop kidney problems from it, even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.2 Other groups at risk for proteinuria are American Indians, Hispanics/Latinos, Pacific Islander Americans, older adults, and overweight people. These at-risk groups and people who have a family history of kidney disease should have their urine tested regularly. </s></s>